Abdomen

Question 1

What’s in the RUQ?

Answer 1

right lobe of liver, gallbladder, duodenum, head of pancreas, right adrenal gland, right kidney, superior part of ascending colon, right of transverse colon

Question 2

What’s in the RLQ?

Answer 2

cecum, appendix, most of ileum, inferior part of right uterine tube, right ovary, ascending colon, right ureter, right spermatic cord

Question 3

What’s in the LUQ?

Answer 3

left lobe of liver, spleen, most of stomach, jejunum and proximal ileum, body and tail of pancreas, left adrenal gland, left kidney, superior part of descending colon, left half transverse colon

Question 4

What’s in the LLQ?

Answer 4

sigmoid colon, inferior part of descending colon, left ovary, left uterine tube, left ureter, left spermatic cord

Question 5

What’s the top quadrants?

Answer 5

hypochondriac (R&L) with epigastric in the middle

Question 6

What are the middle quadrants?

Answer 6

lumbars (R&L) and umbilical

Question 7

What are the bottom quadrants?

Answer 7

iliacs (R&L), with hypogastric in the middle

Question 8

Where does the colon travel between?

Answer 8

peritoneal space and retroperitoneum

Question 9

What are retroperitoneal structures?

Answer 9

SAD PUCKER
Suprarenal (adrenal glands)
Aorta/IVC
Duodenum
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum

Question 10

What area should you save for last in the exam?

Answer 10

area of complaint

Question 11

What is visceral pain?

Answer 11

pain when hollow organs contract forcefully, distended/stretched, become ischemic, pain is also present when solid organs are stretched, but often difficult to localize

Question 12

What is parietal pain?

Answer 12

originating from inflammation in the parietal peritoneum, usually more severe and precisely localized, aggravated by movement

Question 13

What is referred pain (nociception)?

Answer 13

felt more at distant sites innervated by the same spinal levels at the disordered structures

Question 14

What are alarm symptoms?

Answer 14

dysphagia, odynophagia, recurrent emesis, GI bleeding, early satiety, weight loss, anemia, palpable mass, jaundice

Question 15

What is pain that migrates from the periumbilical region combined with N/V and loss of appetite?

Answer 15

appendicitis

Question 16

What should you consider in women with abdominal pain?

Answer 16

PID, ruptured ovarian follicle, ectopic pregnancy

Question 17

What could cramping pain radiating to the flank or groin be?

Answer 17

renal stone

Question 18

What is fever, loss of appetite, and diarrhea with constipation?

Answer 18

diverticulitis

Question 19

What is diffuse abdominal pain with absent bowel sounds and firmness, guarding, or rebound?

Answer 19

bowel obstruction

Question 20

What is severe diffuse abdominal pain with guarding and rigidity?

Answer 20

peritonitis

Question 21

What is obstipation?

Answer 21

no passage of gas or feces

Question 22

What is melena?

Answer 22

black tarry stools

Question 23

What is hematochezia?

Answer 23

red or maroon colored stools

Question 24

What is flatus?

Answer 24

passing excessive gas

Question 25

why does jaundice occur?

Answer 25

increased production of bilirubin or decreaed uptake, decreased liver ability

Question 26

What should you ask with patients with jaundice?

Answer 26

color of urine, color of stool (bile obstruction/impaired GI tract), itching, painless, or painful

Question 27

What are risk factors for liver disease?

Answer 27

hepatitis, alcoholic hepatitis or cirhosis, toxic liver damage, gallbladder disease, hereditary disorders

Question 28

What are men-based urinary questions?

Answer 28

straining, force/caliber, dribbling, hesitancy

Question 29

Where is flank pain?

Answer 29

at the costovertebral angle and associated with kidney pain and dull,aching and steady

Question 30

What is uretral colic?

Answer 30

severe originating at angle and radiating to upper thigh due to sudden distension of uereter and with fever, chills , hematuria

Question 31

What's the order of abdominal examination?

Answer 31

inspect, auscultate, percuss, palpate

Question 32

What are you inspecting in the abdomen?

Answer 32

surface, contours, movement, bulges, skin, peristalsis (skinny), pulsations (normal or from abdominal aortic aneurism)

Question 33

How do you auscultate?

Answer 33

listen for BRUITS, clicks and gurgles, borborygmi (growling)

Question 34

Where can you hear friction rubs?

Answer 34

liver and spleen

Question 35

What do you percuss?

Answer 35

liver, costal margins, four quadrants, spleen

Question 36

What's important in palpation?

Answer 36

finding tenderness or guarding, rigidity, masses. light and deep pressures

Question 37

What can help make the diagnosis?

Answer 37

cough test (identify pain, then palpate) guarding (reflex contraction) rigidity (involuntary reflex contraction) rebound tenderness

Question 38

What should you always observe while palpating?

Answer 38

the face

Question 39

What's a normal liver span?

Answer 39

6-12cm. Can find this percussing up umbilical and down from nipple or above nipple line

Question 40

How do you feel the liver?

Answer 40

Place hands low below rib's edge and ask patient to breathe in

Question 41

What is the hooking technique?

Answer 41

preferred if patient is obese, partially curl you fingers and ask patient to take a deep breath

Question 42

What is Traube's Space percussion?

Answer 42

medial to lateral and should be resonant throughout

Question 43

What is a splenic percussion sign?

Answer 43

start percussion at anterior axillary line and ask patient to take a deep breath, if it remains, normal. Dull, is palpation

Question 44

How can you feel the spleen better?

Answer 44

patient rolling on right lateral decubitus, moving spleen forward, feeling on right side of abdomen

Question 45

What else should you palpate?

Answer 45

bladder, aorta (sides of umbilicus) >50 yrs

Question 46

how do you assess ascites?

Answer 46

percussion - looking for central tympany surrounded by dullness (moon-like circle) shifting dullness and marking with moving patient, fluid wave (tap one flank sharply and feel for a wave; this implies ascites)

Question 47

What indicates appendicitis?

Answer 47

guarding, Rosving's sign, psoas sign, McBurney's point tenderness, localized pain in RLQ

Question 48

What is Rosving's sign?

Answer 48

palpating opposite side in same spot with pain surfacing in RLQ

Question 49

What is the psoas sign?

Answer 49

moving leg back elicits pain

Question 50

What is obturator sign?

Answer 50

flex pts right thigh at hip

Question 51

What is Murphy's sign?

Answer 51

suspicious for acute cholecystitis, hook your left thumb under costal margin of right rectus muscle and have patient take a deep breath palpate, if there is pain, positive

Question 52

What visceral manifestation causes central-right upper quadrant epigastric pain?

Answer 52

biliary tree and liver

Question 53

What visceral manifestation causes central epigastric pain?

Answer 53

stomach, duodenum, pancreas

Question 54

What visceral manifestation causes periumbilical pain?

Answer 54

small intestine, appendix, proximal colon

Question 55

What visceral manifestation causes subrapubic pain?

Answer 55

colon, bladder, uterus, sacral pain from rectum

Question 56

When patients report acute pain in the LLQ, what should you investigate?

Answer 56

fever and loss of appetite

Question 57

When patients report chronic pain in the quadrants of the lower abdomen, what should you ask?

Answer 57

about bowel habit change and diarrhea/constipation

Question 58

What's the difference between radiation of kidney pain and ureteral pain?

Answer 58

Ureteral pain extends entirely down to the groin whereas the kidney just wraps around to the hypochondriac region