Abdomen Flashcards Preview

Physical Diagnosis > Abdomen > Flashcards

Flashcards in Abdomen Deck (42):
1

Anatomic Divisions, Abdomen

(2 methods)

  1. 4 Quadrants
    • ​RUQ
    • LUQ
    • RLQ
    • LLQ
  2. 9 Sections
    • ​Epigastric
    • Umbilical
    • Hypogastric/suprapubic
    • Hypochondriac (L, R)
    • Lumbar (L, R)
    • Iliac (L, R)

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2

Internal Abdominal Anatomy 

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3

Common GI Symptomatic Complaints

(11)

  1. Heartburn - a burning sensation in the epigastric area radiating into the throat; often asst c regurgitation 
  2. Excess air - gas, flatus, needing to belch or pass gas by the rectum, bloating 
  3. Fullness/early satiety - gastroporesis asst c diabetes
  4. Anorexia
  5. Vomit, wretching
  6. Quality
    • ​​Visceral pn
    • Parietal pn
    • Referred pn 
  7. Related medical problems
    1. Hepatitis
    2. Cirrhosis
    3. Gallbladder
    4. Pancreatitis
  8. Prior abdo surgeries
  9. Travel/Occupational hazards
  10. Substance use
    • ​​Tobacco
    • Alcohol
    • Illegal drugs
    • Medications
  11. Heredity

4

Regurgitation

Reflux of food and stomach acid into the mouth

Brine-like taste 

5

Visceral Pain

(2 causes, 4 s/sx)

  • Causes
    • Hollow organ (stomach, colon) forceful contraction/distention 
    • Solid organs (liver, spleen) swell against capsules
  • S/Sx
    • gnawing
    • cramping
    • aching
    • difficult to localize

6

Parietal Pain

(def, asst conditions)

  • Def - inflammation from hollow/solid organs that affect parietal peritoneum
  • Asst Condition - severe prognosis, easily localized (appendicitis)

7

Referred Pain

(def, 1 example)

def - originates at different sites but share innervation fro the same spinal level

ex - gallbladder pn in the shoulder 

8

Periumbilical Pn Causes

(3)

  1. Small Intestine
  2. Appendix
  3. Proximal colon 

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9

RUQ/Epigastric Pn Causes

(2 organs)

  1. Liver
  2. Biliary Tree

10

Suprapubic/Sacral Pn Cause

(1 organ)

Rectum 

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11

Epigastric Pn Causes

(3 organs)

  1. Stomach
  2. Duodenum
  3. Pancreas

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12

Hypogastric Pn Causes

(3 organs)

  1. Colon (more diffuse)
  2. Bladder
  3. Uterus

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13

Pain Description Questions, GI

(9)

  1. Describe in your own words
  2. Point with one finger to the area of pn 
  3. Rank severity (1-10)
  4. What birngs on the pain, timing
  5. Pain fequency
  6. Pain duration 
  7. Pain radiation 
  8. Aggrevating/relieving factors
  9. Associated S/Sx

14

Bowel Movement Historical Questions

(6)

  1. Frequency
  2. Consistency (diarrhea vs constipation)
  3. Pn c bowel movements
  4. Blood
    • ​hematochezia - blood in stool
    • melena - black, tarry stool
  5. Stool color
    • white/gray may indicate liver/GB disease
    • red/purple may indicate beets/dyes 
  6. Associated signs
    • ​jaundice
    • icteric sclerae

15

Urinary Tract History Questions

(8)

  1. Fequency
  2. Urgency
  3. Dysuria - suprapubic pn bladder cancer until proven otherwise 
  4. Describe urine
    • ​color
    • smell
  5. Difficulty starting to urinate
  6. Incontinence
  7. CVA pain - kidney
  8. Low back pn - prostate 

16

Abdomen Inspection Components

(5, 6/3/4/0/2 specifics)

  1. Skin
    • ​scars
    • striae (stretch marks)
    • venous pattern
    • hair distribution 
    • rashes
    • lesions 
  2. Umbilicus
    • ​contour
    • location
    • signs of umbilical hernia 
  3. Contour
    • ​flat
    • rounded
    • protuberant
    • scaphoid
  4. Symmetry
  5. Signs of movement
    • ​peristalsis
    • pulsations 

17

Auscultation 

(rule, procedure)

Rule: always auscultate before palpating or percussing, only in abdomen

Procedure:

  1. Place diaphragm over abdomen
  2. Listen for gurgles
  3. Move stethescope to multiple places only if sounds are absent 
  4. Listen for two minutes before concluding absent 

18

Vascular Bruit Locations

(3)

  1. Aorta (midline)
  2. Renal arteries (above umbilicus off midline)
  3. Bifurcation of common iliac arteries (below umbilicus, off midline)

19

Pathologic Liver Sounds

(2, indications)

  1. Bruit - heptocellular carcinoma or alcoholic hepatitis
  2. Venous hum: portal hypertension 

20

Abodminal Percussion Procedure

 

  1. Percuss over all 4 quadrants 
    • ​Tympany (hollow, normal)
    • Dullness (large stool or mass)
  2. Percuss liver
    • ​Lower border 
      • Start below umbilicus (tympanic)
      • Percuss upwards in right MCL or MSL until liver dullness
    • Upper border
      • Start from lung in MCL or MSL
      • Percuss downward to liver dullness
    • Measure span
      • Male: 8-12 cm
      • Female: 6-10 cm 

21

Ascites, Shifting Dullness Eval 

(5 steps)

 

  1. Determine border of tympany and dullness by percussion in supine position, beginning at the umbilicus and moving laterally (mark the spot c a pen)
  2. Repeat percussion in the same direction c pt rolled on that same side
  3. In the presence of ascites, tympany-dullness margin will move upward towards umbilicus, as ascitis fluid pools in dependent side of peritoneal cavity 
  4. In absence of ascites, margain remains stationary 

22

Ascites, Fluid Wave Eval 

  1. Position ulnar side of hand in midline of abdomen 
    • ​prevents false negative from fat/flatus 
  2. Tap lateral side of abdomen and assess transmission of a wave to contralateral side using other hand
    • ​+ =  palpable thrill
    • - = no palpable thrill 

23

Ascites Phys Exam Tests

(2)

  1. Fluid Wave
  2. Shifting Dullness

24

Light Palpation 

(4 techniques)

  1. Start palpating the abdomen using gentle probing c hands
    • ​This reassures and relaxes the patient
  2. Identify superficial organs/masses​
  3. Assess for voluntary guarding vs involuntary guarding
    • ​voluntary - patient consciously flinches when you touch him
    • involuntary - muscles spasm when you touch the pt but he canot control his rxn 
  4. Use relaxation techniques to assess voluntary guarding 
    • ​tell pt to breathe out deeply
    • tell pt to breathe through outh c jaw dropped open 
    • distract pediatric pts, play a game c hands 

25

Deep Palpation, General

 

Deeply palpate in periumbilical area and both lower quadrants.

Look for rebound tenderness - inc pn when examiner dec pressure against abdomen 

26

Liver Palpation Procedure

Average-sized person

  1. With left hand, support back @ ribs 11 and 12
  2. With right hand, press abdomen inferior to liver border
  3. Palpate superiorly until liver is realized 
  4. Ask pt to take deep breath
    • ​Painful in liver/GB disease
  5. Find inferior liver border
    • ​Diaphragm lowering during inspiration forces liver downward

Obese person - "hooking" technique"

  1.  Place both hands, side by side, on right abdomen below border of liver dullness
  2. Press in c fingers going up towards costal margin
  3. Ask pt to take a deep breath
  4. Liver should be palpable under fingertips of both hands

27

Spleen Palpation 

  1. Position pt on left side
  2. Support back c left hand, palpate c right hand
  3. Have pt inspire

Note - usually only palpable in the presence of splenomegaly  

28

Kidney Palpation 

Left Kidney

  1. ​Place patent on left side
  2. Position right hand under 12th rib
  3. Lift up, trying to displace kidney anteriorly 
  4. Position left hand on LUQ
  5. Ask patient to inhale 
  6. At peak of inspiration, place left hand deeply into upper quadrant trying to "capture" kidney between hands

Right Kidney

  1. Place patient on right side
  2. Lift back with left hand
  3. Position right hand on RUQ
  4. Repeat procedure for left kidney 

Both Kidneys

  1. Palpate costovertebral angle on each side of back for kidney tenderness
  2. Palpate over suprapubic area for bladder tenderness  

29

Ascites-Specific Tests/Results

  • Inspection: protuberant abdomen c bulging flanks
  • Percussion: lateral dullness c anterior tympany (fluid accum pattern)
  • Special Tests:
    1. ​Shifting dullness
    2. Fluid wave

30

Appendicitis-Specific Tests/Results

  • Palpation: involuntary guarding and rebound tenderness in RLQ during LLQ palpation (Rovsing's Sign)
  • Special Tests:
    1. Rectal exam in both sexes, pelvic exam in females (or at least offer it)
    2. Psoas Sign - supine pain when pt flexes thigh against examiner's hand
    3. Obturator Sign - pain with passive internal (and external) leg rotation c flexed up

31

Rovsing's Sign

(description, possible pathology)

Description: RLQ pn on LLQ palpation

Pathology: Appendicitis 

32

McBurney's Sign

(Description, Possible Pathology)

Description: tenderness @ McBurney's point (1/3 along line extending from ASIS to umbilicus)

Pathology: Appendicitis 

33

Rebound Tenderness

(Description, Possible Pathology)

Description: Pn on quick withdrawal of palpation. Check for peritonitis before asssessing rebound tenderness by asking pt to cough or lightly jar bed; if this reproduces abdo pn then there is no need to maximize pn by demonstrating rebound tenderness

Pathology: peritonitis 

34

Murphy's Sign

(Description, Possible Pathology)

Description: Arrest of deep inspiration on RUQ palpation (hand contact c gallbladder ellicits pn)

Pathology: Cholecystitis 

35

Courvoisier's Sign

(description, possible pathology)

Description: Painless, palpable distended gallbladder

Pathology: Pancreatic cancer

36

Cullen's Sign

(description, pathology)

Description: Blue discooration of periumbilical area caused by retroperitoneal hemorrhage tracking around anterior abdominal wall

Pathology

  1. Acute hemorrhagic pancreatitis
  2. Ectopic pregnancy 

37

Grey-Turner's Sign

(description, possibl pathology)

Description: Blue discoloration of flank caused by retroperitoneal hemorrhage

Pathology:

  1. Acute hemorrhagic pancreatitis
  2. Ruptured abdominal aortic aneurysm
  3. Strangulated bowel 

38

Kehr's Sign

(description, possible pathology)

Description: left shoulder pn exacebated by elevating foot of bed (referred pn; diaphragmatic involvement)

Pathology: splenic rupture

39

Psoas Test

(description, pathology)

Description: pn on flexion of hip against resistance

Pathology:

  1. Appendicitis 
  2. Psoas inflammation (ex - retroperitoneal abscess)

40

Obturator Test

(Description, Possible Pathology)

Description: Pn c 90 degree hip and knee flxn, gently rotate hip; first internally then externally

Pathology

  1. Pelvic appendicitis
  2. Diverticulitis
  3. PID
  4. Other cuases of inflammation in obturator internus region 

41

Positive Carnett's Sign

(Description, Possible Pathology)

Description: Abdominal pn/tenderness exacerbated when pt lifts feet above bed without bending knees

Pathology: Abdominal wall pn (sprain/strain/hernia) because stretching abdo wall worsens any intra-muscular lesion 

42

Negative Carnett's Sign

(Description, Pathology)

Description: Abdominal wall pn/tenderness alleviated when pt lifts feet above bed without bending knees

Pathology: Source of pn is inside abdominal cavity because stabalizing abdo wall protects organs within