Physical Exam - Abdomen

Front 1

What is the scratch technique for auscultating liver borders?

Back 1

Place stethoscope over the liver.
With the finger of your other hand, scratch abdominal surface lightly, moving toward liver border.
When you encounter the liver, the sound will intensify.

Front 2

What causes a venous hum heard during ausculation of the abdomen?

Back 2

Increased collateral circulation between portal and systemic venous systems causes this sound in the abdomen

Front 3

What is Kehr's sign?

Back 3

Pain in at the lower neck/supraclavicular area due to phrenic irritation (of the diaphragm)

Front 4

What types of stimulus or irritation are sensed by the somatic innervation of the abdomen?

Back 4

1. Themal
2. Tactile
3. Chemical

Front 5

What types of stimulus or irritation are sensed by the visceral innervation fo the abdomen?

Back 5

1. Distension
2. Ischemia
3. Mesenteric traction

Front 6

Pain from the foregut is referred to what abdominal region and dermatomes?

Back 6

Abdominal region = epigastrium
Dermatomes = T6-8

Front 7

Pain from the midgut is referred to what abdominal region and dermatomes?

Back 7

Abdominal region = Periumbilical
Dermatomes = T9-T10

Front 8

Pain from the hindgut is referred to what abdominal region and dermatomes?

Back 8

Abdominal region = Hypochondrium
Dermatomes = T11-L1

Front 9

Renal and urethral pain is referred to what abdominal regions and dermatomes?

Back 9

Abdominal regions = Flank and Groin
Dermatomes = T9-L2

Front 10

What organ are included in the foregut?

Back 10

Distal esophagus
Stomach
Duodenum
Biliary
Pancreas

Front 11

What organs are included in the midgut?

Back 11

Small bowel
Appendix
Proximal colon

Front 12

What organs are included in the hindgut?

Back 12

Distal colon
Rectum

Front 13

In what abdominal region does the pancreas lie?

Back 13

Epigastric
L hypochondriac (tail of pancreas)

Front 14

In what abdominal regions are the ascending and descending colons located?

Back 14

Ascending - usually the R Lumbar
Descending - usually the L Lumbar

Front 15

What is Cullen sign? What does it indicate?

Back 15

Bluish periumbilical discoloration that suggests intraabdominal bleeding.

Front 16

Describe the normal direction of venous return in the abdomen.

Back 16

Above the umbilicus - flow should be towards the head
Below the umbilicus - flow should be towards the feet

Front 17

List nine possible causes of abdominal distention.

Back 17

Fat, Fluid, Feces, Fetus, Flatus, Fibroid, Full bladder, False pregnancy, Fatal tumor

Front 18

What is the best procedure to listen for a hepatic friction rub? What is heard if the friction rub is present?

Back 18

Use diaphragm of stethoscope
Listen for high pitched sounds heard in association with respiration

Front 19

Where does the upper border of the liver normally begin?

Back 19

5th to 7th RICS

Front 20

What is the normal span of the liver at the midclavicular line?

Back 20

6-12 cm

Front 21

What is the normal span of the liver at the midsternal line?

Back 21

4-8 cm

Front 22

Where is a normal-sized spleen usually located?

Back 22

From the 6th to 10th ribs
6th-9th RICS

Front 23

What does involuntary rigidity of a portion of the abdominal wall indicate?

Back 23

Underlying area of peritoneal irritation

Front 24

What are three ways to overcome the ticklishness of a patient during the abdominal exam?

Back 24

1. Place the patient's hands below yours on the abdomen
2. Begin palpation with the stethoscope
3. Place one hand on a non-ticklish body part to divert attention

Front 25

What are two methods of testing for cutaneous hypersensitivity? What is the purpose of this test?

Back 25

1. Lift skin away from underlying muscle
2. Stimulate skin with a pin
Purpose = pt will perceive pain in the cutaneous zone corresponding to a specific organ in the abdomen