Abdominal - Clinical Skills

Front 1

RUQ pain
-possible pathologies

Back 1

cholecystitis, hepatitis, liver abscess, pancreatitis, hepatic abscess, choledolithiasis, cholangitis, tumour (colon, kidney, liver)

Front 2

epigastric pain
-possible pathologies

Back 2

PUD (complicated or perforated), pancreatitis, thoracic causes (pericarditis, aortic aneurysm, MI), gallstone

Front 3

LUQ pain
-possible pathologies

Back 3

splenic infarct, ruptured spleen, pancreatitis, abscess, gastric ulcer, gastric cancer

Front 4

flank pain
-possible pathologies

Back 4

pyelonephritis, nephrolithiasis, retrocecal appendicitis, retroperitoneal bleeding, sarcoma, abscess

Front 5

lower abdomen pain
-possible pathologies

Back 5

aortic aneurysm, appenditicitis, diverticuluits, colorectal cancer, PID, bowel perforation, sigmoid volvulus

Front 6

variably located abdominal pain
-possible pathologies

Back 6

gastroenteritis, GI obstruction, IBD, ischemic colitis, visceral angina

Front 7

diffuse, steady pain
-possible pathologies

Back 7

peritonitis

Front 8

7 main categories to ask as PMI and associated symptoms

Back 8

(1) Pain (2) Vomiting (3) Energy Level
(4) Weight Change (5) Bowel Habits
(6) GI Bleeding (7) Jaundice

Front 9

questions about vomiting

Back 9

onset, duration, timing, character, colour, auditory changes, tinnitus, sore throat
morning & unrelated to meals = non GI
after meals = GI

Front 10

questions about bowel habits

Back 10

chronic/acute, number of stools/day, character (solid/loose, floating, odor, colour), blood
*travel, food poisoning

Front 11

GI medications to ask Rx history

Back 11

NSAIDs, steroids, ulcer meds, laxatives

Front 12

pertinent FMHx

Back 12

colorectal cancer, gallstones, IBD, celiac and autoimmune disease, IBS, similar sx to PMI

Front 13

pertinent social history

Back 13

sexual practices (anal), decreased libido, alcohol intake, smoking, travel, tattoos/piercings

Front 14

main categories of physical inspection

Back 14

(1) state of patient
(2) skin color/markings
(3) hands & nails (4) facies
(5) abdomen contour (6) umbilicus
(7) hernias/superficial veins (8) JVP
(9) stigmata of liver disease

Front 15

auscultation

Back 15

(1) bowel sounds
(2) bruits - aortic, renal, common iliac, femoral, liver, spleen
(3) venous hum
(4) friction rubs

Front 16

percussion

Back 16

(1) pain (2) tympany/dullness (3) liver (4) spleen (5) ascites

Front 17

Liver - percussion and palpation

Back 17

normal span: 9-11cm mid-clavicular line, 4-8cm mid-sternal line

Front 18

Spleen - percussion and palpation

Back 18

Castell's sign
percuss 10th intercostal space

Front 19

Ascites - physical exam

Back 19

I - bulging flanks
P - shifting dullness (supine - mark - right side - mark again)
- fluid wave (patient place hand vertically on middle of abd - tap on one side and feel for thrill on other; thrill = ascites)

Front 20

6 causes of protroberant abdomens

Back 20

(1) Fat (2) Fluid (3) Feces (4) Flatus
(5) Fetus (6) Fatal growth

Front 21

Palpation

Back 21

light, deep, liver, spleen, kidney

Front 22

Rovsing's sign

Back 22

RLQ pain on LLQ palpation
dx: appendicitis

Front 23

McBurney's sign

Back 23

Tenderness 1/3 along line from anterior sacroileal spine to umbilicus
dx: appendicitis

Front 24

signs for appendicitis

Back 24

Rovsing's
McBurney's

Front 25

Rebound tenderness

Back 25

Pain on qucik withdrawal of palpation
dx: peritonitis

Front 26

Murphy's sign

Back 26

Arrent of deep inspiration on RUQ palpation
dx: cholecystitis

Front 27

Courvoisier's sign

Back 27

Painless, papable distended gallbladder
dx: pancreatic cancer

Front 28

Cullen's sign

Back 28

Blue discolouration of periumbilical area
dx: acute hemorrhagic pancreatitis, ectopic pregnancy

Front 29

Kehr's sign

Back 29

Severe left shoulder pain exacerbated by elevating foot of bed (referred pain from diaphragm)
dx: splenic rupture

Front 30

Gray-Turner's sign

Back 30

Ecchymoses (blood and pus, looks like bruising) of the abdomen and flanks
dx: acute hemorrhagic pancreatitis, ruptured abdominal aortic aneurysm, strangulated bowel

Front 31

Psoas test

Back 31

Pain on flexion of the hip against resistance
dx: appendicitis, other causes of psoas muscle inflammation

Front 32

Obturator test

Back 32

Pain when thigh is flexed to right angle and gently rotated (internally/externally)
dx: pelvic appendicitis, diverticulitis, PID, other causes of obturator internus muscle inflammation

Front 33

Carnett's sign

Back 33

Abdominal pain/tenderness when patient lifts feet above bed w/o bending knees = pain in abdominal wall
Pain alleviated with same motion = pain inside abdominal cavity

Front 34

upper endoscopy

Back 34

provides view of esophagus, stomach, and duodenum (up to second part)

Front 35

barium enema

Back 35

x-ray examination of the colon after the introduction of barium sulfate contrast
- detects diverticula, fistulae

Front 36

ERCP

Back 36

endoscopic retrograde cholangiopancreatography
-visualize bile duct, gallbladder & pancreatic duct after dye injection

Front 37

MRCP

Back 37

magnetic resonance cholangiopancreatography
-MRI view of bile duct, gallbladder and pancreatic duct

Front 38

Schilling test

Back 38

measurement of radioactive labelled vitamin B12 following oral ingestion
-to evaluated absorption

Front 39

C-14 urea breath test

Back 39

detection of enzyme urease, produced by H pylori

Front 40

H2 breath test

Back 40

measures expired H2 content in air
- indications: lactose intolerance, bacterial overgrowth