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Flashcards in midterm: abdominal exam Deck (13)
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1
Q

What kinds of findings are we looking for on inspection of the abdomen?

A

Skin markings: Scars, striae, dilated vessels.
Contour: Flatness. Distension, noting any of the “7 Fs”. Concavity. Symmetry.
Peristalsis: Increased with obstruction.
Pulsations: From vessels, abdominal aortic aneurysm (triple A).
Hernias: Most are umbilical.
Ecchymosis: Infiltration of the extraperitoneal tissues with blood.

2
Q

What are the 7 F’s for a distended abdomen?

the “7 Fs”:

A

fat, fluid, fetus, feces, flatus, fibroid, fatal growth.

3
Q

Why do we auscultate the abdomen before palpation?

A

So that we don’t falsely increase bowel sounds.

4
Q

Understand normal and abnormal bowel sounds.

A

High-pitched tinkling sounds: Early obstruction.
Absent sounds: Late mechanical obstruction or ileus (adynamic bowel).
Secussion splash: Air and fluid, obstruction, pyloric stenosis.
Peritoneal friction rub: Inflammation.
Borborygmus (long prolonged gurgles): Gastroenteritis.
Bruits over aorta and renal, iliac, and femoral arteries: Obstruction.

5
Q

Be able to perform abdominal percussion using exemplary technique.

A

Percuss all quadrants, listening for patterns of dullness and tympany. Unusual dullness may indicate an underlying abdominal mass. Percuss outline of liver, spleen, and stomach

6
Q

What is the expected liver span at the midclavicular line?

A

should be 6-12 cm in a normal adult

7
Q

What is the splenic percussion sign? Know how to perform it.

A

Percuss the lowest costal interspace in the left anterior axillary line. This area is normally tympanic.
Ask the patient to take a deep breath and percuss this area again. Dullness in this area is a sign of splenic enlargement.

8
Q

Why and how do we do light palpation? What can you do about ticklish patients?

A

Ticklish: use their own hand
Light: Note any guarding or tenderness, hyperesthesia, rigidity.Relax pt
Deep: note masses, guaridng. Palpate liver, spleen, kidneys
Measure the width of the aorta; the normal size is ~3 cm. A large pulsatile mass is suggestive of aortic aneurism.

9
Q

What is the significance of guarding and rigidity?

A

Pain, peritoneal inflammation. Acute process

10
Q

Which arteries are important to auscultate for bruits over the abdomen?

A

Aortic, renal, illiac

11
Q

What is Murphy’s Sign?

A

Gallbladder tenderness on inspiration when it is being palpated.

12
Q

What is rebound tenderness at McBurney’s Point? Referred rebound tenderness (Rovsing)?

A

Mcburney’s point : Between right illiac crest and umbilicus. Deep palpation and sudden release elicits pain= positive for appendicitis.
Rovsings= same as mcburneys but on the left side.

13
Q

Be able to demonstrate psoas sign, obturator sign, costovertebral angle (CVA) tenderness.

A

Psoas: have pt try to flex hip=pain? appendicitis
Obturator: passively internally rotate hip=pain? appendicitis
CVA tenderness with kidney palpation and percussion?=pyloneprhitis