Test 4 Flashcards
Abd exam basic structure:
look
listen
feel - percuss then palpate
Three patterns of pain
1) visceral-solid organ when capsule stretches;hollow organs;difficult to localize;varies in quality (gnawing, burning, cramping..);associated sympt(sweating, pallor, nausea…);
2) pariertal-inflam in parietal peritoneum; steady or achy; more severe than visceral; worse with movement
3) referred-develops as initial pain worsens; superficial or deep; usually localized; may be from a completely dif area
R UPPER QUAD
liver and gallbladder pylorus duodenum head of pancreas right adrenal gland part of R kidney hepatic flexure of colon portions of ascending and transverse colon
L UPPER QUAD
left lobe liver spleen stomach body pancrea left adrenal part of L kidney splenic flexure part of transverse and descending colon
R LOWER QUAD
lower pole of right kidney cecum and appendix bladder (if distended) ovary and salpinx uterus (if enlarged) R spermatic cord right ureter portion of acending colon
L LOWER QUAD
lower pole left kidney sigmoid colon bladder (if distended) ovary and salpinx uterus (if enlarged) left spermatic cord L ureter portion of descending colon
Grey-Turners sign
bruising of the flanks (ecchymosis)
causes: pancreatitis, abd trauma, ruptured AAA, ruptured ectopic prego, hemoperitoneum)
LOW SPECIFICITY AND DISAPPOINTING SENSITIVITY
Cullens sign
Periumbilical ecchymosis
causes: Panceatitis, ruptured ectopic prego
LOW SPECIFICITY AND DISAPPOINTING SENSITIVITY
test name for peritonitis:
heel jar or markle
linea negra
line of pigmentation that often dev during pregnancy
caput medusa
dialated tortuous supervicial veins radiating upward from the umbilicus
diastasis recti
separation between the left and right side of the rectus abdominus muscle
prominent when patient raises head
scaphoid
sunken in abdomen - malnutrition
distended lower half
buldge kind of umbilicus down-ish - bladder distention, pregnancy, ovarian mass, sigmoid tumor
protuberant abdomen
whole abdomen pretty big - excess gass, ascites, organ enlargement, obesity
long prolonged gurgles abdomen
borborygmi:normal sounds
rate of 5-35 per min
stomach growl gr
increased sounds abdomen
gastroenteritis
early obstruction or hunger
high pitched tinkling abdomen
intestinal fluid and air under pressure
early obstruction
decreased sounds abdomen
peritonitis and paralytic ileus
absent sounds abdomen
must listen for a full five minutes
associated with pain and rigidity
==surgical emergency
normal percussion sound usually is
tympanic (gas filled) or dull (fluid filledbowel)
what suggests intestinal obstruction?
protuberant abdomen that is diffusely tympanitic
tympany
muscial note of higher pitch than resonance
located over air filled viscera
hyperresonance
between tympany and resonance
located at base of lung
resonance
sustained note of moderate pitch
located over lung tissue and sometimes abdomen
dullness
shot, high pitched note with little ressonance
located over solid organs adjacent to air-filled structures
what is the test for ascites:
fluid wave test… assistant hand on mid line and you puhs/nudge one side toward midline swiftly… if “wave” is felt to other side of assistnat’s hand then there is ascites
shiftin dullness test
another test for ascites – laying down and standing up … dullness and tympanic sound line will move if ascites
lloyd’s punch test
costovertebral angle tenderness (kidneys)
first palpate and askif pain.. indirect thump then … ifkidney infection or whatever itll be painful
tenderness is…
discomfort elicited by palpation
guarding is
VOLUNTARY contraction of the abd musculature due to tenderness, fear, the examiners cold hands or patient’s anxiety
rebound is…
abd tenderness that is WORSE when palpating fingers are quickly removed from the place of palpable tenderness
peritonitis is…
inflamation of the peritoneum made worse by patient movement, abd wall percussion, and with palpation
burning pain in adbomen
peptic ulcer
cramping pain in abd
biliary colic, gastroenteritis
colicky pain in abd
appendicitis with impacted feces, renal stone
aching pain in abd
appendiceal irritation
knifelike pain in abd
pancreatitis
ripping or tearing pain in abd
aortic dissction
gradual pain in abd
infection
sudden pain in abd
duodenal ulcer, acute pancreatitis, obstruction, or perforation
common pancreatitis stuff
-sudden LUQ epigastric or umbilical pain
-may refer to L shoulder
-associated: vomitting, fever, shock
-PE: epigastric tenderness; + Grey turner;
+ Cullen
-most common causes: gallstones and excessive alcohol
-less commonly: hypertriglycidemia
common cholecytitis stuff
- severe, unrelenting RUQ or epigastric pain
- refers to right subscapular area
- associated: anorexia, vomiting, fever, jaundice
- PE:RUQ tender; +Murphy
common diverticulitis stuff
- LLQ pain or localized to diseased area
- associated: fever, anorexia, dhiarrea
- PE:LLQ pain on palpation; borborygmus
- common of large intestine - formation of pouches (diverticula) on the outside of colon and inflamation of the diverticula
common pelvic inflamatory disease stuff
- Lower quad in sexually active female
- associated: nausea, vomiting, cervical dischange, dyspareunia
- PE: adnexal and cervical tenderness
- basically infection of uterus, fallopian tubes and ovaries - can form scar formation
common appendicitis stuff:
- intitially present with periumbilical or epigastric pain that localized to RLQ
- colicky
- associated: fever, nausea, vomiting, anorexia
- PE: guarding; +obturator, iliopsoas, rovsing, markle, Mcburney signs
- inflmation of appendix
colon risk factors:
- 50+ years
- family history
- personal history: polyps, crohns or ulcer diease, FAP, HNPCC, ovarian or endometrial cancer
- ethnic: Jewish
- low fiber and high fat
- low fruit and veg intake
- obesity
- smoking
- lack of reg exercise
- alchol in high q
blumberg
rebound tenderness (peritoneal irritation, appendicitis)
cullen
ecchymosis around umbilicus (hemoperitoneum, pancreatitis or ectopic prego)
dance
absence of bowel sounds
kehr
abdominal pain radiating to left shoulder (spleen rupture, renal calculi, or ectopic prego)
romberg-howship
pain medial aspect thight to knee (strangulated obturator hernia)
rowsing
RLQ pain worsened by palpation of LLQ (peritoneal irrituation or appendicitis)
ballotement
palpation technique use to find/examine floating objects in the body
chelecytisis
inflammation of the gallbladder
cholelithiasis
stone formation in the gallbaldder
colic
spasm in any hollow tubular soft organ accompanied by pain
dyschezia
painful or difficult cowel movement
dyspepsia
imperfect digestion - not a disease itself but symptomatic of other diseases. vague abd discomfort, sense of fullness after eating, erucation, heartburn, nausea, vomiting, loss of appetite
dysphagia
difficulty swallowing
hematemesis
vomiting of blood
hematochezia
blood in poop
icterus
pigmentation of skin and eye (jaundice thing)
striae
streaks or lines (with a slivery or purple hue) skin striae result from weakening of the lastic tissue associated with pregnancy, weight gain, rapid growth, and high levels of corticosteroids
melena
evacuations resembling tar due to action of intestinal juices on free blood
intussusceoption
prolapsing or telescoping of one segment of intestines into another, causing intestinal obstruction
aaron
pain or distress occurs in the area of the patients heart or stomach on palpitation of mcburneys point (appendicitis)
ballance
fixed dullness to percussion in left flank & dullness in right flank (peritoneal irritatuino)
rovsing sgin
right lower quadrant pain is increased with palpation of LLQ
equiv to rebound tenderness
