Abdomen

Question 1

For abdomen, order of exam?

Answer 1

1) inspection
2) AUSCULTATION
3) percussion
4) palpation

Question 2

Percussion looks for what? (4)

Answer 2

1) size/density of organs
2) fluid
3) air distribution
4) masses

Question 3

Percuss for liver span, start where?

Answer 3

umbilicus and MCL -> move up

4th ICS and MCL -> move down

Question 4

Liver upper border U where?

Answer 4

5-7th ICS

Question 5

Liver span U how big?

Answer 5

6-12 cm at MCL

4-8 cm at mid sternal line

Question 6

Palpation of abdom looking for what? (4)

Answer 6

1) mm spasm
2) masses
3) fluid
4) tenderness

Question 7

Aorta >3 cm may indicate?

Answer 7

AAA

Abdom aortic aneurysm

Question 8

What is PQRST

Answer 8

rating of abdom pain:

Provocative/Palliative (makes better/worse)
Quality
Region/Radiation
Severity
Temporal pattern/assoc sxs

Question 9

What is BRBPR?

Answer 9

Bright Red Blood Per Rectum

Question 10

Linea Nigra?

Answer 10

hyperpigmented line down pregnant abdomen

Question 11

Normal venous flow in abdom?

Answer 11

Upward above umbilicus

Downward below umbilicus

Question 12

Shunting of blood from lower abdom to upper abdom may mean?

Answer 12

IVC or portal vein obstruction

Question 13

Caput medusae is what?

Caused by what?

Answer 13

Radiating venous flow from umbilicus (network of visible blue veins)

portal venous obstruction with ascites (serous fluid accumulation)

Question 14

Shunting from up abdom to low abdom may mean?

Answer 14

SVC obstruction

Question 15

Diastasis recti is?

Answer 15

separation of rectus abdom mm

seen as ridge in abdomen when pt lifts head in supine position

Question 16

Bulging flanks may mean?

Answer 16

ascitic fluid

Question 17

Suprepubic bulge may mean? (3)

Answer 17

1) full bladder
2) tumor
3) pregnancy

Question 18

Ascites is?

Answer 18

free intraperitoneal fluid accumulated in dependent part of abdom cavity

Gas-filled loops float to top

Question 19

Visible peristaltic activity may mean?

Answer 19

intestinal obstruction

gastroenteritis

Question 20

What is a gridiron incision?

Answer 20

muscle-splitting

Question 21

What is pfannenstiel incision?

Answer 21

suprapubic

Question 22

Purpose of auscultation? (2)

Answer 22

Bowel Sounds (intestinal activity)
Narrowing of vascular structures (bruits)

Question 23

Hyperactive BS may mean? (3)

Answer 23

Gastroenteritis
Early obstruction
Early peritonitis (infection)

Question 24

Borborygmi is?

Cause by?

Absence means?

Answer 24

(bawr-buh-RIG-me)
gurgling, splashing sound over the large intestine

caused by passage of gas through liquid

absence = (P) paralytic ileus or obstruction

Question 25

High-pitched Tinkling BS may indicate? (2)

Answer 25

Mechanical small bowel obstruction | Intestinal fluid under pressure

Question 26

Hypoactive BS, I must determine what?

Answer 26

quite vs silent (listen for several minutes)

Question 27

Hypoactive BS may indicate? (2)

Answer 27

Paralytic ileus | Late Peritonitis

Question 28

What arteries should be auscultated for bruits? (4)

Answer 28

Aorta Renal aa Iliac aa Femoral aa

Question 29

Purcussion for ascites sounds like?

Answer 29

tympanic over air-filled loops | dullness heard lower in abdomen (shifting dullness)

Question 30

Shifting dullness exam?

Answer 30

Pt supine, percuss for border of dullness | Pt roll to side, if border of dullness shifts = ascites

Question 31

Palpation for ascites?

Answer 31

Looking for fluid wave: Use hand to wall-off one side of abdom fat from other Tap on one side sends wave of fluid to other

Question 32

Paracentesis is?

Answer 32

needle (tap) removal of fluid

Question 33

Splenomegaly may indicate? (6)

Answer 33

``` mono (tender, fragile) hematologic disorders cirrhosis cysts hypersplenism other infections ```

Question 34

Superficial abdmoninal reflexes exam?

Answer 34

draw line out from umbilicus: Up abdom: T7-9 Low abdom: T11-12 Cremaster: T12-L2

Question 35

Diverticulitis (large bowels) pain (U) seen where?

Answer 35

LLQ

Question 36

Explosive, excruciating pain in abdomen may mean? (5)

Answer 36

``` coronary occlusion biliary colic ruptured viscus ruptured aneurysm renal colic ```

Question 37

Severe, constant pain may mean? (3)

Answer 37

acute pancreatitis bowel strangulation mesenteric thrombosis

Question 38

Gradual onset, steady pain may mean? (4)

Answer 38

acute cholecystitis acute appendicitis diverticulitis pelvic inflammatory dx (PID)

Question 39

Intermittent, colicky pain may mean? (2)

Answer 39

early/subacute pancreatitis | mechanical small bowel obstruction

Question 40

Peritoneal Signs are? (3)

Answer 40

Guarding: rigidity and tenderness of abdom wall when touched Abdom wall rigidity, generalized Reboud/contralateral rebound tenderness

Question 41

Acute appendicitis may have + results for what tests? (5)

Answer 41

1) rebound 2) psoas sign 3) obturator sign 4) rovsing sign 5) rectal exam

Question 42

Rebound tenderness exam?

Answer 42

over site of tenderness, press in then suddenly release classic sign of peritoneal irritiation

Question 43

Psoas Sign exam?

Answer 43

Hand on pt's knee, have pt lift against resistance (tenses iliopsoas) + result detects appendix inflammation

Question 44

Obturator Sign exam?

Answer 44

Pt supine, R knee bent Passive internal rotation of hip (stretches internal obturator) pain in RLQ = appendix inflamm

Question 45

Rovsing's Sign exam?

Answer 45

Referred, rebound pain: Press LLQ, quickly withdraw suddend pain in RLQ = append inflamm

Question 46

Murphy's Sign exam?

Answer 46

``` R hand under R costal margin Pt takes deep breath OR L hand flat over liver percuss w/ R fist ``` + = gallbladder or liver inflamm