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36 Cards in this Set
- Front
- Back
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What is the difference between hematochezia and melena?
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Hematochezia is the passage of maroon-colored stool, commonly associated with lower GI bleeding (brighter red can be rectal bleeding). Melena, which is stool with blood that has been altered by reaction with stomach acids and appears black.
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What are some items that should be included in the S portion of the SOAP note for a person with abdominal problems?
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OTC medications, travel, diet, occupation, alcohol
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What are some items that should be included in the O portion of the SOAP note for a person with abdominal problems?
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Guaiac test, Labs and Imaging studies etc.
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What is dyspepsia?
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Upset stomach or indigestion, impaired digestion. Characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating. Can be accompanied by bloating, belching, nausea, or heartburn.
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Define Dysphagia & Odynophagia.
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Odynophagia is painful swallowing, in the mouth or esophagus. It can occur with or without dysphagia, or difficult swallowing.
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A pelvic exam is not included in an abdominal evaluation T/F?
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False
A thorough evaluation of the abdomen includes a pelvic and rectal exam, because the “abdomen” does include the pelvis |
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What is the order of the abdominal examination?
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Inspection/ Observation
Auscultation Percussion Palpation then: Osteopathic exam Rectal & prostate Pelvic exam Special tests/Guaiac test/ labs/imaging studies |
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What is the Grey Turner Sign?
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bruising on flank area meaning your pancreas ate your insides – make a will
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What are the components of the abdominal inspection?
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Remember to stand on side of dominant eye, look for:
• Symmetry • Bulging, scars, hernias • Coloration • Pulsation • Bruising |
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What will you hear with normal bowel sounds?
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5‐35 clicks and gurgles per minute
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Borborygmi means . . .
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stomach growling, prolonged gurgles
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Bruits indicate . . .
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indicate occlusive vascular disease
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What abdominal arteries do you need to ascultate?
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R & L Renal
R & L Iliac R & L Femoral Aorta |
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What are the predominant sounds in the abdomen with percussion? What else can you hear?
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Tympani - fluid or air in gut
Dullness over organs or masses, resonance over lungs |
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What is Lloyd's sign?
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A symptom of renal calculus, consisting of pain in the loin on deep percussion over the kidney (costo-vertebral angle), even when pressure causes no pain.
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What is the Dance sign?
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Feel a sausage like bulge in the RLQ
Inspection of the right lower quadrant of the abdomen for retraction, which can be an indication of intussusception, i.e. those with intussusception may have retraction of the right iliac fossa. |
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Where do you ascultate the liver? How big should it be?
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midclavicular line – below nipple by one inch – will go from resonance to dullness- tympani at end –typically 6-12 inches
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Where do you find the spleen?
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midaxillary line – rib 4-10
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What are the three levels of palpation?
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Light (1cm)
Medium (>1cm- side of hand) Deep (>1cm – palm of hand) make sure to begin with light – bimanual deep (both hands) |
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What is the difference b/t Murphy's and Courvosier's sign?
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should not be able to feel gallbladder
- if you can and it hurts with deep breath + murphys sign (gall stones) Courvoisier – No pain but enlarged – bile duct compressed – could be pancreatic cancer |
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Compare McBurney and Rovsing signs
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McBurney = appendicitis – 1/3 distance from ASIS to umbilicus pain = positive
Rovosing- when opposite side of quadrant is compressed the appendix area is painful - same diagnosis, different way of testing |
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Typical TART findings for gallbladder problems are found where on the spine?
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T5-L2
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What is Psoas sign?
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Psoas is close to the appendix – pain her upon flexing can indicate appendicitis
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What is rebound tenderness?
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any place in abdomen that is compressed and when let go it hurts –could be peritonitis
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What is the difference b/t Visceral Pain, Parietal Pain & Referred Pain?
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- Visceral Pain - Poorly localized, gnawing, aching, burning, cramping - Parietal Pain - Precisely localized, aggravated by movement
- Referred Pain- Travels to other sites |
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What do you suspect with gradual onset of pain? Sudden onset?
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Gradual onset – infection, inflammation
Sudden onset – perforation, obstruction |
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What illness do you think of with cramping pain? Knifelike?
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Cramping – gall stones, gastroenteritis
Knifelike – appendix, pancreatitis |
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What is the timeframe and etiologies for acute and chronic symptoms?
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Acute ‐ < 2 weeks – think infectious
Chronic ‐ > 4 weeks – think noninfectious (IBD) |
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Poo poo that is frothy or foul smelling and floating is called . . . what diseases can cause this?
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Steatorrhea - High fat in stool – Sprue, pancreatic insufficiency
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If patient has indigestion what type of questions are pertinent?
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Character, Location, Associated with what?, Onset, What relieves it?, Medications, Nausea
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What arteries do you auscultate with the bell side?
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Listening for bruits on AA, renal artery, iliac artery, and femoral artery
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When listening to bowel sounds what is the necessary listening time before you can pronounce that there are no bowel sounds?
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2-5 minutes otherwise put hypoactive
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What type of things make a tympanic percussive noise?
What types of things result in a dull percussive sound? |
air filled viscera (liver, spleen)
Dull over solid organs |
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How should the liver feel?
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smoothe and non tender
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What is the scratch test?
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if you suspect liver mass, place diaphragm of stethoscope over upper margin of liver and lightly scratch below the anticipated lower edge of the liver
- scratch higher until sound is magnified by the mass |
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What are usually positive for appendicitis (physical tests)?
What is unique test for peritonitis? |
McBurney/s, Rovsings, Iliopsoas, obturator test
- heel jar test--> banging the bottom of the heel |
