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PCM 2 > The Abdominal Exam > Flashcards

The Abdominal Exam Flashcards

1
Q

What are the types of abdominal pain?

A
  • visceral pain
  • parietal pain
  • referred pain
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2
Q

What causes visceral pain?

A
  • visceral pain fibers
  • secondary to distention, stretching or contracting hollow organs, stretching the capsule of solid organs, or organ ischemia
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3
Q

Where is visceral pain usually felt?

A
  • midline at the level of the structure involved

- not localized

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4
Q

What type of pain is periumbilical pain with early appendicitis?

A

visceral pain

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5
Q

What is parietal (somatic) pain caused by?

A
  • stimulation of the somatic pain fibers

- secondary to inflammation in the parietal peritoneum

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6
Q

What does parietal (somatic) pain feel like?

A
  • usually constant and more severe than visceral pain
  • localized
  • aggravated by movement or coughing
  • alleviated by remaining still
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7
Q

What type of pain is RLQ parietal tenderness later finding in acute appendicitis?

A

parietal (somatic) pain

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8
Q

What type of pain is LLQ parietal tenderness, later finding in acute diverticulitis?

A

parietal (somatic) pain

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9
Q

What is referred pain?

A

originates within the abdomen but is felt at distant sites which are innervated at approximately the same spinal levels as the disordered structure

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10
Q

What are examples of referred pain?

A
  • duodenal and pancreatic pain referred to back

- biliary tree referred to right shoudler

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11
Q

List what to ask for a GI focused ROS?

A 
nausea
vomiting
diarrhea
black stools
blood in stool
blood in vomit
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12
Q

List what to ask for a GU focused ROS?

A

dysuria
polyuria
hematuria
flank or CVA pain

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13
Q

List what to ask for a GYN focused ROS?

A

vaginal bleeding
vaginal discharge
LMP
possibility of pregnancy

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14
Q

What is relevant PMHx in general?

A 
HTN
DM
CAD
CHF
COPD
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15
Q

What is relevant PMHx for an abdominal complaint?

A 
Hepatitis and/or liver problems
GERD/PUD
GB
IBD (Crohn's, UC)
Cancer
chronic abd pain
constipation
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16
Q

What are some common PSHx for the abdominal and gynocologic regions?

A

abdominal

  • cholecystectomy
  • appendectomy

GYN

  • hysterectomy
  • BTL
  • C-section
  • ovarian cyst
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17
Q

What are medications to be aware of for GI complaints?

A
  • GI prescriptions (H2 blockers, PPI, dicyclomine)
  • OTC meds (tylenol, aspirin/ibuprofen, antacids, laxatives)
  • herbs
  • blood thinners
  • NSAIDs
  • Narcotics
  • Steroids
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18
Q

What to ask about in a social history for abdominal complaint

A
  • smoking
  • alcohol
  • drugs
  • stress
  • travel
  • well water
  • ingestion of undercooked meat
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19
Q

What is the order of a GI exam?

A
  1. inspect
  2. auscultation
  3. percussion
  4. palpation
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20
Q

What are the landmarks for the abdomen?

A
  • xiphoid process of sternum
  • costal margins
  • umbilicus
  • anterior superior iliac spine
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21
Q

What is in the RUQ?

A
  • liver
  • gallbladder
  • stomach
  • SB
  • LB
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22
Q

What is in the RLQ?

A
  • appendix
  • ovary
  • SB
  • LB
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23
Q

What is in the LLQ?

A
  • sigmoid colon
  • ovary
  • SB
  • LB
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24
Q

What is in the LUQ?

A
  • spleen
  • stomach
  • SB
  • LB
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25
Q

What is in the epigastric area?

A
  • pancreas
  • liver
  • gallbladder
  • stomach
  • SB
  • LB
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26
Q

What do you look for on inspection of the abdomen?

A
  • skin color
  • surgical scars
  • striae
  • dilated veins
  • rash
  • ecchymoses
  • contour of abdomen: flat, round, scaphoid, bulges, obese, protuberant
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27
Q

What do you use to listen for bruits?

A

bell

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28
Q

What can absent bowel sounds indicate?

A

None for 2 minutes

  • long lasting intestinal obstruction
  • intestinal perforation
  • mesenteric ischemia
29
Q

What can decreased bowel sounds indicate?

A

None for 1 minute

  • post surgical ileus
  • peritonitis
30
Q

What can increased bowel sounds indicate?

A
  • diarrhea

- early bowel obstruction

31
Q

What are high pitched bowel sounds? What does this indicate?

A
  • sounds like tinkling (raindrops on metal)

- suggests early intestinal obstruction

32
Q

What are bruits? What does this indicate?

A
  • vascular sounds resembling a heart murmur over the aorta or other abdominal arteries (renal artery, iliac artery, femoral artery)
  • vascular obstruction
33
Q

What are friction rubs? What does this indicate?

A
  • grating sounds with respiratory variation
  • inflammation of the peritoneal surface of an organ
  • listen over liver and spleen
34
Q

What are venous hums? What does this indicate?

A
  • soft humming noise
  • increased collateral circulation between portal and systemic venous systems
  • listen over epigastric and umbilical regions
35
Q

What does percussion allow?

A

allows assessment for fluid and solid-filled masses, the amount of gas in the abdomen, and sizing of the liver and spleen

36
Q

Where do you percuss?

A

all 4 quadrants

37
Q

What is tympany during percussion?

A

high pitched air filled

38
Q

What is dullness during percussion?

A

non-resonating solid organs or masses

39
Q

What is resonance during percussion?

A

hollow abdominal organs (lungs)

40
Q

What is hyper-resonance during percussion?

A

air-filled hollow organ (pneumothorax)

41
Q

What is normal to hear during percussion of the abdomen?

A
  • tympany

- because of gas in the GI tract, scattered areas of dullness is normal from fluid and feces

42
Q

What is abnormal during percussion of the abdomen?

A

large dull areas from a mass or enlarged organ

43
Q

What may a protuberant abdomen tympanic throughout indicate?

A

intestinal obstruction

44
Q

What is the goal of palpation of the abdomen?

A

to discern abdominal tenderness, resistance, superficial organs and masses

45
Q

How do you palpate the abdomen?

A
  • use the palmar aspect of your hand with fingers together
  • gently palpate all 4 quadrants
  • medium depth
  • then deep depth
  • *always start away from/farthest from tender area
46
Q

Describe assessment of the liver

A
  • mostly covered by rib cage, assessment is difficult

- assess shape and size by percussion and palpation

47
Q

Describe assessment of the spleen

A
  • normally not palpable, unless enlarged
  • when spleen enlarges, it expands anteriorly, downward, and medially
  • percussion and palpation help assess splenomegaly
48
Q

How do you percuss the liver?

A
  • right MCL, start in RLQ (tympany) and percuss cephalad to an area of dullness = lower border of the liver
  • right MCL, start in RUQ (lung resonance) and percuss caudad toward liver dullness = superior border of liver
49
Q

What is the normal liver vertical span?
When is it increased?
When is it shrunken?

A

6-12 cm
enlarged liver = cirrhosis, lymphoma, hepatitis, right sided heart failure, amyloidosis, hemachromatosis
**falsely enlarged in right pleural effusion

shrunken liver = cirrhosis

50
Q

How do you palpate the liver?

A

– Left hand behind patient supporting the right 11th and 12th ribs
– Push left hand upward, towards patient’s anterior
– Right hand on patient’s right abdomen
– Press in and cephalad gently with right hand
– Ask patient to take deep breath
– Feel the liver edge as it comes down to meet your right hand

51
Q

What does a normal liver feel like?

A

slightly tender, soft, smooth surface

52
Q

What does an irregular edge/nodules on the liver indicate?

A

hepatocellular carcinoma

53
Q

What does firmness/hardness of the liver indicate?

A
  • cirrhosis
  • hemachromatosis
  • amyloidosis
  • lymphoma
54
Q

How do you percuss the spleen?

A

– Starting from border of cardiac border of left anterior axillary line, percuss
laterally
– If tympany is prominent laterally in midaxillary line, splenomegaly not likely
– Dullness at midaxillary line= splenomegaly

55
Q

How do you palpate the spleen?

A

– With left hand, reach over the patient
and grasp posterior aspect of LUQ
– With right hand below left costal margin,
press posteriorly towards spleen
– Ask patient to take deep breath in
– Try to feel edge as it comes down to meet
your left hand

56
Q

What percent of healthy adults have a palpable spleen?

What group of people have a palpable spleen?

A

5%

-COPD - low, flat diaphragm

57
Q

What causes splenomegaly?

A
  • portal htn
  • blood malignancies
  • HIV
  • splenic infarct
  • mononucleosis
58
Q

What is the shifting dullness test?

A 
for ascites
• Percuss the borders of tympany and
dullness with patient supine
• Then have patient lay on side and
percuss borders again
• Normal= borders stay the same
• Ascites/ positive test= dullness
shifts to dependent side and
tympany to top side
59
Q

What is the test for a fluid wave?

A 
for ascites
• Ask the patient to rest his or her
hands over chest
• Have an assistant place the ulnar
aspects of hands midline, then tap
one flank sharply with finger tips
• Normal= no impulse felt on the other
flank
• Ascites/positive test= impulse
transmitted to the other flank
60
Q

What is McBurney’s point tenderness?

A

draw an imaginary line from ASIS to umbilicus and palpate 2 inches medial to ASIS on that line

+=tenderness

61
Q

What is Rovsing’s sign?

A

palpate deeply in LLQ

+=pain felt in RLQ

62
Q

What is psoas sign?

A

place hand above patient’s right knee and ask pt to raise thigh against resistance, then turn pt onto their left side and extend right leg at the hip
+=increased abdominal pain

63
Q

What is obturator sign?

A

flex pt right hip with knee bent, then internally rotate the hip
+=right hypogastric pain

64
Q

What is Murphy’s sign?

A

with right hand palpate deeply under the patient’s right costal margin, ask the pt to take a deep breath in and palpate deeper
+=sharp increase in tenderness with stop in inspiratory effort

65
Q

What is lloyd’s sign (punch)?

A

pain to deep percussion in the area of CVA
+=pain in CVA with deep percussion
implies kidney pathology: pyelonephritis or ureterolithiasis

66
Q

What is guarding?

A
  • voluntary contraction of the abdominal wall
  • when palpating the abdomen, the abdominal musculature “guards” the underlying inflamed organs from the pressure of palpation, and become tense and contracted
67
Q

What is rigidity?

A
  • involuntary reflex contraction of the abdominal wall
  • will seen stiff, board-like muscle contraction on inspection, also may not see the abdomen move with respirations- can also be felt with palpation
68
Q

What is rebound tenderness?

A

-occurs when you push down deep into the abdomen and then let go quickly
+=more tenderness when letting go than pushing in

PCM 2 (1 decks)

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