Abdomen Flashcards

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

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

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

Lower L kidney & ureter
L Ovary
Descending colon
Sigmoid colon

Important strudtures: Liver, Stomach, Spleen , Kindeys

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

Loss of appetite

localized post-prandial epigastric discomfort

inability to consume a normal size meal

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

spasmodic movements of chest and diaphragm

raising gastric contents w/o N/V/Retching

forceful expulsion of gastric contents through mouth

vomiting blood (often “coffee-ground” appearance)

-usually peptic ulcer disease

difficulty swallowing

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

- 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)

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

1.Visceral
2. Parietal
3. Referred

-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.

-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.

-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).

-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 ?

-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)

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

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.

-Flat
-Rounded
-Scaphoid
-Distended (protuberant)

Look for Hernias, Pulsations, Peristaltic Activity

above 3cm atotic
above 5cm = bad

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

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

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

-Bowel sounds are typically absent with peritonitis.

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

Dullness: Ascites, organomegaly, tumor

Tenderness:Peritonitis,Anxious patient

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

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

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

-Tenderness

-Organomegaly:Liver, spleen, kidneys, bladder

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

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

-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

-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.

-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)

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)

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

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

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

-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

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

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

Atypical Pain: Retrocecal Appendix

Atypical Pain: Pelvic Appendix

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

Retrocecal appendix

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

Pelvic appendix.

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

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

Inspection
Auscultation
Percussion
Palpation

Vascular Bruit - CAD will hear bruit

Friction Rubs:
-Hepatomegaly
-Splenomegaly

CVA tenderness = Pyelonephritis or MS cause

-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.

-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.