Abdomen

Question 1

Visceral Pain

Answer 1

Inflamed/distended/stretched
Deep organs
Frequently along midline
Achy, gnawing, cramping, DULL
Ex: distention from organomegaly

Question 2

Parietal Pain

Answer 2

Inflammation of parietal peritoneum
More severe/localized
Worsens with movement, coughing
Ex: peritonitis, appendicitis

Question 3

Referred Pain

Answer 3

Pain @ site distant from injury
Sites innervated at same level in spinal cord
Ex: flank pain from kidney issues

Question 4

Abdominal pain- associated symptoms/risk factors

Answer 4

Risk factors: food, meds (opioids), position (GERD)

Symptoms: bloating, bowel issues, fever, dysuria

Question 5

Abdominal pain- atypical presentations

Answer 5

Respiratory symptoms: regurg
N/V: MI
Migraines: seen in kids with GI issues

Question 6

Causes of early satiety

Answer 6

Ascites, tumor, gastroparesis

Question 7

Cancer Red Flags

Answer 7

Dysphagia (difficulty)
Odynophagia (pain)
Recurrent vomiting
Weight loss
GI bleed

Question 8

Hepatitis Risk Factors

Answer 8

HepA: travel
HapB: unsafe sex, blood exposure
HepC: blood exposures, transfusion pre-1987

Question 9

Risk factors for GI cancers

Answer 9

Family history
PMH of cancer
H/o adenomatous polyp
Crohn's disease
Ulcerative colotis

Question 10

Scaphoid abdomen

Answer 10

Concave/sunken in in middle

Question 11

Order for abdominal examination

Answer 11

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

Question 12

Abdominal Auscultation

Answer 12

Diaphragm of stethoscope

30 seconds in each quadrant

Question 13

Abnormal Abdominal Sounds: Bruit

Answer 13

Murmur-like sounds over arteries may suggest partial occlusion
Ex: vascular occlusive disease, atherosclerotic disease, renal artery stenosis

Question 14

Abnormal Abdominal Sounds: venous hum

Answer 14

Rare

Indicates collateral circulation between portal and venous system

Question 15

Abnormal Abdominal Sounds: hepatic bruit

Answer 15

suggests CA or ETOH cirrhosis

Question 16

Abnormal Abdominal Sounds: hepatic or splenic friction rub

Answer 16

Grating sound suggests inflamed peritoneum in area

Ex: hepatoma, gonococcal infection around liver, splenic infarct, pancreatic carcinoma

Question 17

Borborygmi

Answer 17

High pitched gurgles of hyper-peristalsis due to colon obstruction or diarrhea
Due to hyper-motility

Question 18

Abdominal Tympany: normal

Answer 18

Percussing over gas
Ex. stomach, lung (resonance)
Sometimes bowel

Question 19

Abdominal Tympany: abnormal

Answer 19

Percussing over trapped air

Ex: obstruction

Question 20

Abdominal Dullness: normal

Answer 20

Percussing over solid or fluid

Ex: liver, ribs

Question 21

Abdominal Dullness: abnormal

Answer 21

Percussing over frank ascites, full bladder, hepatomegaly, a baby

Question 22

Normal liver vertical span

Answer 22

6-12 cm at right midclavicular line

4-8 cm at midsternal line

Question 23

Causes of positive CVA tenderness

Answer 23

Pyelonephritis

MSK problem

Question 24

Assessing for ascites

Answer 24

1. Shifting dullness: sitting up, dullness around flanks and lower abdomen; lying on side, tympany on upper side and fullness on side closer to bed
2. Fluid wave- will transmit through fluid (not fat)

Question 25

Rebound tenderness cause

Answer 25

peritoneal inflammation/parietal pain | Ex. appendicitis

Question 26

Causes of splenomegaly

Answer 26

Portal HTN, infarct, HIV, malaria, hematologic malignancy

Question 27

How to palpate for kidney

Answer 27

On inspiration, catch between hands, on expiration let it slide back. L flank mass may be spleen Normal tympany or can place fingers between mass and costal margin = kidney

Question 28

Murphy's sign

Answer 28

pain under costal margin with inspiration | Dx: acute choleycystitis

Question 29

Appendicitis: typical presentation

Answer 29

Starts as vague per-umbilical deep, gnawing pain Shifts to RLQ + peritoneal signs = rebound tenderness, hurts when coughing Accompanying fever, N/V

Question 30

McBurney's point

Answer 30

2" from anterior superior spinous process of ilium | (+) = localized tenderness in RLQ

Question 31

Rovsing's sign

Answer 31

Referred rebound tenderness: press deeply on LLQ and quickly withdraw + = pain in RLQ

Question 32

Psoa's sign

Answer 32

irritation of Psoa's muscle by inflamed appendix: place hand above R knee and have pt raise thigh against hand (or lay on L side, extend R leg at hip) (+) = pain

Question 33

Obturator sign

Answer 33

R hip flexion with bent knee and internal rotation of knee (foot goes outwards) (+) = RLQ pain

Question 34

Cutaneous hyperesthesia

Answer 34

Light lifting of skin on abdominal wall | (+) = pain

Question 35

Abdomen PE

Answer 35

1. Inspect for distention, color, symmetry, movement, scars, veins 2. Diaphragm- all 4 quadrants for bowel sounds and arteries for bruits 3. Percuss all 4 quadrants 4. Percuss for shifting dullness 5. Percuss and measure liver span 6. Percuss for splenic enlargement 7. Palpate abdomen and suprapubic/epigastric areas lightly and then deeper 8. Assess for fluid wave 9. Assess for rebound tenderness 10. Palpate kidneys (2 hands) 11. Palpate spleen (2 hands) 12. Palpate liver edge 13. Assess for Murphy's sign, Psoa's sign, obturator sign 14. Assess for CVA tenderness