PD Exam 2-Abdominal Exam

What is the order for the abdominal exam?

Inspection, Auscultation, Percussion, Palpation

How much does the stomach hold?

1-3L

What is a common location for ulcers?

Duodenum

What can create umbilical pain?

Small intestine

What is the location for colon cancer?

Large intestine

What is the emulsifier of fat?

Bile

What vascular, solid organ is tucked under the right anterior ribs?

Liver

What can cause ascites, venous congestion, spider angiomas, and jaundice?

Hepatitis of any kind

What may indicate hepatitis?

Tenderness

Does the right kidney sit slightly higher or lower?

Lower

What can CVA tenderness reveal?

Renal disease or infection

What level ribs does the spleen lie?

9th-11th

Where does the head of the pancreas sit?

C-loop of duodenum

What organ is in charge on insulin production?

Pancreas

Pelvic disease and pregnancy can cause what to ascend into the abdomen?

Ovaries and uterus

A prominent lateral pulsation of the aorta suggests what?

Aortic aneurysm

A patient may complain of what if an aortic aneurysm is present?

Back pain

Where is the aorta located?

Between the xyphoid process and umbilicus, slightly left to midline

What diseases are associated with pain the RUQ?

Hepatitis, Cholelithiasis, Pancreatitis, Renal Colic, Constipation, Pnemonia

In what quadrant is the liver and gallbladder, Pylorus, Duodenum, Head of pancreas, Right adrenal gland, Superior aspect of right kidney, hepatic flexure, and portions of ascending and transverse colon found?

RUQ

What diseases are associated with pain in the LUQ?

Mononucleosis, peptic ulcer, disease, renal colic, constipation, cardiac disease

In what quadrant is the left lobe of liver, spleen, stomach, body on pancreas, left adrenal gland, superior aspect of left kidney, splenic flexure, portion of transverse and descending colon found?

LUQ

What diseases are associated with pain the RLQ?

Renal colic, Appendicitis, Crohn’s disease, Ectopic pregnancy, Ovarian cysts

In what quadrant is the lower pole of right kidney, cecum and appendix, portion of ascending colon, right ovary and fallopian tube (uterus if enlarged), and right ureter (bladder, if distended) found?

RLQ

What diseases are associated with pain in the LLQ?

Constipation, Diverticulitis, Colon cancer, Ulcerative colitis, Ovarian cysts

In what quadrant is the lower pole of left kidney, sigmoid colon, portion of descending colon, left ureter (bladder if distended), and left ovary and fallopian tube (uterus if enlarged) found?

LLQ

What can be found in the epigastric region?

Pyloric area of stomach, duodenum, pancreas, portion of liver (PUD, pancreatitis, gallbladder disease)

What can be found in the suprapubic/ hypogastric region?

Ileum, bladder, uterus (UTIs and pregnancy)

Should the patient’s bladder be emptied prior to the exam?

Yes if possible

With the patient lying with their arms at sides and knees bent, where do you expose?

From xyphoid to public line

What would be indicated with a flat inspection of the abdomen?

Common in patients with good muscle tone

What would be indicated with a scaphoid inspection of the abdomen?

Sunken in, may be normal or a disease state

What would be indicated with a rounded inspection of the abdomen?

Obesity vs disease

What would be indicated with a distended or protuberant inspection of the abdomen?

Rounded, firm usually associated with disease

During inspection of masses, valsalva or inhaling deeply can demonstrate?

Masses, hernias, and changes in contour

When inspecting scars what should be described?

Location, shape, size, color

When inspecting striae what should be described?

Location, size, color

What can dilation of venous patterns indicate?

Liver disease or pregnancy

What are examples of rashes or lesions?

Spider nevi, moles, maculopapular rashes

What should you notice when inspecting umbilicus?

Location, contour, inflammation or hernia

When can peristalsis be seen?

On a thin individual or hyperactivity due to disease

For auscultation is diaphragm or bell used?

Diaphragm

What is heard with hypoactive sounds?

Slow, sluggish, scant -acute abdomen, possible blockage

What is heard with active sounds?

Normal range 5-34/min (Normo active)

What is heard with hyperactive sounds?

Rushes, boyborygmi, gurgles- associated with hunger and disease

When can bowel sounds be said are absent?

No sound in any area for over 2 minutes of listening

Where is the abdominal aorta?

Midline between xyphoid and umbilicus

Where is the renal artery?

1-2 inches lateral of midline in upper quadrants

Where is the iliac artery?

Midpoint on the line drawn from ubilicus to anterior superior iliac spine

When percussing, what does a hollow, tympanic sound indicate?

Air filled

When percussing, what does a dull, resonant sound indicate?

Solid

When percussing, what does a dullness in the lower area, hollow in upper area indicate?

Fluid

What is the normal distance when percussing the liver?

6-12 cm in MID CLAVICULAR LINE

If tympany is prominent, is splenomegaly likely?

NO

What aids in assessment of organs, muscle spasms, masses, tenderness, fluid?

Palpation

What kind of motion should you use when palpating?

Dipping motion

What is light palpation assessing for?

Superficial masses, muscular resistance (guarding or splinting), involuntary guarding (peritoneal inflammation)

What is deep palpation indentifying?

Masses: location, size and shape, consistency and mobility, tenderness

If rebound tenderness is present, what does it suggest?

Peritoneal irritation

Where is McBurney’s point?

Surgical landmark- 1/3 of distance from ASIS to umbilicus on right

Where is tenderness of appendicitis localized?

Over McBurney’s point (prior to rupture and peritonitis)

What is a “normal” results for abdominal aorta pulsation?

< 3cm with pulse in anterior direction

What is the hook method?

Flex fingers of the hand in a “claw like” position under the rib cage

What must you be careful with when palpating the spleen?

To not rupture an enlarged spleen, if it is reachable, it is fragile

Pain with the murphy’s sign indicates?

Cholecystitis

Tenderness with the murphy’s sign indicates?

Hepatic inflammation/irritation

What does a positive psoas sign indicate?

Peritonitis due to appendicitis

What does a positive obturator sign indicate?

Peritonitis due to appendicitis

What does a positive heel tap test indicate?

Peritonitis due to appendicitis

What does a positive rovsing’s sign indicate?

Peritonitis due to appendicitis

What does a positive shifting dullness sign indicate?

Ascites

What does CVA tenderness check for?

Kidney infection