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PCM II Midterm > The abdominal exam > Flashcards

The abdominal exam Flashcards

1
Q

What are the three types of Abdominal Pain

A
  • Visceral Pain (more general and broad)
  • Parietal Pain (localized and sharp)
  • Referred pain
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2
Q

what is visceral pain

A
  • Caused by stimulation of the visceral pain fibers
  • Secondary to distention, stretching or contracting of hollow organs, stretching the capsule of solid organs or organ ischemia

-Not localized

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3
Q

what is Parietal pain

A
  • Caused by stimulation of the somatic pain fibers
  • Secondary to inflammation in the parietal peritoneum
  • usually constant and more severe than visceral pain
  • localized
  • aggravated by movement or coughing
  • alleviated by remaining still
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4
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

i.e: duodenal and pacreatic pain referred to back
Bilary tree refrerred to right shoulder

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5
Q

What are the biggest take aways that the HPI must get?

A

Location!

and aggravating and alleviating factors

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6
Q

what are some medicines that are important to note when getting a medication history for abdominal pain

A
  • GI prescriptions (H2 blockers, proton pump inhibitors, dicyclomine)
  • OTC meds (tylenol, asprin/ibuprofun, antacids, laxatives)
  • blood thinners
  • NSAIDS
  • Narcotics (can cause constipation)
  • steroids
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7
Q

what are the 4 quadrants and what are some organs found in each one

A

Right upper quadrant: (RUQ)
-liver, gallbladder, stomach, SB, LB

Right lower quadrant (RLQ)
-appendix, ovary, SB, LB

Left lower quadrant (LLQ)
-Colon, ovary, SB, LB

Left upper quadrant (LUQ)
-stomach, spleen, SB, LB

Epigastric area:
-Pancreas, liver, gallbladder, stomach, SB, LB

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8
Q

what are the normal bowel sounds and what does it mean if it is absent, decreased, or increased

A

Normal bowel sounds: 5-34 clicks/gurgles per minute

absent bowel sounds: none for more than 2 minutes
-long lasting intestinal obstruction, intestinal perforation, mesenteric ischemia

Decreased bowel sounds: none for 1 minute
-Post surgical ileus, peritonitis

Increased bowel sounds
-Diarrhea, early bowel obstruction

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9
Q

WHen listening for bruits what do we use?

A

Bell of the stethoscope

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10
Q

Other abnormal bowel sounds: High pitched bowel sounds

A

sounds like tinkling (raindrops on metal)

-suggests early intestinal obstruction

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11
Q

Other abnormal bowel sounds: Bruits

A

Vascular sounds resembling a heart murmur, over the aorta or other abdominal arteries (renal, iliac, femoral arteries)
-vascular obstruction

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12
Q

Other abnormal bowel sounds: Friction rub

A

grating sounds with respiratory variation

  • inflammation of the peritoneal surface of an organ
  • listen over liver and spleen
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13
Q

Other abnormal bowel sounds: Venous hum

A

soft humming noise

  • increased collateral circulation between protal and systemic venous systems
  • listen over epigastric and umbilical regions
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14
Q

when percussing for tympany and dullness what are the 4 different sounds you can hear

A

Tympany: high pitched, air filled

Dullness: non resonating, solid organs or masses

REsonance: hollow abdominal organs (lungs)

Hyper resonance: airfilled hollowed organ (pneumothorax)

tympany predominates in the abdomine

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15
Q

what is the order you should palpate the abdomen

A

start away from the tender most area

  • first light palpate
  • then deep palpation
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16
Q

when is the spleen palpable?

A

normally not palpable unless enlarged

  • when spleen enlarges, it expands anteriorly, downward, and medially
  • percussion and palpation help asses splenomegaly
17
Q

How to percuss the liver?

A

Right mid clavicular line and start in RLQ (area of tympany) workup until get to an area of dullness which is the inferior border

Start in right midclavicular line, start in RUQ (area of lung resonance) and percuss downward until dullness to find superior border

18
Q

What does it mean if there is a vertical span that is increased or decreased and what is the normal span

A

Normal span: 6-12 cm

increased: with enlarged liver
- cirrhosis, lymphoma, hepatitis, right sided heart failure, amyloidosis, hemachromatosis
- right pleural effusion (falsely increased)

Decreased: shrunken liver
-cirrhosis

19
Q

how should a normal liver feel and what does it mean if it is irregular or hard

A

Normal liver: slightly tender, soft, smooth surface

Irregular edge: hepatocellular carcinoma

firmness/hardness: cirrhosis, hematochromatosis, amyloidosis, lymphoma

20
Q

how to percuss for spleen and when to know it is splenomegaly?

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
  • if dullness at midaxillary line = splenomegaly
21
Q

How to liver palpate?

A

Left hand behind patient supporting the right 11th and 12th ribs

  • push left hand upward, towards patients anterior
  • right hand on patients right abdomen
  • ask patient to take a breath
  • feel the liver edge as it comes down to meet your right hand
22
Q

how to spleen palpate, and what are some causes of splenomegaly

A
  • with left hand, reach over the patient and grasp the posterior aspect of LUQ
  • With right hand below left costal margin, press posteriorly to take deep breath in
  • try to feel edge as it comes down to meet your left hand
  • normally only 5 percent of spleens are palpatable in adults
  • Splenomegaly: portal hypertension, blood malignancies, HIV, splenic infarct, hematoma, mononucleosis
23
Q

Shifting dullness test

A

Test 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 dependant side and tympany to top side
24
Q

Test for a fluid wave

A
  • 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
25
Q

Mcburneys point tenderness

A

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

-positive test = tenderness

for appendicitis

26
Q

Rovsings sign

A

for appendicitis

  • palpate deeply in LLQ
  • positive test = pain felt in RLQ
27
Q

Psoas sign

A

for appendicitis

  • place hand above patients right knee and ask patient to raise thigh against resistance, then turn patient onto their left side and extend their right leg at the hip
  • positive test for either maneuver = increased abdominal pain
28
Q

Obturator sign

A

for appendicitis

  • flex patients right hip with knee bent then internally rotate the hip
  • positive test = right hypogastric pain
29
Q

Murphys sign

A

for Biliary Cholic

  • with right hand palpate deeply under the patients right costal margain and ask the patient to take a deep breath in and palpate deeper
  • positive test = sharp increase in tenderness with sudden stop in inspiratory effort
30
Q

Lloyds sign

A

Punch for kidney inflammation/distention
-pain to deep percussion in the area of the costovertebral angle

  • positive test = pain in the area of the CVA with deep percusion
  • implies kidney pathology
  • pyelonephritis, ureterolithiasis
31
Q

what are the two types of gaurding and the signs of peritoneal inflammation, an acute abdomen

A

Voluntary: patient consciously protects the abdomen when palpated

Involuntary, unconscious contraction of the abdominal wall musculature when abdomen is palpated

Rigidity: involuntary reflex contraction of the abdominal wall
-abdominal muscles are stiff board like

Rebound tenderness

  • occurs when you push down deep into the abdomen and then let go quickly
  • positive = more thenderness when letting go than pushing in
32
Q

Systematic approach to finding a broad differential diagnosis:
VINDICATE mnemonic

A 
Vascular
INfectious/Inflammatory
NEoplasm
Drugs/Degenerative
Iatrogenic/Idiopathic
Congenital
Autoimmune/Allergic/Anatomic
Trauma
Endocrine/Environment

PCM II Midterm (9 decks)

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