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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
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
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
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.
Order of the abdominal exam?
Pink purple striae are a sign of?
long prolonged gurgles of hyperperistalisis - stomach growling
What does hearing a bruit in the epigastrium area ( each quadrant) suggest?
renal artery stenosis - as the cause of hypertension
What does a friction rub over the liver or the spleen indicate?
- liver tumor
- gonococcal infection around the liver
- splenic infarction
Which sound predominates in the GI tract?
Tympany - if abdomen in protrubent with tympanic sound = intestinal obstruction
What does an area of dullness suggest?
- fluid or feces filled
- can also be organs such as liver, heart or spleen.
Signs of peritoneal inflammation
- abdo pain and tenderness esp associated w/ muscle spasm.
- abdominal pain on coughing or light percussion with pain
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.
Normal liver span measures? ( midsternal line and right midclavicular line)
- midsternal line: 4-8 cm
- Right midclavicular line: 6-12 cm
What does a normal spleen look like on exam ( location)?
- Normal spleen: ant axillary line, to mid axillary line
With what conditions do you normally see splenomegaly?
- portal HTN
- Splenic infarts
- hematologic malignancies
What does nilateral kidney enlargement suggests?
Which kidney can be palpated in a thin woman?
- Polycystic kidney disease
What does pain at CVA tenderness test suggest?
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
What is a positive Rovsing's sign?
- Pain in the RLQ with left sided pressure indicates appendicitis.
- used to dx appendicitis
- raised right thigh against provider's hand resistance
- extend/ flexing the patient's right leg at the hip. - pain = appendicitis
- Flex right thigh to hip with knee bent, and rotate leg internally and externally
What is Murphy's sign and what does it indicate?
- Cholecystitis - gallbladder, liver inflammation
- pain when pt takes deep breath while PCP push
Testing for ventral hernia?
- Raise both hands and shoulders off the table
- 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
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