Abdominal exam

Question 1

physical exam- order

Answer 1

IAPP

• inspection
• auscultate
• percussion
• palpation

Question 2

9 regions of abdomen

Answer 2

• right and left hypochondriac
• epigastric
• right and left lumbar
• umbilical
• right and left iliac
• hypogastric

Question 3

cullen’s sign

Answer 3

-ecchymoses around umbilicus (hemoperitoneum, acute pancreatitis)

Question 4

grey turner’s sign

Answer 4

-ecchymoses of flanks (hemoperitoneum, acute pancreatitis)

Question 5

hypertension- inspection

Answer 5

• jaundice
• caput medusae
• ascites

Question 6

normal bowel sounds / min

Answer 6

-5/34 gurgles/min

Question 7

absent bowel sounds

Answer 7

none for > 2 min

-long-lasting intestinal obstruction, intestinal perforation, mesenteric ischemia

Question 8

decreased bowel sounds

Answer 8

none for 1 min

-post-surgical ileus, peritonitis

Question 9

increased bowel sounds

Answer 9

-diarrhea, early bowel obstruction

Question 10

high pitched bowel sounds- suggest what?

Answer 10

early intestinal obstruction

Question 11

bruits- suggest what?

Answer 11

vascular obstruction
(over renal, iliac, femoral a's)

Question 12

friction rub- listen where? suggests what?

Answer 12

• listen over liver and spleen

- infl. of peritoneal surface of an organ

Question 13

venous hum- listen where? suggests what?

Answer 13

• listen over epigastric and umbilical regions

- increased collateral circulation between portal and systemic venous systems

Question 14

percussion- assess for?

Answer 14

• tympany (air-filled)

- dullness (solid organs/masses)

Question 15

abnormal percussion

Answer 15

• large dull areas- from enlarged organ or mass

- large tympanic areas- intestinal obstruction

Question 16

visceral pain- when?

Answer 16

• when hollow organs contract or are stretched
• ischemia
• diff. to localize
• palpable at midline at level of structure involved

Question 17

parietal pain- when?

Answer 17

• infl. in parietal peritoneum

- easy to localize

Question 18

parietal pain- in RUQ, epigastric, RLQ, LLQ

Answer 18

• RUQ/epigatric- acute cholecystitis
• epigastric- acute pancreatitis
• RLQ- later finding in acute pancreatitis
• LLQ- acute diverticulitis

Question 19

referred pain- duodenal and pancreatic pain

Answer 19

referred to back

Question 20

referred pain- biliary tree

Answer 20

right shoulder

Question 21

organ assessment

Answer 21

liver and spleen

Question 22

liver percussion- normal vertical span?

Answer 22

• 6-12 cm
• right midclavicular ilne- start in RLQ and percuss cephalad
• right midclavicular line- start in RUQ and percuss caudad

Question 23

liver- vertical span increased with

Answer 23

> 12 cm

• enlarged liver- cirrhosis, lymphoma, hepatitis, right-sided heart failure
• right pleural effusion (falsely increased)

Question 24

liver- vertical span decreased with

Answer 24

-shrunken liver- cirrhosis

Question 25

irregular edge/nodules- liver

Answer 25

-hepatocellular carcinoma

Question 26

firmness/hardness- liver

Answer 26

-cirrhosis, hematochromatosis, amyloidosis, lymphoma

Question 27

spleen percusion- normal? splenomegaly?

Answer 27

- start at cardiac border of left anterior axillary line- percuss laterally (ribs 6-10) - normal- tympany laterally in midaxillary line - splenomegaly- dullness at midaxillary line

Question 28

splenomegaly- due to?

Answer 28

-portal hypertension, blood malignancies, HIV, splenic infarct, hematoma, infectious mononucleosis

Question 29

tests for ascites

Answer 29

- shifting dullness test- percuss borders of tympany and dullness with pt supine. have pt lay on side and percuss borders again. positive test if dullness shifts to dependent side and tympany to top side - test for a fluid wave- assistant places ulnar aspects of hands midline, tap 1 flank sharply with finger tips. positive test when impulse transmitted to other flank

Question 30

tests of appendicitis

Answer 30

- mcburney's point (ASIS to umbilicus) - rovsing's sign (palpate deeply in LLQ- + if pain felt in RLQ) - psoas sign (have pt raise thigh against resistance- + if increased abdominal pain) - obturator sign (flex pts right hip with knee bent, then internally rotate the hip- + if right hypogastric pain)

Question 31

tests for cholecysitis

Answer 31

-murphy's sign (palpate under pt's right costal margin with right hand, ask pt to take a deep breath in and palpate deeper- + if sharp increase in tenderness with sudden stop in inspiratory effort)

Question 32

sign for enlarged non-tender gallbladder

Answer 32

courvoiser's sign

Question 33

signs of peritoneal infl.

Answer 33

- guarding - rigidity (stiff, board-like m's) - rebound tenderness (more tenderness when letting of of pressing on abdomen)

Question 34

test for pyelonephritis

Answer 34

-lloyd's punch/kidney punch/CVA tenderness (test with fist percussion- place ball of one hand on costovertebral angle and strike with ulnar aspect of other hand- + if tenderness)

Question 35

test for abdominal wall mass vs. intraabdominal mass

Answer 35

ask pt to raise head and shoulders when lying supine - palpate for mass again - abdominal mass- remains palpable - intraabdominal mass- no longer palpable

Question 36

tests for ventral hernia

Answer 36

-when lyine supine, ask pt to raise both head and shoulders off the table- + if bulge of hernia appears