Abdomen - Lecture portion

Question 1

The most common complaint for an abdominal visit is…

Answer 1

Abdominal Pain

Question 2

Visceral abdominal pain differs from parietal pain in that visceral pain is (more precisely/difficult) to localize whereas parietal pain is (more precisely/difficult) to localize

Answer 2

1. Difficult
2. More precisely

Question 3

What category of abdominal pain develops as the initial pain worsens and is felt both superficially or deep?

Answer 3

Referred Abdominal Pain

Question 4

Which organ is not located in the peritoneum and is what we call, “retroperitoneal”?

Answer 4

They Kidneys

Question 5

Abdominal Pain History is done using what mneumonic?

Answer 5

OPQRST

Onset, Prior episodes, progression, palliate/provoke, quality of symptoms, quantity of symptoms, region, radiation, associated symptoms, timing, treatment

Question 6

When documenting, the anatomic landmarks you can use are either the ________ which are lines that cross at the umbilicus or the nine regions that usually just get the medial portions documented which are the 1. ________ region, 2. ________ and the 3. ________ region

Answer 6

1. Four quadrants
2. Epigastric
3. Umbilical
4. Hypogastric

Question 7

The Epigastric region contains what three structures?

Answer 7

1. Abdominal Aorta
2. Stomach
3. Pancreas

Question 8

The Hypogastric/Suprapubic region contains what two structures?

Answer 8

1. Bladder
2. Uterus

Question 9

The main 3 organs in the RUQ are the:

Answer 9

1. Liver
2. Gallbladder
3. Right Kidney

Question 10

The main 3 organs in the RLQ are the:

Answer 10

1. Cecum
2. Appendix
3. Right Ovary

Question 11

The main 2 organs in the LUQ are the:

Answer 11

1. Spleen
2. Stomach

Question 12

The main 2 organs in the LLQ are the:

Answer 12

1. Sigmoid colon
2. Left ovary

Question 13

What major disease should always be on the differential for abdominal pain until proven otherwise?

Answer 13

Cancer

Question 14

The initial screening question for alcohol abuse is: “”

Answer 14

How many times in the past year have you had 3+ drinks in a day (female) or 4+ drinks in a day (male)

Question 15

The CAGE questionnaire used for screening alcohol abuse stands for:

Answer 15

C - have you ever felt you should Cut down on your drinking?
A - have people Annoyed you by criticizing your drinking?
G - Do you ever feel bad or Guilty about your drinking?
E - Have you ever had a drink first thing in the morning to make you feel less nervous or get rid of a hangover? Eye opener

Question 16

What is considered more than moderate alcohol consumption?

For both males and females

Answer 16

1. Females = >1 drink per day
2. Males = >2 drinks per day

Question 17

What age is considered a risk factor for Colorectal cancer?

Answer 17

> 50 years old

Question 18

What 4 lifestyle habits are a risk factors for Colorectal cancer?

Answer 18

1. Obesity
2. Lack of exercise
3. Smoking
4. Alcohol consumption

Alcohol consumption when it is more than the “moderate” amount

Question 19

What are the Personal and Family history criteria to be considered a risk factor for Colorectal cancer?

Answer 19

1. Personal or Family history of colorectal cancer or FAP
2. Personal history of intestinal polyps or inflammatory bowel disease (Crohn’s or ulcerative colitis)

Familial Adenomatous Polyposis

Question 20

What is the MUST-DO order when performing an abdominal exam?

Answer 20

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

Question 21

When you see Ecchymosis such as the Grey-Turner’s Sign or Cullen’s sign, what should we see and what should we assume happened to result in this?

What two defining words should we think of?

Answer 21

There is bleeding underneath the skin that is visible and we assume some sort of TRAUMA and RUPTURE that occured to the patient (due to the patient bleeding)

Question 22

When listening for bowel sounds, what part of the stethoscope should we be using?

Answer 22

Diaphragm

Question 23

When listening for bruits, what two structures do we listen over and what part of the stethoscope do we use?

Answer 23

1. Abdominal aorta
2. Renal arteries
3. Bell

Question 24

Hearing increased bowel sounds could indicate what 3 things?

Answer 24

1. Gastroenteritis
2. Early obstruction
3. Hunger - so just being fasted could also result in this

Question 25

**High-pitched tinkling** bowel sounds could indicate what?

Answer 25

Small bowel obstruction ((food is being blocked and cannot enter intestines)

Question 26

**Decreased** bowel sounds could indicate what 2 things?

Answer 26

1. Constipation - VERY COMMON 2. Peritonitis (inflammation of peritoneum)

Question 27

Absent bowel sounds are when you have listened for what length of time and what does that indicate?

Answer 27

1. 2 minutes of listening 2. Surgical emergency!

Question 28

Percussing the abdomen helps assess what 3 things? | What does it give us an idea of what is happening in the abdomen?

Answer 28

1. Distribution of **Gas** 2. Possible **masses** 3. Size of **liver and spleen**

Question 29

A distended (swollen) abdomen that is diffusely tympanic suggests what condition?

Answer 29

An intestinal obstruction | Something is blocking the intestines and food cannot pass through

Question 30

Tympany notes when percussing should be heard in what type of organs? | What healthy organs should have this sound?

Answer 30

Air-filled viscera

Question 31

Hyperresonant notes when percussing should be heard over what organ and where?

Answer 31

The **base** of the lungs

Question 32

Resonance notes when percussing should be heard over what organ and where?

Answer 32

Over **tissue** of the lungs | so actually in the lungs

Question 33

Dullness notes when percussing should be heard over what organs? | What healthy organs would have this sound?

Answer 33

Solid organs | I.e. liver and spleen

Question 34

Measuring the vertical liver span of a patient using percussion should be done using what anatomical landmark? | What side of the body and what bone do we use as a guide as to where we

Answer 34

**Right**, **midclavicular** line

Question 35

What is the normal liver span of a patient?

Answer 35

6-12 centimeters

Question 36

Detecting splenomegaly is done by percussing the (lowest/highest) intercostal space in the (left/right) anterior axillary line

Answer 36

1. Lowest 2. Left

Question 37

When percussing to check for splenomegaly, you should hear what percussion note? If you hear a different note, why are you hearing that?

Answer 37

1. Tympany 2. Patient has an enlarged spleen because you are percussing in an area where the spleen **shouldn't** be and dullness indicates the spleen has gotten larger and is encroaching on that area

Question 38

How should the patient's knees be situated when palpating the abdomen?

Answer 38

Flexed so the abdominal muscles are relaxed

Question 39

General palpation of the abdomen should be done both light with ____ hand(s) and deep with ____ hand(s)

Answer 39

1. One 2. Two

Question 40

When palpating the liver, one option is to place your nondominant hand under the rib cage of what rib numbers and on what side of the patient? Why do you have the patient take a deep breath in when doing this?

Answer 40

1. Ribs 11 and 12 2. Right side 3. Upon inhalation is when you should feel the liver

Question 41

When palpating the liver using the "one-hand" technique, the liver is palpable in line with what landmark?

Answer 41

The midclavicular line

Question 42

When palpating the liver, one option is the "**hooking**" technique, this technique is more helpful in what demographic of patients?

Answer 42

Obese patients

Question 43

When palpating the spleen, the this technique is done with your nondominant hand lifting the rib cage and your dominant hand pressing in as you ask the patient to ________. This is similar to palpating what other organ?

Answer 43

1. Inhale 2. Liver with the "one-hand" technique ## Footnote You can repeat the exam with the patient on the right side with legs flexed if there is concern for splenomegaly

Question 44

What 3 conditions can cause the liver to be enlarged?

Answer 44

1. Hepatitis 2. Non-alcoholic Steatohepatitis AKA fatty liver disease - **very common in diabetic patients ** 3. Cirrhosis

Question 45

What 3 conditions can cause the spleen to be enlarged?

Answer 45

1. Portal hypertension 2. Leukemia 3. Mono

Question 46

When palpating the kidneys, one hand is under the ribs and the other hand is placed in either what 2 quadrants? The goal of palpating the kidneys is to "________" the kidneys between your hands

Answer 46

1. RUQ or LUQ 2. "Capturing"/"trap" ## Footnote Not expected to feel kidneys as the kidneys require very deep palpation

Question 47

What 2 big conditions would cause the kidney's to be enlarged?

Answer 47

1. Polycystic kidney disease 2. Wilm's tumor - very important to rule out when doing a wellness child visit because this is the most common reason for an enlarged kidney

Question 48

The specific test for the kidneys what test? This is also known as looking for ________________________ tenderness

Answer 48

1. Lloyd's test 2. Costovertebral angle | this is a percussive test NOT a palpation test ## Footnote This can be very painful if patient has issue with kidneys such as kidney stones or kidney infection

Question 49

What 2 other organs can you palpate?

Answer 49

1. Bladder - unlikely to feel 2. Aorta

Question 50

At what age would you palpate the aorta and what is considered the normal width?

Answer 50

1. > 50 years old 2. < 3 cm - over 3 cm = enlarged

Question 51

*Guarding* and *Rigidity* when assessing for peritonitis **both** involve ________ of the abdominal muscles

Answer 51

1. Contraction

Question 52

What 2 reasons is the presence of *Rigidity* **far more concerning** than *Guarding* when assessing for peritonitis?

Answer 52

1. Rigidity is **involuntary** 2. It is a **response** to peritonitis | Guarding can just be due to patient being scared about it hurting when y ## Footnote Assessing for peritonitis = 1. Guarding vs Rigidity 2. Rebound Tenderness 3. Percussive Tenderness

Question 53

The key to rebound tenderness when testing for peritonitis is when the patient says it hurts more when you...

Answer 53

Pull away! This is a response to an irritated peritoneum ## Footnote Assessing for peritonitis = 1. Guarding vs Rigidity 2. Rebound Tenderness 3. Percussive Tenderness

Question 54

Percussive tenderness is when the patient describes pain when you...

Answer 54

Percuss over a certain area - This is a response to an irritated peritoneum

Question 55

What are the 4 peritoneal signs?

Answer 55

1. Rovsing's sign 2. Obturator sign 3. Psoas sign 4. Heel-jar test

Question 56

The **fluid-wave** test is specific to test for what?

Answer 56

Ascites - fluid collection in the abdomen

Question 57

The **shifting dullness** test is specific to test for what? What would you see if it is a positive test?

Answer 57

1. Ascites 2. Dullness line shifts from when they are supine to when they are on their side

Question 58

What are the 3 primary causes of ascites?

Answer 58

1. Heart failure 2. Liver cirrhosis 3. Cancer | cirrhosis and cancer are both due to blocking of hepatic portal vein

Question 59

When is a Murphy's sign positive? What does a positive Murphy's sign indicate?

Answer 59

1. When the patient **stops inspiration** because of the pain 2. Acute Cholecystitis

Question 60

McBurney's Point is testing for what? Where on the abdomen is the test done?

Answer 60

1. Appendicitis 2. 1/3 from ASIS to umbilicus