Abdominal Exam

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Author:
Aulockhart
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200264
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Abdominal Exam
Updated:
2013-02-13 08:43:10
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Abdominal
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Abdominal
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  1. Blumberg’s sign
    Rebound tenderness - Pain upon removal of pressure to the abdomen.

    Peritonitis
  2. Test for appendicitis
    • Psoas Sign - by resistance of knee flexion
    • Obturator Sign - Raise right leg, internally rotate.
    • Rovsing's sign - LLQ pressure LRQ referred pain.
  3. Pushing on abdomen in LLQ elicits pain on both left and right side or just left.
    bladder, uterus, descending (left) colon, fallopian tubes, ovaries, or other structures. 
  4. Peritonitis
    • Cough sign 
    • Blumberg's sign

    absent bowel sounds
  5. Bulging flanks
    DX: Fluid wave test, Shifting dullness 

    Checking for ascites
  6. When checking for ascites using Shifting dullness. The following can cause what complication?
    – Mesenteric fat
    – Feces in bowel
    – < 500cc of fluid
    False positive.
  7. Burning or gnawing pain,
    epigastric, may radiate to the back.
    • Precipitated by long periods of no food or skipping meals.
    • Often feel pain early in morning, which is relieved by intake of food
    or antacids.
    Peptic Ulcer Disease (PUD)

    – Chronicity, Rhythmicity, Periodicity
  8. Burning, epigastric or xiphisternal. Radiates to the retrosternum.
    • Precipitated by over-eating, bending over, or being in a reclined
    position.
    GastroEsophageal Regurgitation Disorder (GERD):
  9. Cannot get comfortable
    • ~Kidney pain
    • Bowel obstruction
  10. Cannot move due to ab pain.
    • Peritoneal pain 
    • Perforated bowel
  11. radiates to the groin.
    Renal Colic
  12. radiates to back, scapula, or right shoulder.
    Gallbladder pain
  13. radiates to back.
    • Splenic pain
    • Pancreatic pain
  14. LOCALIZING PAIN to INTRAABDOMINAL SITES
    INVOLUNTARY GUARDING AND MUSCLE RIGIDITY:
    • – Perforated ulcer
    • – Perforated bowel - doesn't want to move
    • – Peritonitis
  15. Diabetic Ketoacidosis and other metabolic disorders can simulate an acute abdomen?
    True
  16. Paroxysms sharp colicky RUQ pain, radiating to back, right mid-abdomen.
    Intolerance to greasy foods may be found.
    Ultrasound is usually diagnostic.
    CHOLELITHIASIS and BILIARY COLIC
  17. Often accompanied by nausea, emesis, and early satiety. Pain is worsened by eating.
    DELAYED GASTRIC EMPTYING
  18. Chronic abdominal pain
    – Caused by alcoholism
    – May be exacerbated by eating
    CHRONIC PANCREATITIS:
  19. Chronic abdominal pain
    – Weight loss, abdominal pain, anorexia, weakness / fatigue, diarrhea common
    – Pain is variable in quality, and often ameliorated by sitting in knee-chest position
    PANCREATIC CARCINOMA

    Do ETOH
  20. – Bloating and cramps; flatus and diarrhea
    LACTASE DEFICIENCY
  21. – Defecation relieves the pain.
    IBD
  22.  If tightening of abdominal wall relieved symptoms or were done as a guarding action, then that would be visceral pain.
    • Causes: Herpes Zoster, Hernias,Neuromas.
  23. ANOREXIA
    • Differential diagnosis:
    • – Neoplasms
    • – Chronic Renal Failure
    • – Psychiatric: Anorexia nervosa, depression
    • – Infections: Hepatitis, chronic infections.
  24. Seen in hyperthyroidism,
    malabsorption syndromes, especially
    pancreatic insufficiency
    Polyphagia:
  25. Delayed Gastric emptying possible causes.
    • Pyloric Outlet Obstruction: Ulcers, pyloric stenosis, Crohn's Disease, neoplasms. 
    • Neuromuscular: Scleroderma, vagotomy, demyelinating diseases (MS), Polio
    • Metabolic: Diabetic gastroparesis, hypothyroidism.
    • Drugs: Anti-cholinergics, ganglionic blockers, opiates
    • Psychiatric: Anorexia Nervosa
  26. – CVA, stroke
    – Parkinson's
    – Reflux Esophagitis
    – Esophageal rings and webs
    – Achalasia
    – Esophageal Tumors
    – Candidiasis (e.g. in AIDS)
    Odnyophagia: Painful difficulty swallowing.Common Causes:
  27. Excretion of more than 300 g of stool per
    day.
    Diarrhea

    MC cause is viral
  28. Symptom Cluster: Fever, myalgia, chills, nausea, vomiting, diarrhea, cramping abdominal pain.
    • Diarrhea
    • Infectious agent is MC
    • – Lactose Intolerance
    • – Antibiotic-associated (loss of normal flora)
    • – Inflammatory bowel
  29. Chronic diarrhea:
    • – Dietary habits (coffee)
    • – Parasitic infection: giardiasis, amebiasis.
    • – Inflammatory bowel disease
  30. sphincter dysfunction:
    • – Diabetes Mellitus
    • – Previous rectal or perirectal surgery.
    • – Errant episiotomy from a traumatic childbirth.
  31. Aganglionic Megacolon
    – Lifelong constipation
    – Ocassional passage of enormous stools
    – Absence or marked dimunition of ganglion cells in rectal tissue
    Hirschsprung's Disease
  32. HEMATEMESIS
    - not coughing up blood
    • – PUD or erosive Gastritis
    • – Mallory-Weiss Tear of esophagus
    • – Esophageal varices, portal hypertension
  33. Occult blood in stool.
    • HEMATOCHEZIA
    • – Possible Causes
    • – Colorectal carcinoma
    • – Shigella, Salmonella, Campylobacter, invasive E. Coli may all cause hematochezia.
    • – Hemorrhoids
    • – Chronic diverticular disease
  34. Passage of black or very dark stool, reflecting hemebreakdown products in stool. Causes?
    • MELENA
    • Iron-containing
    • drugs, bismuth-containing drugs, charcoal, lots of black cherries.
  35. Maroon-Colored Stools
    Unstable vitals due to large amount of blood loss.
  36.  Tympany: Increased tympany is heard
    upon percussion of the abdomen in cases of?
    partial bowel obstruction
  37. Normal Liver Span
    10-12 cm in men, 8-11cm in women.
  38. + Merkle's sign
  39. RUQ pain aggravated by inspiration
    Murphy's sign Gallbladder
  40. Gallbladder is palpable in 25% of cases of  pancreatic carcinoma, due to painless distension.
     Courvosier's Law:
  41. Possible causes of palpable kidney's
    • hydronephrosis
    • polycystic disease of kidney
    • large simple cyst
    • renal carcinoma (hypernephroma)
  42. Normal-sized kidney displaced inferiorly into abnormal position; pelvic kidney.
    Renal ptosis:
  43. – Absent Bowel Sounds:
    – Increased Bowel Sounds
    – High-pitched bowel sounds indicating small bowel obstruction.
    • Ileus
    • Gastroenteritis
    • Borborygmi
  44. Succussion splash after fasting?
    pyloric obstruction.

    Otherwise normal if after a large meal.
  45. ABDOMINAL BRUITS causes
    calcification of aorta,celiac compression, and alcoholic hepatitis.
  46. – suspicion of appendicitis
    – DiffDx: UTI; salpingitis; PID
    RECTAL EXAM

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