L6 Abdominal Exam

Question 1

What is the order of examination?

Answer 1

Inspection, auscultation, percussion and palpation

Question 2

What is the main concern when a patient has a hernia?

Answer 2

Incarcerations or strangulations

Question 3

Umbilical hernia

Answer 3

Herniation of abdominal contents through a defective umbilical ring
Spontaneously resolves between 1-2

Question 4

Incisional hernia

Answer 4

Herniation of abdominal contents through a previous incision site

Question 5

Diastasis recti

Answer 5

Laxity of the linea alba that leads to separation of the rectus abdominis muscles and the abdominal contents form a midline ridge

Question 6

When is diastasis recti most obvious?

Answer 6

When the patient flexes the neck by “lifting their head up”

Question 7

Ascites

Answer 7

Accumulation of fluid in the peritoneal cavity, usually secondary to cirrhosis
See bulging flanks

Question 8

Peristalsis

Answer 8

Visible waves of movement seen beneath the skin

Question 9

When do you see peristaltic waves?

Answer 9

Intestinal obstruction (seen in thin people)

Question 10

When do you see increased pulsation?

Answer 10

Abdominal aortic aneurysm

Question 11

What skin markings do you look for?

Answer 11

Color, rashes/lesions, scars, striae, dilated veins

Question 12

When can ecchymosis be seen?

Answer 12

Intraperitoneal or retroperitoneal hemorrhage

Question 13

When are pink-purple striae seen?

Answer 13

Cushings

Question 14

What do prominent veins suggest?

Answer 14

Portal hypertension from cirrhosis

Question 15

Caput medusa

Answer 15

When portal hypertension promotes collateral venous circulation radiating from the umbilicus to the abdominal wall

Question 16

Abnormal auscultation sounds

Answer 16

High-pitched tinkling, hyperactive or hypoactive

Question 17

Normal auscultation sounds

Answer 17

Clicks, gurgles, borboygmi

Question 18

Borborygmi

Answer 18

Prolonged gurgles of hyperperistalsis, “stomach growling”

Question 19

What is associated with high-pitched tinkling bowel sounds?

Answer 19

Intestinal obstruction interrupting the normal flow of contents
The sound is from intestinal fluid and air under tension in a dilated bowel

Question 20

What are reasons for hyperactive bowel sounds?

Answer 20

Diarrhea (gastroenteritis) or early peritonitis

Question 21

What are reasons for hypoactive bowel sounds?

Answer 21

Ileus (little to no bowel activity), peritonitis (may be hyperactive at first but lessens due to progressively severe inflammation and my progress to ileus)

Question 22

What does percussing tympani suggest?

Answer 22

This predominates because of gas in the GI tract

Question 23

What does percussing dullness suggest?

Answer 23

Underlying mass, enlarged organs or scattered areas of fluid/feces

Question 24

Distended abdomen that is tympanic throughout

Answer 24

Intestinal obstruction or paralytic ileus

Question 25

Protuberant abdomen with bulging flanks and dullness

Answer 25

Evaluate for ascites (free fluid sinks to dependent part of abdominal cavity where gas-filled loops of bowel float to the top)

Question 26

Where do you measure the vertical span of the liver?

Answer 26

Midclavicular line (6-12 cm)

Question 27

What happens when the spleen enlarges?

Answer 27

It expands anteriorly, downward and medially

Question 28

When can fullness be percussed in the bladder?

Answer 28

Over 400-600 mL

Question 29

When is the bladder tender?

Answer 29

Cystitis (UTI)

Question 30

When is the bladder distended?

Answer 30

Urethral stricture, prostatic hyperplasia, neurogenic bladder

Question 31

What is the purpose of light palpation?

Answer 31

Elicits abdominal tenderness, assesses for muscular resistance and identifies superficial masses and organs

Question 32

What is guarding?

Answer 32

Voluntary contraction of the abdominal wall muscles with palpation (can diminish when patient is distracted) If present, then it's a peritoneal sign

Question 33

What is rigidity/stiffness?

Answer 33

Involuntary reflex contraction of the abdominal wall muscles and persists If present, it is a peritoneal sign

Question 34

What is the purpose of deep palpation?

Answer 34

Delineate pain, identifies masses and organs, inspiration moves liver and spleen inferiorly

Question 35

Reasons for abdominal masses seen on deep palpation

Answer 35

``` Physiologic: pregnant uterus Inflammatory: diverticulitis Vascular: aortic aneurysm Neoplastic: colon cancer Obstructive: distended bladder or dilated loop of bowel ```

Question 36

Acute cholecystitis

Answer 36

Inflammation of the gallbladder RUQ pain that may radiate to right scapular area + Murphy's sign

Question 37

Acute pancreatitis

Answer 37

Acute inflammation of the pancreas | Epigastric pain that may radiate to the back

Question 38

Acute appendicitis

Answer 38

Acute inflammation of the appendix Pain classically begins near umbilicus then migrates to RLQ + Psoas, obturator or Rovsing's sign

Question 39

Acute diverticulitis

Answer 39

Acute inflammation of a colonic diverticulum (sac like mucosal outpouching) LLQ pain Seen more commonly in sigmoid colon

Question 40

Acute pyelonephritis

Answer 40

Infectious inflammatory process involving kidney | + costovertebral angle tenderness (CVAT)

Question 41

Nephrolithiasis

Answer 41

Stones that may lodge throughout urinary tract | Acute, severe, colicky flank pain that radiates down to groin

Question 42

What makes you suspicious for liver disease?

Answer 42

Firmness or hardness of liver, bluntness or rounding of its edge and surface irregularity

Question 43

Reasons for kidney enlargement

Answer 43

Hydronephrosis, cysts/tumors, polycystic kidney disease

Question 44

When do you suspect aortic aneurysm?

Answer 44

Diameter over 3 cm

Question 45

What does positive rebound tenderness indicate?

Answer 45

Appendicitis or peritoneal sign (intraperitoneal infection or friction)

Question 46

What is Rovsing's Sign?

Answer 46

Press in LLQ and pain in RLQ is positive sign

Question 47

What are the peritoneal signs?

Answer 47

Guarding, rigidity and rebound tenderness