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Location of organs? Liver, spleen, gallbladder, stomach, duodenum, pancreas, kidneys?
- Liver - RUQ - from 7-11 rib - reaches left side at 6th rib
- Spleen -LLQ - at level of 9, 10, 11th rib - posterior of mid axillary
- Gallbladder - behind liver
- stomach, duodenum and pancreas - upper quadrant, cannot be palpated.
- kidneys - upper portions protected by the ribs
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Where do we assess for kidney tenderness?
the costosternal angle - angle formed by lower border of the 12th rib and the transverse of the upper lumbar vertebrae
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Difference between visceral pain, parietal pain, and refered pain? ( all abdominal pain)
Visceral pain: usually can be palpated in the midline, occurs with hollow abdominal organs ( tube like organs, biliary tree, intestines, etc) - either while they contract forcefully or stretched --> can be seen with alcoholic hepatitis ( pain at liver, RUQ)
Parietal pain --> comes from inflammation. Steady aching pain, that is more localized in the affected area. Aggravated by mvt or coughing - pt prefer to lie still
Referred pain: felt in more distant sites - well localized
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What is the difference between kidney pain and ureteral pain?
- Kidney pain: flank pain, below the costal margin near the costovertebral angle - may radiate towards the umbilicus
- Kidney pain =- visceral pain bc it is caused by distention of the renal capsule, it dull, aching, and steady
Uretheral pain: severe, colicky, starting at the costovertebral angle and radiating at the level of the trunk in the LQ of abdo., possibly into upper thigh and testicle or labium.
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Order of the abdominal exam?
- Inspection
- Auscultation
- Percussion
- Palpation
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Pink purple striae are a sign of?
Cushing's syndrome
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Define borborygmi?
long prolonged gurgles of hyperperistalisis - stomach growling
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What does hearing a bruit in the epigastrium area ( each quadrant) suggest?
renal artery stenosis - as the cause of hypertension
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What does a friction rub over the liver or the spleen indicate?
- liver tumor
- gonococcal infection around the liver
- splenic infarction
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Which sound predominates in the GI tract?
Tympany - if abdomen in protrubent with tympanic sound = intestinal obstruction
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What does an area of dullness suggest?
- fluid or feces filled
- can also be organs such as liver, heart or spleen.
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Signs of peritoneal inflammation
- abdo pain and tenderness esp associated w/ muscle spasm.
- abdominal pain on coughing or light percussion with pain
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How is rebound tenderness tested for and what does it assess?
- 1- press and let go quickily, ask pt which one hurts more ( pressing or letting go?)
- 2- suggest peritoneal inflammation - appendicitis.
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Normal liver span measures? ( midsternal line and right midclavicular line)
- midsternal line: 4-8 cm
- Right midclavicular line: 6-12 cm
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What does a normal spleen look like on exam ( location)?
- Normal spleen: ant axillary line, to mid axillary line
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With what conditions do you normally see splenomegaly?
- Mono
- portal HTN
- IVE
- Splenic infarts
- hematologic malignancies
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What does nilateral kidney enlargement suggests?
Which kidney can be palpated in a thin woman?
- Polycystic kidney disease
- R
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What does pain at CVA tenderness test suggest?
Pyelonephritis
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Define Cutaneous hyperesthesia - and what does it indicate?
- pain from picking up a fold of skin between your thumb and index finger without pinching
- Indicates peritoneal inflammation
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What is a positive Rovsing's sign?
- Pain in the RLQ with left sided pressure indicates appendicitis.
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Psoas sign?
- used to dx appendicitis
- raised right thigh against provider's hand resistance
- extend/ flexing the patient's right leg at the hip. - pain = appendicitis
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Obturator sign?
- Flex right thigh to hip with knee bent, and rotate leg internally and externally
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What is Murphy's sign and what does it indicate?
- Cholecystitis - gallbladder, liver inflammation
- pain when pt takes deep breath while PCP push
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Testing for ventral hernia?
- Raise both hands and shoulders off the table
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Cullen's sign?
- Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
- Sign first described in ruptured ectopic pregnancy
- sign takes 24-48 hours to appear and can predict acute pancreatitis, with mortality rising from 8-10% to 40%. It may be accompanied by Grey Turner's sign (bruising of the flank - sign of acute pancreatitis), which may then be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding
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Alcohol abuse screening
•Screening tools: CAGE & AUDIT
•Women: more than or equal to 3 drinks per occasion or 7 drinks per week
•Men: more than or equal to 4 drinks per occasion and 14 drinks per week
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