Chapter 11 The Abdomen

Question 1

Gastritis/GERD

Answer 1

Often occurs with epigastric pain

Question 2

Cholecystitis

Answer 2

Pain in RUQ

Question 3

IBS (irritable bowel syndrome)

Answer 3

Bloating

Question 4

Aerophagia

Answer 4

Belching from swallowing air

Question 5

GERD

Answer 5

primarily sx of heartburn, reflux, regurgitation; aggravated by alcohol, chocolate, onions, coffee, citrus fruits. Some “alarm sx” include dysphagia and odyophagia, vomiting, weight loss, anemia

Question 6

Renal stone

Answer 6

cramping pain radiating to RLQ or LLQ

Question 7

Caput Medusa

Answer 7

Appearance of distended and engorged umbilical veins which are seen radiating from the umbilicus across the abdomen to join systemic veins. Typically associated with cirrhosis and advanced stages of liver disease.

Question 8

Incisional Hernias

Answer 8

Protrusion through an operative scar.

Question 9

Umbilical Hernias

Answer 9

Protrusion through a defective umbilical ring

Question 10

Direct Inguinal Hernia

Answer 10

directly penetrates the inguinal triangle and creates a bulge superior and medial to the inguinal ligament

Question 11

Indirect Inguinal Hernia

Answer 11

passes through the inguinal canal and creates a bulge over the inguinal ligament as it passes through the inguinal ring. In men it often herniates into the scrotum

Question 12

Diffuse Abdominal distension

Answer 12

6Fs: Fat (obesity), Fluid (ascites or obstructed viscera filled with fluid), Flatus (air), Feces (constipation), Fetus (pregnancy), Fatal cancer

Question 13

Distension of lower abdomen

Answer 13

usually caused by pregnancy, full bladder, ovarian tumor, or uterine fibroids (common benign growths)

Question 14

Visible peristalsis

Answer 14

usually abnormal, unless the patient is emaciated. Otherwise, it is a sign of intestinal obstruction.

Question 15

Borborygmi

Answer 15

loud easily audible sound transmitted across the abdomen so it is not necessary to listen at multiple places, commonly called “growling.

Question 16

Early intestinal obstruction

Answer 16

High pitched , tinkling (raindrops in a barrel) sounds

Question 17

Dull areas of percussion

Answer 17

large liver or spleen, distended bladder, pregnant uterus, ovarian tumor

Question 18

Decreased gut sounds (~1min)

Answer 18

can be markedly decreased after abdominal surgery; abdominal infection or injury

Question 19

Absent gut sounds (~5 min)

Answer 19

Can be caused from perforation, infection, infarction, or ischemia

Question 20

Aortic bruits

Answer 20

Heard in epigastrium; may be a sign of AAA.

Question 21

Renal artery bruits

Answer 21

R& L upper quadrants; may be a sign of renal artery stenosis (tx cause of hypertension)

Question 22

Illiac/femoral bruits

Answer 22

R & L lower quadrants; may be a sign of peripheral atherosclerosis

Question 23

Friction rubs

Answer 23

scratchy sounds that may indicate possible splenic infarction or hepatic infarction, tumor, or abscess.

Question 24

Tympany

Answer 24

hollow sounds; normally present over most of the abdomen in the supine position, caused from bowel gas

Question 25

Enlarged liver

Answer 25

Midclavicular percussion >12 cm (normal 6-12 cm)

Question 26

Small liver

Answer 26

Mid-sternal percussion <4cm (normal 4-8 cm); can cirrhosis, end stage liver disease

Question 27

Rebound tenderness

Answer 27

peritoneal inflammation

Question 28

Tenderness of liver

Answer 28

suggests inflammation as in hepatitis

Question 29

Splenomegaly

Answer 29

if percussion dullness is present

Question 30

Ascites

Answer 30

protuberant abdomen with bulging flanks; from diseases such as cirrhosis and cancer

Question 31

Areas of dullness (ascites)

Answer 31

located on lateral side of abdomen

Question 32

Areas of tympany (ascites)

Answer 32

anterior portion of abdomen

Question 33

Positive splenic percussion sign

Answer 33

change in percussion note from tympany to dullness on inspiration that suggests splenomegaly.

Question 34

Kidney enlargement

Answer 34

hydronephrosis, cyts, and tumors

Question 35

Test for shifting dullness (ascites)

Answer 35

Have the patient roll to one side. In ascites there should be a shift due to free fluid moving with gravity.

Question 36

Voluntary guarding

Answer 36

patient consciously flinches when you touch them

Question 37

Involuntary guarding

Answer 37

muscles spasm when you touch them but the patient cannot control the reaction which is a sign of inflammation or tenderness

Question 38

Techniques to asses voluntary guarding

Answer 38

Have the patient breathe out deeply, Have the patient mouth breathe with the jaw dropped open

Question 39

Rigidity

Answer 39

a constant board-like spasm which is a sign of perforation, peritonitis, or bowel infarction

Question 40

Reducible hernia palpation

Answer 40

when the contents of the hernia can be easily displaced

Question 41

Irreducible or incarceratedm hernia palpation

Answer 41

when the contents cannot be displaced and are stuck

Question 42

Strangulated hernia palpation

Answer 42

an incarcerated hernia that has cut off its blood supply, resulting in tissue necrosis and gangrene.

Question 43

Acute Appendicitis: PE signs

Answer 43

RLQ pain (or pain that migrates from periumbilical region) that leades to positive rebound tenderness, Rovsing's sign, Psoa's sign, Obturator sign

Question 44

McBurney's Point

Answer 44

In appendicitis, tenderness over right side of abdomen that is one third the distance from the anterior superior iliac spine to the umbilicus

Question 45

Rovsing's Sign

Answer 45

Similiar to rebound tenderness but putting pressure on opposite side of LLQ. In the case of appendicitis, the pain is felt in the right lower quadrant despite pressure being placed elsewhere.

Question 46

Psoa's sign

Answer 46

Pain is elicited on hip extension of right thigh (pt lying on left side). If appendix is inflamed and in contact with the psoas muscle, which when stretched will cause pain

Question 47

Obturator sign

Answer 47

Pain on internal rotation of flexed thigh. Inflamed appendix is in contact with the obturator internus muscle, which is stretched in this maneuver.

Question 48

Cholecystitis: PE findings

Answer 48

localized or diffuse RUQ pain that may radiate right to scapula, positive murphy's sign

Question 49

Positive Murphy's Sign

Answer 49

When deep palpation toward the liver at the right costal margin causes severe pain, and possible a palpable mass from an enlarge gallbladder may be noted

Question 50

Pancreatitis: PE findings

Answer 50

severe abdominal pain in LUQ and may radiate to left upper back

Question 51

Grey turner's sign

Answer 51

Ecchymoses on the abdomen noted most often in left flank that occurs with acute hemorrhagic pancreatitis

Question 52

Diverticulitis: PE findings

Answer 52

Sx can feel like appendicitis; LLQ pain with a palpable mass, pain is severe and comes on suddenly

Question 53

to assess in periumbilical area

Answer 53

any mlasses of distended loops of bowl, hepatomegaly, splenomegalo, enlarged kidneys, enlarged gallbladder, pulsatile mass in midline indicating an aortic aneurysm, femoral pulses and inguinal nodes

Question 54

Hepatitis

Answer 54

Cirrhosis of the liver (decrease in size)