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CLASS 22010 GI > PHYSICAL EXAMINATION OF THE ABDOMEN > Flashcards

PHYSICAL EXAMINATION OF THE ABDOMEN Flashcards

1
Q

What is performed as part of the comprehensive physical examination or when a patient presents with signs or symptoms of an abdominalthoracic, thoracic, or genitourinary disease process?

A

Abdominal Examination

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2
Q

What is the sequence of exams for the abdominal exam?

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation
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3
Q

What do additional procedures detect with the abdominal exam?

A

abdominal pathology

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4
Q

What should be asked for abdominal pain?

A
  1. onset
  2. location
  3. characteristics
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5
Q

When indigestion occurs, patients should be questioned about what?

A
  1. character of discomfort
  2. location of pain
  3. any pain associated with food ingestion
  4. onset of symptoms
  5. treatment response
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6
Q

The character as well as the relationship to factors such as eating, diarrhea, pain, or medications should be determined with what on the abdominal exam?

A

Nausea and vomiting

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7
Q

Is travel history important for a patient with diarrhea in an abdominal exam?

A

Yes

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8
Q

Changes in dietary habits, medications, character of the stool, and the pattern of passing stool are important questions to ask with what?

A

Constipation

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9
Q

What are important questions when concerning fecal incontinence?

A
  1. Character of the stool
  2. use of laxatives
  3. presence of underlying disease
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10
Q

What are some important questions to ask a patient with jaundice?

A
  1. duration of color
  2. color of stools
  3. abdominal pain
  4. medications
  5. exposure to hepatitis
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11
Q

True or False

Questions should be asked about the character of dysuria (e.g., pain or volume changes) and exposure to contributing factors (e.g., tuberculosis or infection).

A

True

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12
Q

These are important questions for what?

  1. Changes in usual urination pattern or volume, dribbling, and characteristics of current problem should be noted
  2. Examiner should also record any associated factors (coughing and nocturia) as well as medications taken
A

Urinary frequency or incontinence

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13
Q

Could ingestion of red food dyes caused the false appearance of hematuria?

A

Yes

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14
Q

What is some relevant data to be considered in a patients past medical history

A
  1. Past GI disorders
  2. Liver problems
  3. History of abdominal surgery
  4. Abdominal or urinary tract injuries
  5. UTI’s
  6. Major illnesses
  7. operations
  8. Transfusions
  9. Meds
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15
Q

Periodic peritonitis, gallbladder or kidney disease, malabsorption syndrome, Hirschsprung disease, polyposis, or colon cancer are pieces of important data in concerns of what?

A

Family history of GI diseases

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16
Q

What is some relevant data from the personal and social history of patients for abdominal exams?

A
  1. Nutritional habits
  2. first/last day of menses
  3. physical/emotional stress
  4. drugs/alcohol
  5. exposure to disease
  6. Trauma
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17
Q

Should patients have an empty bladder during an abdominal exam?

A

Yes

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18
Q

What position should the patient be in for an abdominal exam?

A

supine

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19
Q

Inspection

Taking a deep breath does what?

A

Lowers the diaphragm

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20
Q

Inspection

Having the patient raise their head off the table does what?

A

Contracts the rectus abdominis muscles

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21
Q

Inspection

When the head is raised it will caused the rectus abdominis to contract or show signs of separation indicative of what?

A
  1. Diastasis recti
  2. Hernias
  3. Certain masses
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22
Q

Visible intestinal peristalsis may indicate what?

A

Intestinal obstruction

  1. Males: abdominal movement
  2. Females: costal movement
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23
Q

Bluish periumbilical discoloration, also known as Cullen sign, suggests what?

A

Intraabdominal bleeding

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24
Q

Bluish flank discoloration, also known as Gray-Turner sign, suggests what?

A

Retroperitoneal or Intraabdominal bleeding

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25
Q

Purplish striae on the abdomen are indicative of what?

A

Cushing’s Disease

Striae of recent origin are pink or blue but turn silvery gray/white over time.

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26
Q

What refers to the manifestation of excessive corticosteroids within a patient with unique physical characteristics such as striae on the abdomen, “moon face” or a “buffalo hump”?

A

Cushing Disease/Syndrome

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27
Q

Swelling or bulging at the umbilicus may indicate what?

A

Hernia

28
Q

True or False

Asymmetrical distention seen on inspection may not be diagnostically important

A

False

Asymmetrical distention seen on inspection may indicate hernia, tumors, cysts, bowel obstruction, or enlargement of abdominal organs.

29
Q

What is the next step in the abdominal exam after inspection?

A

Auscultation

30
Q

Bowel sounds are heard as clicks and gurgles that occur irregularly and range from __ to __ per minute

A

5-35 per minute

31
Q

How long must you auscultate the abdomen to be able to document absent bowel sounds?

A

5 minutes

32
Q

True or False

Bowel sounds can be assessed most often by listening in one place; however, auscultate in all 4 quadrants if you have any concern

A

True

33
Q

What is known as loud prolonged gurgles in bowel sounds?

A

Borborygmi

34
Q

What are some causes for increased bowel sounds?

A
  1. Gastroenteritis
  2. Early intestinal obstructions
  3. Hunger
35
Q

High pitched tinkling bowel sounds suggests what?

A

Intestinal fluid and air under pressure, as in early obstruction

36
Q

What are soft, low pitched, continuous sounds occurring with increased collateral circulation between the portal and systemic venous systems in the epigastric region and around the umbilicus?

A

Venous hums

37
Q

What may reflect blood flow turbulence and indicate vascular disease?

A

Bruits

Listen at aortic, renal, iliac, and femoral arteries

38
Q

What gives you a sense of overall tympany and dullness with a abdominal exam?

A

Percussion

39
Q

True or False

With percussion you should examine tender/painful areas first

A

False

40
Q

How can you determine the lower border of the liver with percussion?

A

Start at the level of the umbilicus and percuss upward along the midclavicular line

41
Q

How do you determine the upper border of the liver with percussion?

A

Start at the nipple line and percuss downward along the midclavicular line

42
Q

How do you determine splenic borders and contour with percussion?

A

Percuss the spleen just posterior to the midaxillary line on the left side at the inferior costal border

43
Q

True or False

You may hear a small area of splenic dullness from the 6th - 10th rib

A

True

44
Q

During an abdominal exam where do you percuss the kidneys ?

A

Over the costovertebral angles

45
Q

What is known as an excessive intraabdominal fluid build-up?

A

Ascites

46
Q

True or False

When palpating the abdomen you do overall deep palpation first and then light palpation

A

False

Do overall light palpation, then deep palpation

47
Q

When palpating the epigastric area for aortic pulsation, what would a prominent lateral pulsation be indicative of?

A

Aortic aneurysm

48
Q

What is a palpation technique used to assess floating masses?

A

Ballottement

49
Q

What special test is this?

Assess by pressing gently and deeply into a region remote from the area of discomfort. Rapidly withdraw your hand. A positive test is elicited if the removal of your hand causes a sharp stabbing pain at the site of peritoneal inflammation (positive Blumberg sign).

A

Rebound tenderness

50
Q

Rebound tenderness over Mcburney’s point in the right lower quadrant (positive Mcburney’s sign) suggests what?

A

Appendicitis

51
Q

What special tests assesses for peritoneal irritation?

A

Markle (heel jar) test

52
Q

You assess for Rovsing sign when concerned for what?

A

Appendicitis

53
Q

What is a positive Rovsing sign?

A

A positive test is increased right lower quadrant pain with palpation of the left lower quadrant.

54
Q

What special test is this?

Have the patient lie supine and place your hand over the lower right thigh. Have the patient raise the right leg while you push downward. Abdominal pain with this motion is considered a positive “psoas sign”.

A

Iliopsoas muscle test.

55
Q

True or False

You conduct the Iliopsoas test when you suspect an inflamed gallbladder

A

False

Conduct the Iliopsoas muscle test when you suspect appendicitis.

56
Q

You would conduct an Obturator muscle test when you suspect what?

A

Appendicitis or pelvic abscess

57
Q

What special test is this?

With the patient in a supine position, flex the patient’s right hip and knee to 90 degrees. Hold the leg just above the knee, grasp the ankle, and rotate the leg laterally and medially. Abdominal pain with this motion is a positive sign.

A

Obturator Muscle Test

58
Q

What special test do you use to asses for gallbladder irritation or inflammation?

A

Murphy’s sign

59
Q

What special test is this?

Place hands at the inferior costal margin in the right upper quadrant. Have the patient take a deep breath in while keeping your hands in place. Abrupt cessation of inspiration on palpation of the gallbladder means this sign is
present and is suggestive of cholecystitis

A

Murphy’s sign

60
Q

How long do bowel sounds range from?

A

5 - 35 per minute

61
Q

True or False

Liver span is greater in males and tall persons

A

True

62
Q

What does Cullen sign suggest?

A

Intraabdominal bleeding

63
Q

What does Gray-Turner sign suggest?

A

Retroperitoneal or intraabdominal bleeding

64
Q

Purplish striae results from what?

A

Cushing’s disease

65
Q

A pearl like umbilical node suggests what?

A

Intraabdominal lymphoma

66
Q

Scarring from previous abdominal surgeries could be suggestive of what?

A

possible internal adhesions

CLASS 22010 GI (4 decks)

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