The abdominal exam Flashcards
(32 cards)
What are the three types of Abdominal Pain
- Visceral Pain (more general and broad)
- Parietal Pain (localized and sharp)
- Referred pain
what is visceral pain
- Caused by stimulation of the visceral pain fibers
- Secondary to distention, stretching or contracting of hollow organs, stretching the capsule of solid organs or organ ischemia
-Not localized
what is Parietal pain
- Caused by stimulation of the somatic pain fibers
- Secondary to inflammation in the parietal peritoneum
- usually constant and more severe than visceral pain
- localized
- aggravated by movement or coughing
- alleviated by remaining still
what is referred pain
originates within the abdomen but is felt at distant sites which are innervated at approximately the same spinal levels as the disordered structure
i.e: duodenal and pacreatic pain referred to back
Bilary tree refrerred to right shoulder
What are the biggest take aways that the HPI must get?
Location!
and aggravating and alleviating factors
what are some medicines that are important to note when getting a medication history for abdominal pain
- GI prescriptions (H2 blockers, proton pump inhibitors, dicyclomine)
- OTC meds (tylenol, asprin/ibuprofun, antacids, laxatives)
- blood thinners
- NSAIDS
- Narcotics (can cause constipation)
- steroids
what are the 4 quadrants and what are some organs found in each one
Right upper quadrant: (RUQ)
-liver, gallbladder, stomach, SB, LB
Right lower quadrant (RLQ)
-appendix, ovary, SB, LB
Left lower quadrant (LLQ)
-Colon, ovary, SB, LB
Left upper quadrant (LUQ)
-stomach, spleen, SB, LB
Epigastric area:
-Pancreas, liver, gallbladder, stomach, SB, LB
what are the normal bowel sounds and what does it mean if it is absent, decreased, or increased
Normal bowel sounds: 5-34 clicks/gurgles per minute
absent bowel sounds: none for more than 2 minutes
-long lasting intestinal obstruction, intestinal perforation, mesenteric ischemia
Decreased bowel sounds: none for 1 minute
-Post surgical ileus, peritonitis
Increased bowel sounds
-Diarrhea, early bowel obstruction
WHen listening for bruits what do we use?
Bell of the stethoscope
Other abnormal bowel sounds: High pitched bowel sounds
sounds like tinkling (raindrops on metal)
-suggests early intestinal obstruction
Other abnormal bowel sounds: Bruits
Vascular sounds resembling a heart murmur, over the aorta or other abdominal arteries (renal, iliac, femoral arteries)
-vascular obstruction
Other abnormal bowel sounds: Friction rub
grating sounds with respiratory variation
- inflammation of the peritoneal surface of an organ
- listen over liver and spleen
Other abnormal bowel sounds: Venous hum
soft humming noise
- increased collateral circulation between protal and systemic venous systems
- listen over epigastric and umbilical regions
when percussing for tympany and dullness what are the 4 different sounds you can hear
Tympany: high pitched, air filled
Dullness: non resonating, solid organs or masses
REsonance: hollow abdominal organs (lungs)
Hyper resonance: airfilled hollowed organ (pneumothorax)
tympany predominates in the abdomine
what is the order you should palpate the abdomen
start away from the tender most area
- first light palpate
- then deep palpation
when is the spleen palpable?
normally not palpable unless enlarged
- when spleen enlarges, it expands anteriorly, downward, and medially
- percussion and palpation help asses splenomegaly
How to percuss the liver?
Right mid clavicular line and start in RLQ (area of tympany) workup until get to an area of dullness which is the inferior border
Start in right midclavicular line, start in RUQ (area of lung resonance) and percuss downward until dullness to find superior border
What does it mean if there is a vertical span that is increased or decreased and what is the normal span
Normal span: 6-12 cm
increased: with enlarged liver
- cirrhosis, lymphoma, hepatitis, right sided heart failure, amyloidosis, hemachromatosis
- right pleural effusion (falsely increased)
Decreased: shrunken liver
-cirrhosis
how should a normal liver feel and what does it mean if it is irregular or hard
Normal liver: slightly tender, soft, smooth surface
Irregular edge: hepatocellular carcinoma
firmness/hardness: cirrhosis, hematochromatosis, amyloidosis, lymphoma
how to percuss for spleen and when to know it is splenomegaly?
starting from border of cardiac border of left anterior axillary line, percuss laterally
- if tympany is prominent laterally in midaxillary line, splenomegaly not likely
- if dullness at midaxillary line = splenomegaly
How to liver palpate?
Left hand behind patient supporting the right 11th and 12th ribs
- push left hand upward, towards patients anterior
- right hand on patients right abdomen
- ask patient to take a breath
- feel the liver edge as it comes down to meet your right hand
how to spleen palpate, and what are some causes of splenomegaly
- with left hand, reach over the patient and grasp the posterior aspect of LUQ
- With right hand below left costal margin, press posteriorly to take deep breath in
- try to feel edge as it comes down to meet your left hand
- normally only 5 percent of spleens are palpatable in adults
- Splenomegaly: portal hypertension, blood malignancies, HIV, splenic infarct, hematoma, mononucleosis
Shifting dullness test
Test for ascites
- Percuss the borders of tympany and dullness with patient supine
- then have patient lay on side and percuss borders again
- normal = borders stay the same
- ascites/positive test = dullness shifts to dependant side and tympany to top side
Test for a fluid wave
- ask the patient to rest his or her hands over chest
- have an assistant place the ulnar aspects of hands midline then tap one flank sharply with finger tips
- Normal = no impulse felt on the other flank
- Ascites/positive test = impulse transmitted to the other flank
