Abdomen Flashcards


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created 11 years ago by flips04s
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Flashcards for PDx Abdomen Quiz
updated 11 years ago by flips04s
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1
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Right Upper Quadrant (RUQ)
Underlying Structures

Liver & Gallbladder
Pylorus & Duodenum
Head of pancreas
Hepatic Flexure of colon
R adrenal & upper kidney

2

Right Lower Quadrant (RLQ)

Lower R kidney & ureter
Cecum & appendix
R Ovary
Ascending colon

3

Left Upper Quadrant (LUQ)

Left lobe of liver
Spleen & Stomach
Body of pancreas
Splenic flexure of colon
L adrenal & upper kidney

4

Left Lower Quadrant (LLQ)

Lower L kidney & ureter
L Ovary
Descending colon
Sigmoid colon

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Abdominal Cross Section T12 Level

Important strudtures: Liver, Stomach, Spleen , Kindeys

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Pelvic Contents (female)

Important Structues: Decending colon, Sigmoid colon, Uterus, Urinary Bladder, Vermiform Appendix, Cecum, Terminal Ileum,Abdominal Aorta, Psoas Major & Minor

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Anorexia

Loss of appetite

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Indigestion

localized post-prandial epigastric discomfort

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Early Satiety

inability to consume a normal size meal

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Hertburn

sense of retrosternal or epigastric burning with radiation to the neck often associated with possible gastric reflux (r/o coronary artery disease-CAD)

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Retching

spasmodic movements of chest and diaphragm

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Regurgitation

raising gastric contents w/o N/V/Retching

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Vomiting

forceful expulsion of gastric contents through mouth

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Hemetemesis

vomiting blood (often “coffee-ground” appearance)

-usually peptic ulcer disease

15

Dysphagia

difficulty swallowing

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Odynophagia

pain on swallowing (burning or squeezing) – candidiasis vs muscular cause

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Change in Bowel Function

- constipation (less than 3/week)
- obstipation(not even passing gas,secondary to obstruction)
- diarrhea
- melena (upper GI bleed)/hematochezia
- greasy/oily stools (malabsorption vs
pancreatic insufficiency)

18

Symptoms Concerning for GI Pahologies

Anorexia, Indigestion, Early Satiety, Hertburn,Retching, Regurgitation, Vomiting,Hemetemesis, Dysphagia, Odynophagia, Change in Bowel function

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Types of Abdominal Pain

1.Visceral
2. Parietal
3. Referred

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Visceral Abdominal pain

-occurs when hollow organs (intestines or biliary
tree unusually contract, distend or stretch.
-difficult to localize.
-experienced at the midline.
-gnawing, burning, cramping, sweating, pallor,
N/V, restlessness.
-Early stages of appendicitis.

21

Parietal Abdominal Pain

-originates in the parietal peritoneum.
-caused by inflammation.
-steady aching pain over the involved structure.
- P > V (tenderness/guarding -> rigidity/rebound)
-aggravated by movement/coughing.
-Afferent (inflammation) signals are sent from the specific area and localized to the dermatome superficial to the site.

22

Referred Abdominal Pain

-experienced at a more distant site.
-innervated at approximately the same dermatomal level as the disordered structure.
-Often develops as the initial pain intensifies
and appears to radiate.
-radiating pain (acute cholecystitis=R sld,
pancreatitis=back, PUD=back).

23

Abdominal Exam: Examiner:

-Ensure that patient has an empty bladder
-Start on the right side of the patient
-Wash and warm hands; warm stethoscope
-Any areas of pain ?

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Abdominal Exam: Positioning Patient

-Supine (with pillow under head)
-Abdomen exposed (“full exposure from below the xiphoid to the symphysis pubis”)
-Knees flexed and arms at side (to avoid
tightening of abdominal muscles)

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Skin Inspection: Portal Circulation

Veins that transport blood from:
-Digestive organs (stomach, SB, Lg. Intestine) and
-Spleen, pancreas and gall-bladder to the liver.

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Skin Inspection: Portal Hypertension

If blood can’t flow easily through the liver due to scarring (cirrhosis) or inflammation (hepatitis) portal vein pressure increases (hypertension) often causing weak-walled vessels (varices) that can rupture and cause hemorrhaging.

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Inspection of Contour and Symmetry

-Flat
-Rounded
-Scaphoid
-Distended (protuberant)

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Abdominal Inspection

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Look for Hernias, Pulsations, Peristaltic Activity

above 3cm atotic
above 5cm = bad

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Distended Abdomen

Generalized: Obesity (protuberant),Ascites, Intestinal obstruction (gaseous distention), Peritonitis (ileus)

Upper Abdomen:Hepatomegaly, splenomegaly, pancreatic cyst or tumor, gastric outlet obstruction, aortic aneurysm, hernia

Lower Abdomen:Uterus, ovary, bladder, hernia, intestinal mass

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Why Auscultation Before Percussion or Palpation ?

Auscultation first because percussion and palpation may alter the frequency of bowel sounds.

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Auscultation: Increased Bowel Sounds

Increased:(gastroenteritis, laxatives, early intestinal obstruction, GI hemorrhage)

-Bowel sounds may be high pitched and occur in frequent waves (“rushes”) with early bowel obstruction.

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Ausultation: Decreased Bowel Sounds

Decreased:(late bowel obstruction, paralytic ileus, peritonitis)

-Bowel sounds are typically absent with peritonitis.

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Abdominal Exam: Percussion

Tympany:
-The predominant percussion note over abdomen
-Gaseous distention of viscera

Dullness: Ascites, organomegaly, tumor

Tenderness:Peritonitis,Anxious patient

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Percussing Liver Span

Normal:
6-12 cm in right midclavicular line
4-8 cm in midsternal line

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Splenic Percussion Sign

Percuss the left lower anterior chest wall to detect splenomegaly in the area termed :
Traube's Space.

-change in percussion notre from tympany to dullness on inspiration suggests splenic enlargement: Positive splenic percussion sign

36

Light Palpation

-Tenderness
-Guarding: Rigidity (muscular spasm) vs. voluntary
-Superficial masses

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Deep Palpation

-Tenderness

-Organomegaly:Liver, spleen, kidneys, bladder

-Masses:Physiologic = pregnant uterus
Inflammatory = Diverticulitis, Crohn’s disease (iliocecal area)
Vascular = Aneurysms
Neoplastic = CA
Obstructive

38

Peritonitis: Differential Diagnosis

-Perforated viscus (e.g., perforated duodenal
ulcer, ruptured appendix, etc.)
-Pancreatitis
-Mesenteric infarction
-Appendicitis (late)
-Diverticulitis (late)
-PID (late)
-Cholangitis

39

Recognizing Peritonitis

-Pain and tenderness:
-May be well localized or referred
-Pain aggravated by movement and cough
-Rebound or percussion tenderness
-Guarding = Abdominal rigidity (“board-like
abdomen”)body's defense mechanism
-Absent or decreased bowel sounds

40

What is Ascites?

-Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity).

-Usually an indication of severe liver disease.

-Caused by high pressure in the venous blood vessels of the liver (portal hypertension) and low albumin levels.

41

Ascites Differential Diagnosis:

-Hepatitis
-Metastatic colon cancer
-Chronic liver disease (cirrhosis)
-Abdominal malignancy (carcinomatosis)
-Pancreatitis
-Peritonitis
-Right sided heart failure
-Nephrotic syndrome
-Thrombosis of hepatic vein or inferior vena cava (Budd-Chiari syndrome)

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Recognizing Ascites:
1.Bulging Flanks
2.Shifting Dullness
3.Fluid Wave

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Ascititc fluid seeks the lowest point in the abdomen, producing bulging flanks that are dull to percussion. The umbilicus may protrude. Turn the patient onto one side to detect the shift in position of the fluid level (shifting dullness)

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Hepatomeglay Differential Diagnoses

-Infectious Hepatitis
-Cirrhosis
-Malignancy (Metastatic cancer, primary liver cancer, lymphoma, leukemia)
-CHF
-Biliary obstruction
-Fatty liver disease (alcohol, diabetes)
-Hemochromatosis
-Amyloidosis

44

Splenomegaly Differential Diagnoses

-CHF
-Cirrhosis
-Infection (Mononucleosis
Bacterial endocarditis, tuberculosis)
-Neoplasm (Lymphoma, acute and chronic leukemia, PCV)
-SLE, RA
-Amyloidosis

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Recognizing Appendicitis
(Shown Here: Rovising's Sign,McBurney's Point)

Psoas sign - pain on extension of right thigh (retroperitoneal/retrocecal appendix)

Obturator sign - pain on internal rotation of right thigh (pelvic appendix)

Rovsing's sign - pain in right lower quadrant with palpation of left lower quadrant (pain when pressing on oposite side at same point as apendix)

Dunphy's sign - increased pain with coughing

McBurney's Point - half way between ASIS & umbilicus, where you would make incision

46

Recognizing Apendicitis Cont.

-Right lower quadrant pain on palpation (the single most important sign)
-Low-grade fever (38°C [or 100.4°F])--absence of fever or high fever can occur
-Localized tenderness to percussion
-Flank tenderness in right lower quadrant (retroperitoneal or retrocecal appendix)
-Patient maintains hip flexion with knees drawn up for comfort

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Recognizing Appendicitis

-Pain/ Tenderness Pattern:
Anorexia/ nausea
+/- Fever

-Guarding/ Rebound Tenderness
Cough or percussion tenderness
-Cutaneous Hyperesthesia

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Atypical Pain: Retrocecal Appendix

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Atypical Pain: Pelvic Appendix

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Recognizing Appendicitis: Psoas Sign

Psoas sign: Pain with extension of right hip or flexion of right hip against resistance.

Retrocecal appendix

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Recognizing Appendicits: Obturator Sign

Obturator sign: Pain with internal rotation of the right hip.

Pelvic appendix.

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Recognizing Appendicitis: Rectal & Pelvic Exams

Rectal and Pelvic Exams:
Rule out pelvic disease in women
Demonstrate tenderness of pelvic appendix (especially if atypical pain pattern)

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Epigastic, Umbilical, hypogastric (suprapubic)
Hypochondrium, Lumbar (flank), Ingunal (iliac)

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Order of performing the Abdominal Examination

Inspection
Auscultation
Percussion
Palpation

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Vascular Bruit

Vascular Bruit - CAD will hear bruit

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Friction Rubs

Friction Rubs:
-Hepatomegaly
-Splenomegaly

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CVA Tenderness

CVA tenderness = Pyelonephritis or MS cause

58

Cutaneous Hyperesthesia

-Increased sensitivity to sensory stimuli, such as pain or touch.

Procedure:
At a series of points down the abdominal wall, gently pick up skin folds between finger and thumb without pinching the skin.
-Localized pain elicited in the RLQ may accompany appendicitis.

59

Murphy’s Sign

-When RUQ pain/tenderness are present, assess for acute cholecystitis

Move extended fingers of right under the costal margin, ask the patient to exhale and as they take a deep breath, advance the fingers under the costal margin.

-A sharp increase in tenderness with a sudden stop in inspiratory effort is a positive sign.