- epigastric, umbilical, hypogastric, L/R hypochondriac, flank, inguinal

9-region system

- causes constant and dull or moderate intensity abdominal pain

- RUQ pain from liver congestion in CHF

- LUQ pain from splenic congestion

- flank pain from kidney swelling (pyelonephritis)

stretching of encapsulated organs (liver, spleen, kidneys)

- burning type of discomfort

- can be quite severe

- affects esophagus, stomach or duodenum

Irritation of the mucosal lining

(esophagitis, gastritis, peptic ulcer, duodenitis)

- most common cause of abdominal pain

- pain is crampy or colicky in nature

Smooth muscle spasm

- causes a sharp stabbing pain w/ tenderness on palpation

- appendicitis, diverticulitis, acute cholecystitis

Peritoneal irritation

- causes poorly localized abdominal pain

- retroperitoneal processes such as pancreatic cancer or aortic aneurysm

Direct splanchnic nerve stimulation

- may cause abdominal pain in the absence of intra-abdominal pathology

lower lobe pneumonia or inferior myocardial infarction

- causes mid-epigastric abdominal discomfort

- radiates straight thru to the back

Pancreatic disease

- causes RUQ or epigastric abdominal pain

- radiates to the right shoulder blade (R phrenic nerve)

- colicky in nature

Gallbladder disease

- retrosternal and mid-epigastric pain

- brought on by or relieved by swallowing

- increasing intra-abdominal pressure (bending over) may cause reflux and increase pain

Esophageal pain

- common cause of small intestine pain

- crampy periumbilical discomfort

Intestinal ischemia

- causes nausea and periumbilical pain that peaks in intensity in 4-6 hrs and then subsides

- reappears in RLQ at McBurney's points

Appendicitis

- RLQ or LLQ pain that may be constant or occur in spasms

- can be relieved or associated with defecation

Colon pain

- poorly localized pain that can be intense and often associated with the need to defecate

Rectal pain

- RUQ, LUQ, L/R flank, costovertebral angle pain

- constant and moderately severe when due to infection (pyelonephritis)

Kidney pain

- pain in lower quadrants

- radiates to testicles or labia

- excrutiatingly severe when due to passing stones

- appearance of hematuria in pts with flank pain is highly specific for kidney stones

Ureteral pain

- epigastric pain that radiates to left shoulder

- from tumors and ulcers

- worse with eating, better with fasting

Gastric pain (peptic ulcer)

- epigastric pain

- better with eating, worse with fasting

- awaken early, then eat to relieve pain

Duodenal pain (peptic ulcer)

- refers pain to the supraclavicular area (Kehr's sign)

Diaphragm

- refers pain to the epigastrium, jaw, shoulder

Cardiac

- refers pain at the level of the umbilicus (T10)

appendix

- refers pain to the epigastrium (T7, T8)

Hiatal Hernia

5 indications of:

- abdominal distention with tympany to percussion

- tenderness to palpation

- rebound tenderness

- increased or decreased bowel sounds

- cutaneous hypersensitivity

Acute Abdomen

(peritonitis --> surgery now)

- side of the patient an abdominal exam is performed on

Right side

- significant change in examination order involves this tool due to preservation of exam findings

auscultation before palpation and percussion

- shape of abdomen on physical exam that indicates malnourishment

Scaphoid (sunken-in)

- fat, fluid, flatus (air), fetus, feces, fatal growths are causes of this shape of abdomen on physical exam

Protuberant

- location of this structure is normally at the midpoint of the xiphoid and pubic symphisis

- extended down due to hepatomegaly and up with pregnancy or pelvic tumors

Umbilicus

- a crossed hypogastric scar indicates this surgery

Hysterectomy (uterus)

- linea alba line scar indicates this procedure

Laparotomy

- this occurs as an ecchymosis in one or both flanks

- occurs in ovarian cyst hemorrhage, hemorrhagic ascites (w/ cancer), bilateral salpingitis, strangulated bowel with hemorrhage, pancreatitis

Grey Turner's sign

(blood dissecting into abdominal wall)

- periumbilical ecchymosis caused by retroperitoneal or intraperitoneal bleeding (ectopic pregnancy)

- blood follows falciform ligament through lesser omentum and transverse colon

Cullen's sign

- caused by chronic stretching (obesity, pregnancy, ascites, expanding tumors)

- recent ones are pink, become silvery

Striae (stretch marks)

- striae with a purplish hue secondary to erythrocytosis from excess adrenal androgens occurs with this

Cushing's syndrome

- if blood above the umbilicus flows upward and blood below the umbilicus flows downward a pt is:

Normal

- if all abdominal blood flows downward a pt has:

superior vena cava obstruction

- if all abdominal blood flows upward a pt has:

inferior vena cava obstruction

- venous pattern that occurs in response to intrahepatic portal vein obstruction (cirrhosis)

- veins appear to radiate outward from the umbilicus

Caput medusa