Exam of Abdomen Flashcards
(33 cards)
dysphagia
difficulty swallowing
hematemesis
throwing up blood
melena
dark stool
visceral pain
colic pain- source of usually hollow organ caused by distension or stretching. comes and goes, crescendo pattern. not well localized (ANS)
ex. cholic = gas in babies
parietal pain
caused by inflammation of peritoneum. steady aching pain that is usually well localized
referred pain
pain from a distant sight right shoulder = gallbladder left shoulder = spleen back = pancreas or aorta lateral side = kidney pain loin to groin = ureteral pain
examination of abdomen
1- inspection 2- auscultation 3- percussion 4- palpation rectal examination (no abdominal exam is complete without this!) special techniques
most important thing to exposing abdomen
must go from xiphoid to pubis symphysis
caput medusa
varicosities around the umbilicus
three anastamoses
rectal varicies (hemorroids) esophageal varicies umbilical varicies
abdominal striae
stretch marks
auscultation
all 4 quadrants
- RLQ is best place to hear: transition of cecum
- bowel sounds tell us that peristalsis is occurring (every 3-5 seconds)
- no bowel sounds = ileus
ileus
no bowel sounds, most commonly due to post-abdominal surgery
borborygmi
Increased, hyperactive bowel sounds,
Low pitched rumbling
Hyperperistalsis
“stomach growling”
abdominal bruits
A soft sound made by disrupted arterial flow through a narrowed artery.
– turbulent arterial flow causing a soft “hissing sound”
- Aortic – between the umbilicus and xiphoid (bifurcation occurs at the umbilicus of iliac)
- Renal artery – just lateral to the aorta
- Femoral artery – along the inguinal ligament
percussion
should get tympanic sound: presence of gas in stomach and small bowels --> can do this at MCL resonant = lungs dull = liver tympany = stomach/small bowels
liver is normally < 10 cm
fluid wave
–> way to test for ascites
tap on one side, a wave will move across to the other side
Place patient’s or assistant’s hand in midline. Tap on one flank and palpate with the other
hand. An easily palpable impulse
suggests ascites.
shifting dulness
–> way to test for ascites
if patient is laying on back, dullness will be percussed at the fluid level, the fluid will shift from supine position to when patient is laying on their side
- tympany will be palpated where the organs lie
palpation of abdomen
- Light palpation (work towards point of tenderness, using one hand)
- Deep palpation (use one hand on top of other, top hand is the pushing hand, bottom hand is palpating hand)
- Liver palpation (right hand in the RUQ, place one hand under right 11th/12th rib, instruct patient to breath deeply, can feel liver on inhalation)
- Spleen palpation (place left hand under the 11th/12th ribs, place right hand in the LUQ under the costal margin- not normally palpable)
- Kidney palpation (sandwich method above and below the costal margins- not normally palpable)
- Rebound palpation
rebound tenderness
- start away from point of tenderness
- indicated peritoneal tenderness, irritation and inflammation: “peritonitis”
- if it is painful on the rebound “+ rebound tenderness”
Rovsing’s sign
- referred rebound tenderness
- press on the LLQ and release, positive if pain in the RLQ
- indicates appendicitis
aorta palpation
- press firmly in upper abdomen
palpate for aortic aneurysm - dilation of the aorta, can be asscoiated with a bruit - need to listen first!
CVA tenderness
percussion of kidneys - costovertebral angle tenderness indicate Lloyd’s sign
positions of DRE
patient on back: modified lithotomy
**lying on left side : Sim’s position (female)
**standing: bend over the exam table (male- easier access to prostate gland)
DRE: inspection, palpation
