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PD Abdominal


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What are the components of the alimentry tract from oropharynx to anus?
oropharynx, esophagus, stomach, small intestine, large intestine, sigmoid colon, rectum, anus
What are the components of the small intestine?
Duodenum, Jejunem, IIeum, IIeocecal Valve
What are the components of the large intestine?
Cecum, Veriform appendix, Ascending colon, Transverse colon, Descending colon, Sigmoid colon, Rectum
Define Gastritis.
Inflammation of the stomach lining.
Define Colitis.
Inflammation of the large bowel.
Define Enteritis
Inflammation of the small intestine.
What are risk factors for Hep A
international travel, household/sexual contacts, living in epidemic areas, outbreaks, employees or attendees of day care centers.
Risk factors for Hep B
Health care workers via needle sticks, drug user, household/sexual contacts, mothers tranmission to infants.
Risk factors for Hep C
Transfusions, health care workers, household/sexual contacts
What are the land marks to devide the abdomen in to four quadrants
Vertical is xiphoid process to pubic symphysis.

Horizontal is transverse through umbilicus.
What is the order of examination for the abdomen?
What is Caput Medusa?
Dilated superficial veins radiating from the umbilicus.
What type of pt. will have visible pulsations that are considered normal?
Thin patients
A pearl like periumbilical nodule may indicate what?
Intra abdominal lymphoma/cancer also know as a "Sister Mary Joseph's Nodule"
A scaphoid abdominal contour would be seen in what type of Pt.
Thin Pt.
A rounded abdominal countour would be indicative of what in a Pt.
Poor abdominal muscle tone
Flat abdominal contour would be seen in what type of Pt.
Athletic Pt.
What are the 9 "F's" of distention?
1. fat 2. feces
3. flatus 4. fluid (ascites)
5. fetus 6. fatal tumor (typically ovarian)
7. fibroid (uterine muscle tumor) 8. full bladder 9. false pregnancy
Why is auscultation performed before palpation?
Palpation stimulates bowel sounds.
Increased or hyperactive bowel sounds are heard when?
gastroenteritis, early bowel obstruction, hunger
These type of bowel sounds are heard in peritonitis and paralytic ileus.
Decreased bowel sounds
What causes high pitch tinkling bowel sounds
Fluid and air under pressure this is indicative of intestinal obstruction.
If while ascultating you listen to and abdomen for 5 minutes and hear nothing the dx is.
Absent bowel sounds
Define Borborygmi
Long, stomach growling
What is a Venus Hum?
A soft low pitched and continuous sound heard with the bell at the umbilicus.
Define friction rub.
High pitched sound produced by movement of organs associated with respiration.
What produces tympanic percussion notes in the abdomen?
Gastric air bubble or air filled bowels.
What produces dull percussion notes in the abdomen?
Stool, tumor, liver, spleen.
What can produce excessive tympany in the abdomen.
An obstruction or Pneumoperitoneum
What can produce generalized dullness in the abdomen?
Ascites (fluid) or a huge mass
CVA tenderness indicates abnormality of what organ?
The Kidney
How do you relax abdominal muscles when performing palpation
Have Pt. flex their knees.
What motion is avoided durnig palpation of the abdomen, and why?
Avoid short quick jabbing motions, because they cause pain in a otherwise normal Pt.
What is the purpose of light palpation?
It identifies areas of tenderness and resistance.
What is the pupose of deep palpation?
It thoroughly delineates (outlines) abdominal organs, deep masses, and colonic feces.
What type of palpation is useful for obese Pts.
Deep palpation.
What normal findings can be mistaken for an abdominal mass?
Soft, round, boggy mass of feces in colon or the lateral border of rectus abdominus. Also the uterus and the aorta can be mistaken too.
Describe the hooking technique.
Hook fingers under anterior costal angel of ribs, have Pt. inspire, and feel for edge of liver as it descend with the diaphragm
When a Pt. contracts their abdominal muscles and lifts their head an abdominal mass is still present. This mass would be called?
What type of Pt. is the hooking technigue helpful for?
Obese Pt.
The most likely dx for a prominent lateral pulsation or pulsitile mass in the abdomen along the MSL is.
AAA Abdominal Aortic Aneurysm
What causes splenomegaly?
trauma, infectious mono, viral hepatitis, some anemias.
What is ascites?
Fluid in the peritoneal cavity
This is seen on inspection with pt. with ascites?
Glistening taunt skin and bulging flanks.
What may be seen and heard on percussion and palpation of the abd. in a pt. with ascites?
Shifting dullness, fluid wave, puddle sign.
What is the difference between gaurding and rigidity?
Gaurding voluntary
Rigidity involuntary
What is Blumberg sign?
Pain worse with release than intial pressure.
What is Rovsing sign?
Press in LLQ positive is pain in RLQ.
What is McBurney sign?
Pain with pressure at McBurney's point.
Where is McBurney's point?
1.5 - 2 inches from ASIS on a straight line to the umbilicus.
What is Iliopsoas sign and what is positive.
Pt supine place hand on right knee apply counterpressure when pt raises leg.
Positive is pain RLQ.
What is the obturator muscle test and what is positive?
Pt. supine knee and hip flexed and 90 degree rotate leg lateral and medial.
Positive is when Pt has hypogastric pain.
What is a Murphy's sign and what is positive?
Pt. supine palpate RUQ at costal margin and have pt. take deep breath.
Positive is abrupt cessation of inspiraton.
What is Gray Turner sign and what does it indicate?
Eccymosis at flanks indicates retroperitoneal bleeding.
What is Cullen sign and what does it indicate?
Eccymosis around the umbilicus and indicates hemoperitoneum, hemorrhagic pancreatitis, ruptured ectopic pregnancy.
What is Kehr sign?
Abd pain radiating to left shoulder.
What is Romberg-Howship sign?
What is it seen in?
Pain along medial aspect thigh to knee and seen with strangulated obturator hernia.
Describe Markle heel jar sign and what is pos.
Pt stand with straight knees and raised up on toes relaxes to allow heels to hit the floor.
Pos. is abd. pain indicitive of peritoneal irritation or appendicitis.
Define hiatal hernia?
Stomach protrude the diaphragm.
What line seperates rectum from the anus?
Pectinate line.
In terms of pain what is felt above and below the pectinate line?
Above no pain
Below pain
What is Ballottement used to assess?
Freely floating moveable ABD masses.
What are the risk factors for colon cancer?
over 50
personnal Hx of polyps, crohn disease, ulcerative collitis greater than 10 year duration
Diet high in beef and animal fat
low fiber
exposure to asbestos, acrylics and other carcinogens.
What are the risk factors for prostate cancer?
over 50
FHX prostate cancer
Diet high in animal fat
Large amounts of mucus in the stool indicates what disease?
Intestinal inflammation
Light tan clay or gray stool indicates what disease?
Hepatitis or Obstructive jaundice.
Fatty stool indicates what disease?
Pancreatic disease
Presistent pencil like stool could indicate what disease?
Rectal malignancy.
Name two position for DRE.
Left lateral decubitus with right hip flexed.
Erect with body supported by table.
What can laxity of the sphincter tone indicate.
a neuro defect.
On DRE what surface of the Prostate is palpated?
Posterior surface.
Define anal fistula?
Inflammatory sinus tract extending from anal skin to rectal mucosa.
What is a Perianal abscess?
Tender red swelling on the medial buttock.
Scenerio: 52 y/o male c/o frequency, nocturia, dribbling, decrease force of stream, and enlarged prostate on DRE. What is the dx?

1. Prostate carcinoma
2. Benign prostatic hypertrophy
Benign prostatic hypertrophy (BPH)
You can't diagnose carcinoma by DRE.
Can carcinoma be ruled out by DRE?
Hell no!

You need a biopsy Duh!
Painful defication with streaks of bleeding after constipation. Linear ulceration of mucosa on exam. What is Dx.
Anal fissure
Painful lump on buttocks with midline pitting/dimpling in gleutal cleft in TTP. What is the Dx?
Pilonidal cyst
Pain with defication no bleeding ternder swollen bluish ovoid mass. What is the Dx?
External Hemorrhoids.
Doughnut shaped mass of mucosa protruding through anal ring. What is the Dx?
Rectal prolapse.
BRBPR with non-tender moist mass protruding out of the anal canal. No pain,fever chills. What is the Dx.
Internal Hemorrhoids.
Extremely tender swollen prostate fever chills N/V. What is Dx?
Acute prostatitis.
Pain in Epigastric progresses to RLQ with anorexia low grade fever, pos. Rovsing, Pos. Markel, Neg. Murphy. What is the Dx.
Flank pain radiating to left shoulder high protein soda diet with CVA tenderness and hematuria. What is the Dx.
Renal Calculus.
Excruciating pain in the epigastric with fever, vomitting, Pos Grey Turner. What is the Dx?
Acute Pancreatitis.
RUQ pain, radiates to right scapula, Pos N/V, fever, and Pos. Murphy's sign. What is the Dx?
Sudden, severe pain in RUQ, Pt appears toxic, abd. contains free air with distension. What is the Dx.
Perforation of Gastric or Duodenal Ulcer.
Intense colicky flank pain radiating to testicle with dysuria. Frequency fever and hematuria. What is Dx?
Renal Calculus.
LLQ pain especially after eating refer to the back Pos or neg melena or BRBPR. What is the Dx?
Intense LUQ pain radiating to left shoulder after a fall or Hx of mono. What is the Dx?
Spleenic rupture.
Abrupt spasmodic pain refer to epigastrum/umbilicus N/V distension excessive tympany proximal absent bowel sounds (paralytic) hyperactive high pithched tinkling (mechanical). What is the Dx.
Intestinal obstruction.
What is in RUQ?
Head of Pancreas
Rt. Adrenal
Portion of Rt. kidney
Hepatic flexure of colon
Portion of ascending and transverse colon
What is in the LUQ?
Left lobe of liver
Body of Pancrease
Left Adrenal
Portion of Left kidney
Spleenic flexure of colon
Portion of transverse and descending colon
What is in the LLQ?
Lower pole of Left Kidney
Sigmoid colon
Portion of Descending colon
Left ovary/tube
Left spermatic cord
Left ureter
What is in the RLQ?
Lower pole of Rt. Kidney
Portion of Ascending colon
Rt. ovary/tube
Rt. spermatic cord
Rt. ureter.
What is a general term for a number of intraabdominal conditions requiring rapid surgical interventions?
Acute Abdomen
What is the preferred type of light for an abdominal exam?
A scar over RLQ would indicate what?
Define striae?
Stretch marks
Pink or blue striae are considered what type?
Recent/Acute Striae
Silver or white striae are considered what type?
Chronic Striae
What are 2 things to consider when using your stethoscope to auscultate the abdomen?
Warmth of stethoscope and placing light pressure upon auscultation
What question should you ask your patient prior to palpation?
Location of pain
When your patient complains of RLQ pain, what area should you palpate last?
RLQ (Always palpate area of tenderness LAST!)
How do you perform deep palpation of the abdomen?
Use 1 or 2 hands, firm and deep pressure
Which kidney is considered to be more palpable?
Right kidney
Kehr's sign is an indicator of what?
Ectopic pregnancy, ruptured spleen, and renal stones
What is the Aaron sign?
Pain or distress occurs in the area of patients heart or stomach on palpation of McBurney point
What is the length of the anal canal?
2.5-4 cm's
What is the average depth that is palpated on DRE?
6-10 cm's
What are the columns of Morgagni?
Columns of mucosal tissue that fuse to form the anorectal junction
What is a chronic inflammation of perianal skin that results in excoriation, thickening, and pigmentation?
Pruritus Ani (Pt's normally complain of burning or itching that may interfere w/ sleep. Commonly caused by fungal infection in adults and by parasites in children.

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