Lab- Approach to Abdominal Complaint

Question 1

What are the four steps of the abdominal exam (in order)

Answer 1

inspection, auscultation, percussion, and palpation

Question 2

what is grey turner’s sign?

Answer 2

bruising on the flanks

Question 3

what is cullen’s sign and what is it indicative of?

Answer 3

bruising around the umbilicus; indicative of necrotizing pancreatitis with retro or intraperitoneal bleeding

Question 4

why should you auscultate before percussion and palpation?

Answer 4

maneuvers may alter characteristics of bowel sounds

Question 5

what could cause hypoactive bowel sounds?

Answer 5

constipation, ileus, medication side effect

Question 6

what could cause hyperactive bowel sounds?

Answer 6

infectious diarrhea, early stages of intestinal obstruction, bowel prep

Question 7

what are high pitched tinkling sounds caused by?

Answer 7

intestinal fluid and air under pressure- think intestinal obstruction

Question 8

what two types of sounds are you listening for when you percuss the abdomen?

Answer 8

tympanic and dull

Question 9

what is tympanic percussion and where would you expect to hear it?

Answer 9

it is a hollow noise with resonance; most of the abdomen due to the intestines

Question 10

what is dull percussion and where would you expect to hear it?

Answer 10

flat sound without resonance; over organs like the liver and spleen

Question 11

how do you percuss the inferior margin of the liver?

Answer 11

start at the RLQ and percuss up the midclavicular line until the tympany shifts to dullness (liver)

Question 12

how do you percuss the superior margin of the liver?

Answer 12

start at the nipple line and percuss down the midclavicular line until resonance (lung) is replaced by dullness (liver)

Question 13

what is the normal measurement of the liver?

Answer 13

6-12 cm at the midclavicular line and 4-8 cm at the midsternal line

Question 14

how do you percuss the spleen?

Answer 14

find the most inferior intercostal space at the anterior axillary line; should be tympanic at rest- have patient inhale while percussing- should remain tympanic

Question 15

what does dullness of the spleen indicate and what is this sign?

Answer 15

may indicate splenomegaly- Castell’s sign

Question 16

when might an area of dullness decrease?

Answer 16

when there is free air in the abdomen or with COPD

Question 17

when might an area of dullness increase?

Answer 17

when there is ascites fluid, pleural effusion, lung consolidation

Question 18

how do you palpate the liver?

Answer 18

left hand: supporting the 11th/12th rib (posteriorly); right hand: just below the costal margin at the midclavicular line

Question 19

where palpating the liver using the hooking technique, where should your fingertips be placed?

Answer 19

at the right costal margin

Question 20

how do you palpate the spleen?

Answer 20

right hand: below left costal margin (posteriorly); left hand: just below the costal margin at the midclavicular line to anterior axillary line; SHOULD NOT BE ABLE TO FEEL SPLEEN

Question 21

how do you palpate the kidney?

Answer 21

right hand: below, at the 11/12th rib; left hand: just below the costal margin at the LUQ

Question 22

how do you palpate the aorta?

Answer 22

above the umbilicus, midline or slightly left of midline

Question 23

what is the normal measurement of the aorta?

Answer 23

2-3 cm; anything greater than 3 cm is abnormal

Question 24

what causes visceral pain and what can be said about its localization?

Answer 24

caused by distention, stretching, or contraction of hollow organs; it does not localize

Question 25

what causes somatic pain, what aggravates it, and what can be said about its localization?

Answer 25

could be secondary to inflammation in the parietal peritoneum; aggravated by movement or coughing; localized pain

Question 26

what is rebound tenderness and what does it indicate?

Answer 26

pain upon removal of pressure; indicates peritoneal irritation

Question 27

what are the specialty tests used for appendicitis?

Answer 27

McBurney's point, Rovsing Sign, Psoas sign, Obturator test,

Question 28

what is McBurney's point?

Answer 28

rebound tenderness or pain at 1/3 the distance from the ASIS to the umbilicus

Question 29

what is Rovsing's sign?

Answer 29

pain in the RLQ upon palpation of the LLQ

Question 30

what is Psoas sign?

Answer 30

patient is in a lateral position with right side up; you extend the patient's right leg at the hip

Question 31

what is the obturator test?

Answer 31

patient is supine; you passively flex the right thigh at the hip with the knee bent; rotate leg internally

Question 32

what is the specialty test used for peritonitis?

Answer 32

heel strike

Question 33

what is the heel strike test?

Answer 33

patient is supine; you strike the patient's heel with your palm with enough force to jostle the patient

Question 34

what does a positive heel strike test indicate?

Answer 34

peritoneal irritation

Question 35

what is the specialty test used for ascites?

Answer 35

fluid wave test

Question 36

how do you preform the fluid wave test?

Answer 36

assistant places their hands midline; clinician taps one side of the abdomen and feels for an impulse at the other side

Question 37

what is the specialty test used for the gallbladder?

Answer 37

Murphy's sign

Question 38

what is murphy's sign?

Answer 38

clinician compresses at the RUQ, during inspiration direct compression under the costal margin; positive finding: pain or sudden stop of inspiration due to discomfort

Question 39

what is a positive murphy's sign indicative of?

Answer 39

cholecystitis or cholelithiasis

Question 40

what is the specialty test used for the kidneys?

Answer 40

Lloyd punch

Question 41

what is a positive lloyd punch indicative of?

Answer 41

pyelonephritis, perinephric abscess, nephrolithiasis, hydronephrosis

Question 42

what is a viscerosomatic reflex?

Answer 42

localized visceral stimuli producing patterns of reflex response in segmentally related somatic structure

Question 43

what does a viscerosomatic reflex involve?

Answer 43

compromise of the autonomic nervous system

Question 44

what are the sympathetics of the head/neck?

Answer 44

T1-T5

Question 45

what are the sympathetics of the heart?

Answer 45

t1-t6

Question 46

sympathetics of the lungs?

Answer 46

t1-t7

Question 47

sympathetics of the upper GI (includes lower esophagus)?

Answer 47

t5-t10

Question 48

sympathetics for the small intestine/ascending colon?

Answer 48

T9-t11

Question 49

sympathetics for the ascending and transverse colon?

Answer 49

t10-L2

Question 50

sympathetics for the descending and sigmoid colon/rectum?

Answer 50

t12-L2

Question 51

sympathetics for the adrenal glands?

Answer 51

t5-t10

Question 52

sympathetics for the GU tract including the bladder?

Answer 52

t10-L2

Question 53

sympathetics for the ureter (upper)?

Answer 53

t10-t11

Question 54

sympathetics for the ureter (lower)?

Answer 54

t12-L2

Question 55

sympathetics for the upper extremities?

Answer 55

t2-t7

Question 56

sympathetics for the lower extremities?

Answer 56

t11-L2

Question 57

parasympathetics for the upper GI, small intestine, ascending colon, transverse colon, kidneys, upper ureter?

Answer 57

Vagus n (OA and AA)

Question 58

parasympathetics for the descending and sigmoid colon/rectum, bladder, and lower ureter?

Answer 58

s2-s4 (sacrum)

Question 59

what is sympathetic inhibition?

Answer 59

treatment geared toward reducing inappropriate sympathetic tone

Question 60

what are some techniques for sympathetic inhibition?

Answer 60

rib raising (supine), rib raising (seated), and paravertebral muscles

Question 61

what is sympathetic inhibition: paravertebral muscles good for?

Answer 61

thoracic and lumbar spine hypertonic paravertebral muscles associated with abdominal complaint or post-surgical patients

Question 62

how do you treats overactive parasympathetics?

Answer 62

suboccipital release or sacral rocking

Question 63

during sacral rocking, when the patient inhales deeply, what does the physician allow the sacrum to do?

Answer 63

to extend during inhalation

Question 64

during sacral rocking, when the patient exhales, what does the physician allow the sacrum to do?

Answer 64

to flex during exhalation

Question 65

what are chapman reflex points?

Answer 65

a group of palpable points that are reflections of visceral dysfunction or disease

Question 66

what are chapman reflex points diagnosis based off of?

Answer 66

location, palpation, and patient's feedback to pain

Question 67

where are the anterior chapman points for the esophagus?

Answer 67

between rib 2 and 3 parasternally

Question 68

where are the anterior chapman points for stomach?

Answer 68

left-between rib 5-6 and 6-7 at the costochondral junction

Question 69

where are the anterior chapman points for liver?

Answer 69

right- between rib 5-6 and 6-7 at the costochondral junction

Question 70

where are the anterior chapman points for gallbladder?

Answer 70

right, between rib 6-7 at the costochondral junction

Question 71

where are the anterior chapman points for pancreas?

Answer 71

right- between ribs 7-8 at the costochondral junction

Question 72

where are the anterior chapman points for the small intestines?

Answer 72

between ribs 8-11 bilaterally at the costochondral junction

Question 73

where are the posterior chapman points for the esophagus?

Answer 73

lateral to T2 spinous process

Question 74

where are the posterior chapman points for the stomach?

Answer 74

left- lateral to T5 and T6 spinous process

Question 75

where are the posterior chapman points for the liver?

Answer 75

right- lateral to T5 and T6 spinous process

Question 76

where are the posterior chapman points for the gallbladder?

Answer 76

right-lateral to T6

Question 77

where are the posterior chapman points for the pancreas?

Answer 77

right- lateral to spinous process of T7

Question 78

where are the posterior chapman points for the small intestines?

Answer 78

lateral to spinous processes of T8, 9, and 10

Question 79

where are the anterior chapman points for the appendix?

Answer 79

tip of the 12th rib

Question 80

where are the anterior chapman points for the intestinal peristalsis?

Answer 80

lateral to AIIS bilaterally

Question 81

where are the anterior chapman points for the colon?

Answer 81

anterior IT band

Question 82

where are the anterior chapman points for the cecum?

Answer 82

at the right greater trochanter

Question 83

where are the anterior chapman points for the hepatic flexure?

Answer 83

just above the right knee

Question 84

where are the posterior chapman points for the appendix?

Answer 84

transverse process of t12

Question 85

where are the posterior chapman points for the rectum?

Answer 85

posterior-lateral sacrum 1/2 way between sacral sulcus and ILA

Question 86

where are the posterior chapman points for the large intestines?

Answer 86

transverse processes of L2, 3, and 4

Question 87

where are the anterior chapman points for the kidneys?

Answer 87

about 1 inch lateral and 1 inch superior to the umbilicus

Question 88

where are the anterior chapman points for the ureters?

Answer 88

there are none

Question 89

where are the anterior chapman points for the bladder?

Answer 89

the umbilicus

Question 90

where are the anterior chapman points for the urethra?

Answer 90

superior surface of pubic bone relative positions

Question 91

where are the posterior chapman points for the kidneys?

Answer 91

lateral to the spinous process of L1

Question 92

where are the posterior chapman points for the bladder?

Answer 92

transverse process of L2

Question 93

where are the posterior chapman points for the urethra?

Answer 93

transverse process of L3