abdominal

Question 1

RUQ

Answer 1

• liver (right lobe)
• gallbladder
• duodenum
• pancreas (head)
• right kidney (upper pole)
• right adrenal gland
• hepatic flexure of colon
• ascending colon (part)
• transverse colon (part)
• stomach (pylorus)

Question 2

RLQ

Answer 2

• right kidney (lower pole)
• cecum
• appendix
• ascending colon (part)
• right ovary
• right fallopian tube
• right ureter
• right spermatic cord

Question 3

LUQ

Answer 3

• stomach
• liver (left lobe)
• spleen
• pancreas (body)
• left adrenal gland
• left kidney (upper pole)
• splenic flexure of colon
• transverse colon (part)
• descending colon (part)

Question 4

LLQ

Answer 4

• left kidney (lower pole)
• descending colon (part)
• sigmoid colon
• left ovary
• left fallopian tube
• uterus, in enlarged (other side is in midline)
• left ureter
• left spermatic cord

Question 5

9 abdominal regions

Answer 5

• upper: right hypochondriac region, epigastric region, left hypochondriac region
• middle: right lumbar region, umbilical region, left lumbar region
• lower: right iliac (inguinal) region, hypogastric (pubic) region, left iliac (inguinal) region

Question 6

components of abdominal exam

Answer 6

• inspect
• auscultate
• percuss/palpate
• most exams: inspect, palp, percuss, ascultate

Question 7

visual inspection

Answer 7

• skin color/surface changes
• symm, shape, contour
• deformities (masses, hernias, etc)
• movement: pulsations in skinny people normal, perstalsis in most people not normal
• striae
• pigmentation (moles)
• venous patterns
• jaundice
• umbilicus

Question 8

striae

Answer 8

• old: silver (ok)

- new: purple (cushings)

Question 9

abdominal profiles

Answer 9

• scaphoid (really skinny)
• flat
• rounded (kids, americans)
• protuberant (distended)

Question 10

auscultation

Answer 10

• listen for presence of absence (if not there, listen for 5 mins)
• diaphragm
• light pressure in all 4 quads
• frequency: 5-35 per min
• character: high pitched, low pitched, gurgling, etc
• borborygmi

Question 11

borborygmi

Answer 11

rumbling, stomach growling

Question 12

why do GU, rectal, pelvic exam with abdominal exam?

Answer 12

-in case of several symptoms (pain, bleeding, enlarging abdomen, etc) source of problem cannot be fully detected without examining these adjacent systems

Question 13

referred pain in right upper quad

Answer 13

-pleuritic pain

Question 14

referred pain in right lower quad

Answer 14

appendicitis

Question 15

referred pain in periumbilical

Answer 15

appendicitis (transitions to RLQ pain)

Question 16

referred pain in left upper quad

Answer 16

splenic infarct

Question 17

referred pain in left lower quad

Answer 17

diverticulitis

Question 18

referred pain in right shoulder

Answer 18

-acute cholecystitis

Question 19

referred pain in midsternal line

Answer 19

reflux

Question 20

referred pain in epigastric region

Answer 20

angina

Question 21

referred pain to back

Answer 21

acute pancreatitis

Question 22

cullen sign

Answer 22

Bluish color of/around umbilicus indicates intrapeflritoneal hemorrhage, pancreatitis, or ectopic pregnancy.

Question 23

ballottement

Answer 23

90 degrees from abdomen to move thing. Palpate and things move.

Question 24

grey turner sign

Answer 24

Eccymosis of flanks indicates hemoperitoneum or pancreatitis.

Question 25

shifting dullness

Answer 25

Determine border of tympany and dullness by percussion while suppine, mark this border. Have patient shift to their side and reassess. If ascites is present, the dullness will shift to the lowered side. 3cm or more difference from those marked borders indicates fluid is present.

Question 26

murphy sign

Answer 26

Abrupt cessation of inspiration while palpating gallbladder indicates cholecystitis.

Question 27

fluid wave

Answer 27

patient uses own hand as barrier in mid-abdomen. Tap on one side while palpating the other. Wave transmitted across is + for ascites.

Question 28

rovsing sign

Answer 28

RLQ pain intensified by LLQ abdominal palpation

Question 29

iliopsoas muscle test (psoas sign)

Answer 29

Painful RLQ suggests irritated peritoneal lining while flexing psoas muscle

Question 30

mcburney sign

Answer 30

Pain with palpation at McBurney point (RLQ midway between umbilicus and R anterior superior iliac spine) indicative of appendicitis or other peritoneal inflammation.

Question 31

obturator muscle test (obturator sign)

Answer 31

Testing for irritation due to obturator muscle. RLQ pain is + obturator sign.

Question 32

rebound tenderness (blumberg sign)

Answer 32

Pressing gently and deeply into abdomen in region remote to pain, when you take pressure off, the underlying structures rebounding back to their original positions causes pain and a positive rebound tenderness. Suggests peritoneal inflammation/irritation. (Do this last as it is painful for patient)

Question 33

heel jar test

Answer 33

Patient stands on tip toes then drops to heels (or patient is supine and strike their heels). If this causes abdominal pain = positive test for peritoneal inflammation.

Question 34

hematochezia

Answer 34

passage of fresh (bright red) blood within stool (bleeding in lower GI)

Question 35

melena

Answer 35

passage of dark tarry stools (indicates bleeding in upper GI)

Question 36

globus

Answer 36

the persistent or intermittent nonpainful sensation of a lump or foreign body in the throat; occurrence of the sensation between meals; absence of dysphagia and odynophagia

Question 37

singultus

Answer 37

hiccup (the state of having reflex spasms of the diaphragm | accompanied by a rapid closure of the glottis producing an audible sound)

Question 38

gastroparesis

Answer 38

``` aka delayed gastric emptying= a medical condition consisting of a paresis (partial paralysis) of the stomach, resulting in food remaining in the stomach for an abnormally long time ```

Question 39

eructation

Answer 39

belch