1
Q
Heartburn sx
A
- Burning feeling in chest, behind breastbone
- Chest pain after eating or lying down, frequently at night in bed
- Burning sensation in throat, accompanied by bitter/sour taste
- Sensation of something being stuck in chest or throat
- Ongoing cough
2
Q
Indigestion sx
A
- Feeling uncomfortably full
- Burping & flatulence
- Bouts of reflex
- Bloating
- Nausea, vomiting
- Heartburn
3
Q
GERD dominant sx
A
- Heartburn
- Acid regurgitation
4
Q
Odynophagia causes
A
- Esophagitis
- Foreign body
- Pharyngitis
- Achalasia (dysfunction of peristaltic contractions)
5
Q
Character indications of odynophagia
A
- Sharp/burning = mucosal inflammation (reflux, infection)
- Sharp/sticking = mechanical (chx bone)
- Squeezing/cramping = muscular (spasm, achalasia)
6
Q
Common causes of nausea/vomiting
A
- Early pregnancy
- Stomach “bug”
- Medications
- Intense pain
- Emotions
- Gallbladder disease
- Food poisoning
- Overeating
- Heart attack
- Concussion/brain injury or stroke
7
Q
Types of abdominal pain
A
- Visceral
- Parietal
- Referred
8
Q
GI contours
A
- Flat
- Scaphoid
- Distended
- Protuberant
- Symmetrical
9
Q
Bulges on inspection
A
Separation of rectus abdominus muscles can be seen as a ridge when pt is reclining into lying position
10
Q
Cullen’s sign
A
Intraperitoneal hemorrhage
11
Q
Grey Turner’s sign
A
Retroperitoneal hemorrhage
12
Q
Where do you auscultate for friction rubs?
A
Liver & spleen
13
Q
Where do you auscultate for bruits?
A
Aorta, renal, iliac, femoral aa.
14
Q
To determine lower edge of liver
A
- Begin at mid clavicular line over area of tympani & percuss upward to area of dullness (usually heard at costal margin)
- Mark area of dullness w/ pen
15
Q
To determine upper edge of liver
A
- Begin at mid clavicular line over area of lung & continue down until tympani turns to dullness (usually 5th to 7th IS)
- Mark area w/ pen (distance btwn: 6-12 cm)
16
Q
Checking for splenomegaly
A
- Check for splenic percussion sign
2. Splenic percussion
17
Q
Checking for splenic percussion sign
A
- Percuss at lowest interspace in left anterior axillary line (should be tympanic)
- Ask pt to take deep breath & percuss again
- If dullness is heard, pay attention to palpation of spleen
18
Q
Spenic percussion
A
- Percuss left lower anterior chest wall from border of cardiac dullness at 6th rib to the anterior axillary line & down to the costal margin (Traube’s space)
- Note lateral tympany
- If prominent laterally, splenomegaly is not likely
19
Q
Palpation of liver edge
A
- Place left hand under 11-12th posterior ribs/tissue
- Have pt relax
- Place R hand on pt’s RUQ, lateral to rectus muscle
- Have pt take deep breath
- Feel as it comes down w/ diaphragm
OR you can use “hooking technique”
20
Q
Palpation of spleen
A
- Lies below 9th & 10th ribs
- Normal spleen is non-palpable
- If enlarged, it will migrate from LUQ to RLQ
21
Q
Deep palpation of abdominal aorta
A
- Aortic pulsation slightly left of midline
- Press firmly w/ one hand on each side of aorta
- Periumbilical or upper abdominal mass w/ pulsations that expand > 3 cm = abdominal aortic aneurysm
22
Q
Percuss for shifting dullness
A
- Ascitic fluid sinks w/ gravity
1. Percuss outward in different directions from central area of tympany & map borders btwn tympany & dullness
2. Ask pt to turn onto side. Percuss & mark borders again - There should be no change in borders
- In ascites, dullness will shift to dependent position
23
Q
Rebound tenderness
A
Determines presence of peritoneal signs in acute abdomen
24
Q
Costovertebral angle (CVA) tenderness
A
- aka. Murphy’s punch sign
- Assesses for pyelonephritis
25
Percussion of bladder
- Located in the hypogastric region, percuss over the bladder & up toward the umbilicus
- Dullness to percussion indicates a distended bladder
- A full bladder is not usually able to be percussed
26
Murphy's sign
Test for acute cholecystitis
- Place thumb or fingers at lower costal margin on the right, at the lower liver border & press upwards while the pt takes a deep breath
- If pain is elicited, the pt will stop taking a breath & c/o pain = positive sign
27
Ascites: Special tests
- Shifting dullness
| - Fluid wave
28
Appendix: Special tests
- Peritoneal irritation signs
| - McBurney's point
29
Peritoneal irritation: Special tests
- Rebound tenderness
- Rectal exam
- Rovsing's sign
- Psoas sign
- Obturator sign
30
Gallbladder: Special test
Murphy's sign
31
Bladder distention: Special test
Bladder percussion
32
Testing for fluid wave
- Have pt or assistant press edges of both hands firmly down on midline of abdomen
- Place 1 hand on a flank & w/ the other hand, tap the opposite flank.
- If fluid transmits, you should feel it
33
Obturator sign
- W/ pt in supine, examiner passively flexes R hip & knee
- Leg is gently pulled laterally while maintaining position of knee --> internal rotation of hip
34
Abdominal reflexes
- Lightly but briskly stroke each side of abdomen, above (T8, T9, T10) & below (T10, T11, T12) umbilicus
- Note contraction of muscles & deviation of umbilicus towards stimulus
35
Anorectal exam
- Pt placed in lateral position w/ knees bent
- Glove & lubrication ready
- Part buttocks & inspect anal area
- Place lubricated finger at anal sphincter & ask pt to bear down
- Insert finger towards umbilicus
- Note sphincter tone & presence of fecal material
- Insert finger as far as possible to palpate as much rectal wall as possible on 1 side then sweep the other direction
- Perform hemoccult
36
How long should you auscultate bowel before determining absent bowel sounds?
5 minutes
37
What special tests can you perform to test for appendicitis?
Rebound tenderness in McBurney's point
Rovsing sign
Psoas sign
obturator sign
38
Psoas sign
have pt try to lift right leg as you try to push it down
Positive if: pain in RLQ when this is done
39
Obturator sign
have pt supine, passively flex their right knee and hip, perform passive internal rotation
Positive if: pain in RLQ when this is done
40
Murphy's sign
test for acute cholecystitis
place fingers at right lower costal margin & press upwards while pt takes a deep breath
Positive if: pain is elicited
H & P
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Decks in class (8)
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