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PCM II Test 1 > abdominal exam lecture > Flashcards

abdominal exam lecture Flashcards

1
Q

RUQ contents

A

liver, gallbladder

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2
Q

RLQ contents

A

appendix, cecum, ovary

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3
Q

LLQ contents

A

sigmoid colon, ovary

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4
Q

LUQ contents

A

spleen

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5
Q

the epigastric region is often used to describe location of

A

stomach, pancreas, and part of liver

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6
Q

inspection of abdomen, looking for what

A

surface: skin color, scars, rash, ecchymoses
contour of the abdomen
-contour of the abdomen (flat, round, scaphoid, bulges)
-peristalsis
-arterial pulsations

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7
Q

cullen’s sign

A

ecchymoses around umbilicus

  • hemoperitoneium
  • acute pancreatitis
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8
Q

grey turner’s sign

A

ecchymoses of the flanks

  • hemoperitoneium
  • acute pancreatitis
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9
Q

jaundice, ascites, caput medusae is indicative of

A

portal hypertension

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10
Q

auscultation of abdomen use

A

diaphragm

except when listening for bruits, then use bell

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11
Q

normal bowel sounds

clicks/gurgles

A

5-34

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12
Q

if you have absent bowel sounds this can be indicative of what

A

none for >2

intestinal obstruction, intestinal perforation, mesenteric ischemia

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13
Q

decreased bowel sounds

A

post-surgical ileus, peritonitis

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14
Q

increased bowel sounds

A

diarrhea, early bowel obstruction

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15
Q

high pitched bowel sounds

A

early intestinal obstruction

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16
Q

bruits

A

vascular obstruction

renal a, iliac a, femoral a

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17
Q

friction rub sound
what is it
what does it indicate
where to listen

A

grating sounds with respiratory variation

  • inflammation of peritoneal surface of organ
  • listen over liver and spleen
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18
Q

venous hum

what is it, what does it mean, where to listen

A

soft humming noise

  • increased collateral circulation btwn portal and systemic venous systems
  • listen over epigastric and umnilical regions
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19
Q

percussion for what

A

size of liver and spleen

assess for tympany and dullness

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20
Q

tympany
dullness
resonance
hyper-resonance

A

tymp: high pitched, air filled
dullness: non resonating, solid organs or mases
- rosonance: hollow abdominal organs
- hyper res: air filled hollow organ (pneumothorax)

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21
Q

palpation

A

gently palpate then deeply palpate all 4 regions

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22
Q

what does periumbilical visceral pain indicate

A

acute appendicitis

pain from SI, or proximal colon

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23
Q

visceral pain

A

difficult to localize

can be palpable in the midline at level of structure involved

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24
Q

epigastric pain could be from

A

stomach, duod, pancreas

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25
suprapubic or sacral pain from
rectum
26
hypogastric pain from
colon, bladder, uterus
27
parietal pain
more severe than visceral pain and easier to localize
28
RUQ/epigastric parietal tenderness
acute cholecystitis
29
epigastric parietal tenderness
actue pancreatitis
30
RLQ parietal tenderness
later finding in acute appenicitis
31
LLQ parietal tenderness
actue diverticulitis
32
referred pain: duod and pancrease
referred to back
33
biliary tree referred pain
to right shoulder
34
is spleen normally palpable
no, unless enlarged
35
normal liver vertical span | where to check
6-12 cm, checking at midclavicular line on right
36
vertical span decreased by
cirrhosis, free air under diaphragm
37
irregular edge/nodules on liver palpation may be
hepatocellular carcinoma
38
firmness/hardness of palpated liver may be
cirrhosis, hematochromatosis, amyloidosid, lymphoma
39
what can cause splenomegaly
portal hypertension, blood malignancies, HIV, splenic infact, mono
40
test for ascites
shifting dullness test - percuss borders of tympany and dullness w/ patient supine - have patient lay on side and percuss borders again - normal = borders stay same - ascites/postive test if dullness shifts to dependent side and tympany to top side
41
another test for ascites
test for a fluid wave assistant places ulnar aspects of hands midline, tap one flank sharply with finger tips normal = no impulse other flnk -acites/postive test = impulse transmitted to other flank
42
(+) mcBurney's point
appendicites
43
rovsings sign
palpate deeply in LLQ and if pain felt RLQ then positive for appendicitis
44
psoas sign
dr places hand on thigh of pt and have them try to flex at hip, if abdominal pain then appendicits possible
45
obturator sign
flex patients right hip with knee bent, internally rotate hip -if right hypogastric pain then irritation of obturator muscle from inflamed appendix
46
murphy's sign test for
cholecystitis
47
signs of peritoneal inflammation
guarding rigidity rebound tenderness
48
test for pyelonephritis or renal stone
lloyds punch
49
test for abdominal wall mass vs intraabdominal mass
ask patient to raise head and shoulders when lying supine -palpate for mass again -abdominal wall mass remains palp intraabdominal mass, no longer palp
50
test for ventral hernia
when lying supine, ask patient to raise head and hsoulders off table -positive test = bulge of hernia will usually appear
51
depth of light vs mod vs deep palp
``` light = 1 cm mod = 2-3 cm deep = more than 3 cm ```
52
what is courvoisier's sign
enlarged, non tender gallbladder 2ndary to pancreatic disease or cancer
53
what rib level are you at on pts back when feeling for liver? spleen?
``` liver = 11 and 12 on right side spleen = 12 on left side ```
54
aorta palpation location and width
above umbilicus slightly left of midline 2-3 cm pulsation in anterior-inferior direction
55
sympathetic levels of esophagus
T2-T8
56
symp levels stomach
T5-T9
57
symp levels of liver
T6-T9
58
symp levels of GB
T6-T9
59
symp levels of SI
T9-T11
60
symp levels colon
T10-T12
61
symp levels of pancres
T5-T11
62
symp levels of appendix
T12
63
parasymp, vagus nerve
esophagus through transverse colon
64
parasymp S2-S4
descending colon, sigmoid, rectum
65
heel stirke
pt supine, doc strikes patient's heel | -pain upon striking could indicate appendicitis
66
percussion of spleen, span from what ribs
6 to 10
67
documentation of normal abdominal exam
Abd S/NT/ND/BS+ x 4, no R/G/R, HSM or CVAT abdomen is soft, nontender, nondistended, bowel sounds heard in all 4 quadrants, no rebound, guarding, rigidity, hepatosplenomegaly, or costovertebral angle tenderness

PCM II Test 1 (5 decks)

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