Abdominal Exam Flashcards
(56 cards)
1
Q
- Types of abdominal pain
A
- Visceral
- From stim of visceral pain fibers
- Secondary to distension, stretching or contracting of hollow organs, stretching capsule of organs or organ ischemia
- NOT LOCALIZED
- Parietal
- From stim of somatic pain fibers
- Secondary to inflammation in parietal peritoneum
- Localized
- Referred
- Originates within abdomen but felt at distant sites which are innervated at approximately same spinal levels as disordered structure
2
Q
- Focused ROS is based on _
- General ROS is performed _
A
- CC
- All the time
3
Q
- When asking about past surgical history, what surgical procedures should you be asking about?
A
- Abdominal
- Cholecystectomy
- Appendectomy
- Gynecologic
- Hysterectomy
- BTL
- C Section
- Ovarian Cyst
- Etc
4
Q
- What type of GI prescriptions may a patient be taking?
A
- H2 Blockers
- PPI
- Dicyclomine
5
Q
- What steps do you perform an abdominal exam?
- What else must you always do
A
- Inspection
- Ascultation
- Percussion
- Palpation
Drape the patient
6
Q
- What are the landmarks of the abdomen to look for during inspection?
A
- Xiphoid process of sternum
- Costal margin
- Umbilicus
- ASIS
7
Q
- What organs are located in which abdominal quadrants?
A
- RUQ
- Liver
- Gallbladder
- Stomach
- SB
- LB
- RLQ
- Appendix
- Ovary
- SB
- LB
- LUQ
- Spleen
- Stomach
- SB
- LB
- LLQ
- Sigmoid colon
- Ovary
- SB
- LB
- Epigastric area
- Pancreas
- Liver
- Gallbladder
- Stomach
- LB
- SB
8
Q
- Ascultation
- Use bell to listen for _
- What is the normal amount of bowel sounds/min
A
- Bruits
- 5-34 clicks/gurgles per min
9
Q
- Absent bowel sounds
A
- No bowel sounds for > 2 min
- Causes:
- Long lasting intestinal obstruction
- Intestinal perforation
- Mesenteric ischemia
10
Q
- Decreased bowel sounds
A
- None heard for 1 min
- Causes:
- Post surgical ileus
- Peritonitis
11
Q
- Hyperactive bowel sounds causes
A
- Diarrhea
- Early bowel obstruction
12
Q
- What are high pitched bowel sounds indicative of (raindrops on metal)
A
- Early intestinal obstruction
13
Q
- What are bruits heard in the abdominal aorta or other abdominal arteries suggestive of?
A
- Vascular obstruction
14
Q
- What is a friction rub?
- What is it indicative of?
A
- Abnormal grating spunds with respiratory . variation
- Inflammation of peritoneal surface of an organ (usually over liver or spleen)
15
Q
- Where should you listen for venous hum?
- What is this abnormal sound indicative of?
A
- Epigastric and umbilical regions
- Increased collateral circulation between portal and systemic venous systems
16
Q
- _ sound predominates when percussing the 4 quadrants of the GI tract. Why?
A
- Tympany
- Gas in Gi tract, scattered areas of dullness is normal for fluid and feces
Abnormal-large dull areas from mass or enlarged organ
Protuberant abdomen that is tympanic throughout may indicate intestinal obstruction
17
Q
- Tympany
A
- High pitched, air filled
18
Q
- Dullness
A
- Non-resonating, solid organs or masses
19
Q
- Resonance
A
- Hollow abdominal organs (lungs)
20
Q
- Hyper-resonance
A
- Air filled hollow organ (ie: pneumothorax)
21
Q
- Palpation
A
- Helpful for discerning abdominal tenderness. resistance, superficial organs and masses
- Use palmar aspect of hand with fingers together
- Gently then deeply palpate all 4 quads
- ALWAYS START FURTHEST FROM TENDER AREA
22
Q
- What two organs need additional assessment
A
- Liver
- Spleen
23
Q
- How do you assess liver size and shape
A
- Percussion and palpation
- Percussion
- Right midclavicular line, start in RLQ and percuss cephalad to an area of dullness (lower border of liver)
- Right midclavicular line, start in RUQ, percuss caudad towards liver dullness (superior border of liver)
- Normal liver span (6-12 cm)
- Vertical span increased with
- Cirrhosis
- Lymphoma
- Hepatitis
- Right sided heart failure
- Amyloidosis
- Hemochromatosis
- Vertical span decreased with
- Cirrhosis
24
Q
- Liver palpation
A
- Left hand behind patient supporting ribs 11-12
- Push left hand up
- Right hand on abdomen-press cephalad
- Ask patient to breathe deeply
- Feel liver edge as it comes down to meet right hand
Normal-slightly tender, soft, smooth surface
Irregular edge/nodules=hepatocellular carcinoma
Firmness/hardness=cirrhosis, hemochromatosis, amyloidosis, lymphoma
25
* Spleen percussion
* Start from border of cardiac border of left anterior axillary line, percuss laterally
* If tympany is prominent laterally in midaxillary line, splenomegaly is not likely
* Dullness at midaxillary line-splenomegaly
26
* Spleen palpation
* With left hand, reach over patient and grasp posterior LUQ
* Right hand below left costal margin, press posteriorl toward spleen
* Ask patient to take deep breath in
* Feel edge of spleen as it comes down to meet your hand
* **5% normal patients-spleen is palpated**
27
* Splenomegaly can be caused by?
* Portal HTN
* Blood Malignancies
* HIV
* Splenic infarct
* Hematoma
* Mononucleosis
28
* How do you test for ascities
29
* How do you test for appendicitis
30
* How do you test for biliary colic
31
* How do you test for kidney inflammation/distension
32
* Signs of peritoneal inflammation/acute abdomen
* Guarding
* Voluntary contraction of abdominal wall
* When palpating abdomen, abdominal musculature guards underlying inflamed organs and becomes tense and contractred
* Rigidity
* Involuntary reflex contraction of abdominal wall
* Will see stiff, board like muscle contractions on inspection
* May not see abdomen move with respirations
* Can also be felt during palpation
* Rebound tenderness
* Occurs when you pish down deep into abdomen and let go quickly
33
* Process for developing and working thru DDX
* **Develop broad Dx**
* Based on CC, Sex, age, race
* Narrow Dx
* HPI, History, PE
* **Develop working Dx**
* Most common/likely diagnosis and life threats
* **Pursue working Dx**
* Therapeutic innerventions
* Confirmatory/Exclusionary diagnostic testing
* **Assessment and plan (final primary and secondary diagnosis)**
* Treatment
* Disposition
* Communication/Documentation
34
* What pneumonic can be used when helping develop a differential diagnosis?
* VINDICATE
* V=Vascular
* I=Infections/Inflammatory
* N=Neoplasm
* D=Drugs/Degenerative
* I=Iatrogenic/Idiopathic
* C=Congenital
* A=Autoimmune/Allergic/Anatomic
* T=Trauma
* E=Endocrine/Environment
Anatomic location of pain
Sex of patient
35
* Normal findings on an abdominal exam
* Flat
* Nondistended
* Normoactive bowel sounds throughout
* Tympanic throughout
* Soft
* No masses
* Nontender
* No hepatomegaly/splenomegaly/hepatosplenomegaly/organomegaly
* EX; Abd-Soft, NT/ND, BS+ x4, no HSM
36
* Abnormal findings on abdominal exam
* Distended
* Round
* Obese
* Scaphoid
* Hyperactive/hypoactive/diminished bowel sounds
* TTP (tenderness to palpation)
* Rebound
* Guarding
Rigid
* Palpable mass (would describe area located and size of mass)
* Special tests positive or negative
37
* GERD
* Typical Sx
* Atypical Sx
* Typical
* Heartburn-retrosternal sensation of burning or discomfort that usually occurs after eating, when lying supine, or bending over
* Regurgitation-return of gastric and/or esophageal contents into pharynx
* Dysphagia-30% GERD-sensation that food is stuck in retrosternal area
* Atypical
* Coughing/Wheezing
* Hoarsness, sore throat
* Otitis media
* Noncardiac chest pain
* Enamel erosion or other dental manifestation
38
* GERD Differential Dx
* Achalasia
* Acute/Chronic Gastritis
* Chronic Gastritis
* Coronary disease
* Esophageal cancer
* Esophageal spasm
* Esophagitis
* Cholelithiasis
* H.Pylori infection
* Hiatal hernia
* Intestinal malrotation
* IBS
* PUD
39
* GERD Lifestyle modification
* Losing weight
* Avoiding known triggers
* Avoiding large meals
* Avoid lying down until 3 hrs after meal
* Elevating head of the bed by 8 inches
40
* GERD medication therapies
* Antacids
* H2 receptor antagonists-famotidine,cimetidine, ranitidine, nizatadine
* PPis-omeprazole, lansoprazole, rabeprazole, esomeprazole
41
* Constipation
* Most common digestive complaint in US
* SYMPTOM NOT DISEASE
* Tools used to categorize
* ROME III
* Bristol Stool Scale
42
* ROME III Criteria for Constipation
* Must have at least 2 over preceding 3 months
* Fewer than 3 Bms/week
* Straining
* Lumpy or hard stools
* Sensation of incomplete defecation
* Manual maneuvering req to defecate
43
* Bristol Stool Scale
* 1-2: usually patients presenting with constipation
* 3-4: normal
* 7-Diarrhea (all liquid)
44
* What might constipation look like on an abdominal exam?
* Distension or masses (colonic stools or tumor)
* Abdominal wall hernias may interfere with generation of intraabdominal pressure req for initiation of defectation
45
* Pelvic exam for females (presenting with constipation)
* Palpate posterior vaginal wall at rest and while straining
* Checks for internal prolapse or rectocele
46
* What may be some exam findings for constipation on an anorectal exam
* Perianal excoriation
* Skin tags/Hemorrhoids
* ANal fissure
* Prolapse during straining
* Anorectal masses
* Tone of internal anal sphincter
* Presence of gross blood or occult bleeding
* Presence of fecal impaction
47
* Positioning for performing a rectal exam
48
* Skin tags v external hemorrhoids
49
* Nonspecific term, primary manifestation is diarrhea, but nausea vomiting and abdominal pain can accompany
* What most people consider the stomach flu
* Gastroenteritis
50
Etiology of Gastroenteritis
* Infectious agents are usual cause
* Viral (50-70%)
* Norovirus or rotavirus
* Bacterial (15-20%)
* Salmonella
* C Diff
* E COli
* Parasitic (10-15%)
* Giardia
* Food-borne toxigenic
* Drug-associated
* Antibiotics
* Laxatives
* Colchicin
* Quinidine
* Sorbitol
* PPis
51
* Most common viral causes of gastroenteritis
52
* Most common causes of bacterial gastroenteritis
53
* Most common cause of parasitic gastroenteritis
54
* IBS: Functional GI Disorder
* Manifestations
* Common
* Manifestations:
* Altered bowel habits
* Abdominal pain, bloating, distension
* Common
* Postprandial urgency
* Alternating between constipation and diarrhea, with one dominating per individual patient
* Intractability to laxatives
* Defecation improves abdominal pain but does not relieve it
55
* Associated symptoms with diarrhea
* Nausea
* Vomiting
* Abdominal Cramping
* Abdominal Bloating
* Fever
56
* Questions to ask patient presenting with diarrhea
* Stools
* Frequency
* Amount
* Color
* Consistency
* Historical clues
* Travel
* Changes in meds
* Recent hiking/camping
Large volumes of stool-enteric infection
Small stools-colonic infection
Blood-can indicate colonic ulceration
White/bulky-small bowel pathology (ie: malabsorption)
Copious rice water diarrhea=hallmark for cholera
