Abdominal Complaint 1

Question 1

What are the types of abdominal pain?

Answer 1

Parietal pain
Visceral pain
Referred pain

Question 2

Visceral pain

Answer 2

Stimulation of visceral pain fibers

• Secondary to distention or stretching of organs
• • NOT LOCALIZED

Question 3

Parietal pain

Answer 3

Stimulation of somatic pain fibers

• Secondary to inflammation in the parietal peritoneum
• • LOCALIZED

Question 4

Referred pain

Answer 4

Originates within the abdomen but is felt at distant sites which are innervated at same spinal levels as the disordered structure

Question 5

Important information to get from the HPI?

Answer 5

Location

Aggravating and Alleviating factors

Question 6

Important information to get from medications?

Answer 6

Blood thinners
NSAIDS
Narcotics, steroids

Question 7

What is the order of the physical exam for an abdominal complaint?

Answer 7

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

Question 8

What must you do to start the physical exam for an abdominal complaint?

Answer 8

Drape your patient

Question 9

What is the importance of ausciltation?

Answer 9

Bowel sounds - bowel motility information

Question 10

What do you use to listen (ausiltation) to bowel sounds?

Answer 10

Diaphragm of stethoscope (bigger side)

Question 11

What are the normal bowel sounds?

Answer 11

5-34 clicks/gurgles per minute

Question 12

Absent bowel sounds are none for how long?

Answer 12

At least 2 minutes

Question 13

Decreased bowel sounds are none for how long?

Answer 13

1 minute

Question 14

Increased bowel sounds can indicate?

Answer 14

Diarrhea, early bowel obstruction

Question 15

High pitched bowel sounds can suggest?

Answer 15

Early intestinal obstruction

Question 16

What does percussion allow you to assess for?

Answer 16

Fluid and solid-filled masses
Amount of gas in the abdomen
Sizing of liver and spleen

Question 17

Tympany of percussion

Answer 17

High-pitched = air filled

Question 18

Dullness of percussion

Answer 18

Non-resonating = solid organs or masses or feces

Question 19

Resonance of percussion

Answer 19

Hollow abdominal organs (lungs)

Question 20

Hyper-resonance of percussion

Answer 20

Air-filled hollow organ = pneumothorax

Question 21

Most common percusssion?

Answer 21

Tympany because of gas in GI tract

- Scattered dullness is normal from fluid and feces

Question 22

Gently palpate in all 4 quadrants and then _____ in all 4 quadrants

Answer 22

Deeply palpate

Question 23

When palpating, always start where?

Answer 23

AWAY from area of reported tenderness

Question 24

Is the spleen normally palpable?

Answer 24

NO, unless enlarged

Question 25

How can you tell if the liver is enlarged when palpating?

Answer 25

Vertical span is increased

Question 26

Where do you palpate for the liver?

Answer 26

Right midclavicular line

Question 27

What is the best test for testing for Ascites?

Answer 27

Test for a fluid wave

Question 28

Describe the way to test for a fluid wave for Ascites

Answer 28

- Patient rests hands over chest - Have assistant place ulnar aspects of hands midline - Place your hands on flanks and tap one flank sharply with finger tips

Question 29

Normal response for test for a fluid wave for Ascites?

Answer 29

NO impulse felt on other flank

Question 30

ABnormal response for test for a fluid wave for Ascites?

Answer 30

(+) = impulse transmitted to the other flank

Question 31

What are the special tests for appendicitis?

Answer 31

McBurney's Point Tenderness Rovsing's Sign Psoas sign Obturator sign

Question 32

Best test for appendicitis?

Answer 32

McBurney's Point Tenderness

Question 33

Describe McBurney's point tenderness

Answer 33

Draw imaginary line from ASIS to umbilicus and palpate 2 inches medial to ASIS on that line (1/3 of way to umbilicus on that line)

Question 34

(+) McBurney's point tenderness test?

Answer 34

Tenderness = indicates appendicitis

Question 35

Describe the Rovsing's sign

Answer 35

Palpate deep in LLQ | (+) = pain in RLQ - indicates appendicitis

Question 36

Psoas sign

Answer 36

Have patient raise right thigh against resistance, then turn patient on left side and extend right leg at hip (+) = increased abdominal pain for either maneuver - indicates appendicitis

Question 37

Obturator sign

Answer 37

Flex patient's right hip with knee bent, then internally rotate hip (+) = right hypogastric pain - indicates appendicitis

Question 38

Special test for biliary colic

Answer 38

Murphy's sign

Question 39

Describe Murphy's sign

Answer 39

With right hand, palpate deeply under patient's right costal margin - ask patient to take a deep breath in and palpate deeper

Question 40

(+) murphy's sign

Answer 40

Sharp increase in tenderness with sudden stop in inspiration when deeply palpating below right costal margin = biliary colic

Question 41

Special test for kidney inflammation/distention

Answer 41

Lloyd's sign (punch)

Question 42

Describe (+) Lloyd's sign

Answer 42

Pain to deep percussion in the area of the costovertebral angle

Question 43

What are the peritoneal signs of an acute abdomen?

Answer 43

Guarding Rigidity - abdominal muscles are stiff Rebound tenderness - more tenderness when letting go than when pushing in during palpating