Term
| Know the correct sequence of performing the abdominal exam |
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Definition
| inspection, auscultation, percussion, palpation (examine any areas where the patient complains of pain LAST) |
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Term
| know the anatomic location of intra-abdominal organs |
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Definition
"RUQ: liver, gall bladder, pylorus, duodenum, head of pancreas, R adrenal gland, upper pole of R kidney, hepatic flexure, parts of ascending and transverse colon
RLQ: lower pole of kidney, cecum, appendix, portion of ascending colon, R ovary & fallopian tube, R ureter, R spermatic cord, if enlarged: uterus & bladder
LUQ: L lode of liver, spleen, stomach, body of pancreas, L adrenal gland, upper pole of L kidney, splenic flexure, portion of transverse and descending colon
LLQ: lower pole of L kidney, sigmoid colon, part of descending colon, L ovary & fallopian tube, L ureter, L spermatic cord, if enlarged: uterus & bladder" |
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Term
| know how to assess liver span |
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Definition
"assessed via percussion
upper border: start at midchest, along R midclavicular line until sound goes from resonant → dull
lower border: continue percussion down until dull → tympanic (reached end of liver and now over colon)
upper and lower borders should be no more that 10cm apart
" |
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Term
| know the technique for examination of the spleen |
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Definition
"percussion:
patient lies supine
percuss lowest ICS in the left anterior axillary line
splenomegaly = dull percussion note
palpation:
patient on back, examiner at right side
left hand over patient’s chest and elevate L rib cage
right hand placed flat below patient’s L costal margin and press inward and upward toward anterior axillary line
examiner’s left hand exerts anterior force to displace spleen laterally
attempt to feel spleen tip during its descent as patient inspires deeply
" |
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Term
| know the anatomic location for referred pain from intra-abdominal exam |
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Definition
"AREA OF REFERRED PAIN → affected organ; clinical example
SUBSTERNAL → esophagus; esophagitis
SHOULDER → diaphragm; subphrenic abscess
EPIGASTRIC
→ stomach; peptic gastric ulcer
→ duodenum; petic duodenal ulcer
→ gallbladder; cholecystitis
→ liver; hepatitis
→ bile ducts; cholangitis
→ pancreas; pancreatitis
R SCAPULA → biliary tract; bililary colic
MIDBACK
→ aorta; aortic dissection
→ pancreas; panceatitis
PERIUMBILICAL → small intestine; obstruction
HYPOGASTRIUM → colon; ulcerative colitis, diverticulitis
SACRUM → rectum; proctitis, perirectal abscess" |
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Term
| know the physiology and significance of percussion used during the abdominal exam |
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Definition
| Percuss the abdomen lightly in all four quadrants to assess the distribution of tympany and dullness. Tympany usually predominates because of gas in the gastrointestinal tract, but scattered areas of dullness due to fluid and feces are typical. Note any large dull areas that might indicate an underlying mass or enlarged organ. This observation will guide your palpation. On each side of a protuberant abdomen, note where abdominal tympany changes to the dullness of solid posterior structures (liver and spleen) |
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Term
| know the technique for auscultation of abdominal and renal bruits |
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Definition
| Listen to the abdomen before performing percussion or palpation, since these maneuvers may alter the frequency of bowel sounds. Listen for abdominal aortic bruits using the diaphragm a few inches above the umbilicus, and listen for renal bruits to the right and left of the aorta. |
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Term
| know the physical exam findings in patients with ascites |
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Definition
| Dullness to percussion on both sides of the flank indicates assessment for ascites. Fluid will move the lowest portion of the abdomen, causing the dullness of percussion. Look for the feature of 'shifting dullness', move the patient on their side and the dullness should shift to the lower portion. |
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Term
| know the terminology for associated physical exam findings in patients with cirrhosis |
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Definition
| You may observe pitting edema of the extremeties, a continuous venous hum at the liver due from increased collateral flow, clubbing of the fingers, you may observe dilated, visible veins on the abdomen, an enlarged liver. |
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Term
| know the physical exam finding in patients with abdominal aortic aneurysms |
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Definition
| Patient will describe an intense searing/ripping pain in the abdomen that started abruptly. The AAA may occlude downstream arteries, so check for decreased pulses in the iliac arteries, increased pulsation proximal to the AAA, at the AAA a periumbilical, pulsatile mass will be felt (which is a dead giveaway in an older person) |
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Term
| know the physical exam findings in patients with diverticulitis |
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Definition
"Diverticulitis: inflammation of the colonic diverticulum, usually located in the sigmoid colon, with subsequent microperforation
-most common physical sign is tenderness in the left lower quadrant on palpation
-occasionally, an abdominal mass in the left lower quadrant can be palpated
-may be other signs of peritoneal inflammation such as involuntary guarding, and percussion tenderness in a localized area
-abdominal distention may be apparent on inspection since diverticulitis is an obstructive lesion
-there will be some tenderness of the pelvis with a rectal examination
-with an early obstructive lesion, there may be increased bowel sounds, but decreased bowel sounds with a high pitch also indicate an obstructive lesion because the sounds are due to air and intestinal fluids in the distended bowel proximal to the obstruction" |
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Term
| know the physical exam findings in patients with peritonitis |
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Definition
"Peritonitis: generalized inflammation of the peritoneum
-board-like generalized muscular rigidity and tenderness throughout the abdomen are typically present
-decreased or absent bowel sounds
-rule out a lesion limited to the musculature of the abdominal wall by asking the patient to raise head and shoulders while in the supine position, the lesion is in the abdominal wall if the tenderness persists, and the lesion is deeper if the tenderness decreases because it is protected by the tightened muscles
-the abdomen will be tympanic on percussion
-Summary: a silent, tympanic, distended abdomen suggests peritonitis" |
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Term
| know the physical exam findings in patients with anemia |
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Definition
"Anemia: most common blood disorder, a decrease in the overall number of red blood cells or a decreased amount of hemoglobin in the blood, 3 main classifications are designated by cause, hemorrhage, excessive hemolysis (hemolytic anemia), or deficient RBC production (deficient hematopoiesis)
-splenomegaly
-pallor
-jaundice (yellowed skin and sclera) due to increased production of bilirubin (with severe hemolytic anemia)
-heart murmurs due to the increased blood flow
-accentuated S1 due to the high output state
-in children, persistent S2 splitting may indicate an increased right ventricular volume load
-strong and bounding pulse pressure due to volume overload and decreased TPR" |
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Term
| know the physical exam findings in patients with pyelonephritis |
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Definition
"Pyelonephritis: infection of the kidney (usually caused by ascending urinary tract infection or hematologic spread)
-toxic appearance
-costovertebral angle tenderness
-fever" |
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Term
| know the physical exam findings in patients with appendicitis |
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Definition
"-pain classically begins near the umbilicus, then shifts to the lower right quadrant, where coughing increases it
-localized tenderness anywhere in the right lower quadrant, even in the right flank
-early voluntary guarding may be replaced by involuntary muscular rigidity
-right-sided rectal tenderness is possible (due to inflammation)
-rebound tenderness suggests peritoneal inflammation
-pain in right lower quadrant during left-sided pressure (positive Rovsing's sign)
-right lower quadrant pain on quick withdrawl (referred rebound tenderness) (Bates 347)" |
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Term
| know the physical exam findings in patients with acute and chronic hepatitis |
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Definition
"-acute: low grade fever, jaundice, hepatomegaly, splenomegaly
-chronic: hepatomegaly, palmar erythema, spider angioma
" |
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Term
| know the physical exam findings in patients with cholecysitis |
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Definition
"-a sharp increase in tenderness with a sudden stop in inspiratory effort
-more well localized than with hepatic tenderness
-signs are maximal in the right upper quadrant"
pain can also be in the epigastric region (right upper quadrant pain is more common though) (Bates, p. 950) |
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Term
| know the physical exam findings in patients with diastasis recti, ventral hernia, inguinal hernia |
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Definition
"-diastasis recti: a separation of the two rectus abdominis muscles, through which the abdominal contents bulge to form a midline ridge when the patient raises head and shoulders
-ventral hernia: any defect in the wall through which tissue protrudes; can be elucidated by having the patient raise their head and shoulders
-inguinal hernia: bulge that appears on straining"
inguinal hernia: bulge appears on straining along or just below the inguinal ligament; palpate the inguinal canal and ask the patient to turn and cough or bear down, feel for tissue brushing against your finger through the inguinal canal (I don't think this portion of the exam is on the physical exam CCAs but it could be on the written exam) |
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