Study Guide
Mid-term Comprehensive
Review Quiz 1 & 2 study guides as well as:
Week 6: Objectives:
1. To review the anatomy & physiology of the abdominal system
● 4 lays of large flat muscles
○ Linea alba- tendinous seam
○ Rectus abdominis
○ External oblique
● Viscera
○ Internal organs
○ Solid- maintain shape: liver, pancreas, spleen, adrenal glands, kidneys,
ovaries, uterus
○ Hollow- shape depends on content- stomach, gallbladder, intestine, and
colon
■ Not palpable
● RUQ
○ Liver, gallbladder, head of pancreas, right kidney and adrenal gland
hepatic flexure of colon, part of ascending and transverse colon
● LUQ
○ Stomach, spleen, left lobe of liver, left kidney, splenic flexure of colon ,
part of transverse and descending
● RLQ
○ Cecum, appendix, right ovary, right ureter, spermatic cord
● LLQ
○ Part of descending colon, sigmoid colon, left ovary tuber, left ureter, left
spermatic cord
● Midline
○ Aorta
○ Uterus
○ Bladder
○
2. To procure a history and physical of the patient with an abdominal complaint
Health history cues
■ Appetite, dietary changes
■ Dysphagia
, ■ Food
■ Intolerance
■ n/v
■ Abd pain, bowel habits
■ Blood in stool
■
Infants
● Colic, distention, poor feeding, vomiting, rigidity, changes in elimination
Pertinent negatives
● Signs of peritoneal irritation
● Markedly decrease or absent BS
● Involuntary guarding
● Pain < 48
● Pain followed by vomiting
● Advance age
● Prior surgery
1. To differentiate between normal and abnormal findings in the abdomen
● Inspection
○ Contour- flat, rounded, scaphoid, protuberant
○ Symmetry- tangential ligament
○ Normal- symmetric
○ Abnormal- bulges, masses, asymmetric shape, hernia, enlarged liver
● Umbilicus
○ Normal- midline, inverted no discoloration or inflammation/hernia
○ Abnormal- everted and ascites, mass, pregnancy,sunken, enlarged hernia
■ Cullen's sign- bluish periumbilical occurs with intra abd bleed
○ Infant
■ Umbilical cord- normal to be 2 inch thick
■ artery and vein
■ Hernia
● Skin
○ Symmetry- tumor, cysts, obstruction
○ Rectus abd muscle
■ Normal no ridge
○ Pigment and color
○ Scars
○ Infants
■ Round belly
■ Blood vessels and peristalsis
, ■ Diastasis recti may be noted
○ Pot Belly appearance in infants- malabsorption d/t celiac disease, cystic
fibrosis, constipation
○ Striae
■ Long stretch marks (pregnancy, cushing's, obesity, and ascites)
○ Pulsations
■ Marked aorta of AAA- HTN visible peristalsis, abd distention and
obstruction
○ Hair
■ Changes seen in endocrine or hormonal imbalance
○ Respiratory movement
■ 0 Abnormal - retractions- appendicitis, pancreatitis, biliary colic,
perf ulcer
○ Masses or nodules
○ Abn may indicate tumors
○ Umbilicus
■ Depressed or protruding, abn may be r/t hernia
■ Sisters mary joseph's nodule intra abd pressure
3. Identify the internal anatomy of the abdomen that can manifest as symptoms.
` AEIOU
■ Appendix
■ Ectopic
■ Inflammatory
■ Ovarian
■ Urinary
● Abdominal Wall Tenderness
○ Pain on palpation may arise from abdominal wall, parietal pain, peritoneum,
underlying visus
○ After finding tenderness apply hand over site have patient sit up with arms
crossed
○ If tenderness is increase it is AWT
■ Muscular strain
■ Viral myositis
■ Fibrositis
■ Nerve entrapment
■ Truma
.
, 4. Perform the special maneuvers for specific abdominal complaints that assist in
diagnosing.
● Rebound Tenderness - McBurney's point
○ Associated with peritoneal inflammation
○ Apply several sec of pressure and release quickly
○ Pain = + McB point associated with appendicitis
● Rovsing’s signs
○ Associated with peritoneal inflammation
○ Press deeply for 5 seconds in LLQ
○ Pain felt in RLT = appendicitis
● Murphy’s Point
○ Seen in cholecystitis
○ Palpate at inspiration at liver margin
○ Pain at inspiration = + murphy’s
● Iliopsoas muscle test
○ Associated with abdominal pain/ appendicitis
○ Irritation of the underlying lateral iliopsoas muscle
○ Place hand on R thiuigh and push down while raising leg
○ Pain in RLQ = + iliopsoas associated with appendicitis
● Obturator Test
○ Irritation of the obturator internus muscle
○ Flex r leg at hip and knee, rotate leg internally and externally
○ Pain in hypogastric area = + obstrutor sing with ruptured appendix
5. Review colorectal cancer risks and presentation
● Colorectal Cancer
○ Older age
○ AA highest incidence in the US
○ Jews of eastern european descent
○ Lifestyle: obesity, inactive lifestyle, smoking
○ Personal history
○ T2DM
● Risk factors
○ Strong family history of colorectal cancer
■ Cancer polyps in second degree of first degree relative
■ 2 or more first degree polyps
■ Need to know family history
Mid-term Comprehensive
Review Quiz 1 & 2 study guides as well as:
Week 6: Objectives:
1. To review the anatomy & physiology of the abdominal system
● 4 lays of large flat muscles
○ Linea alba- tendinous seam
○ Rectus abdominis
○ External oblique
● Viscera
○ Internal organs
○ Solid- maintain shape: liver, pancreas, spleen, adrenal glands, kidneys,
ovaries, uterus
○ Hollow- shape depends on content- stomach, gallbladder, intestine, and
colon
■ Not palpable
● RUQ
○ Liver, gallbladder, head of pancreas, right kidney and adrenal gland
hepatic flexure of colon, part of ascending and transverse colon
● LUQ
○ Stomach, spleen, left lobe of liver, left kidney, splenic flexure of colon ,
part of transverse and descending
● RLQ
○ Cecum, appendix, right ovary, right ureter, spermatic cord
● LLQ
○ Part of descending colon, sigmoid colon, left ovary tuber, left ureter, left
spermatic cord
● Midline
○ Aorta
○ Uterus
○ Bladder
○
2. To procure a history and physical of the patient with an abdominal complaint
Health history cues
■ Appetite, dietary changes
■ Dysphagia
, ■ Food
■ Intolerance
■ n/v
■ Abd pain, bowel habits
■ Blood in stool
■
Infants
● Colic, distention, poor feeding, vomiting, rigidity, changes in elimination
Pertinent negatives
● Signs of peritoneal irritation
● Markedly decrease or absent BS
● Involuntary guarding
● Pain < 48
● Pain followed by vomiting
● Advance age
● Prior surgery
1. To differentiate between normal and abnormal findings in the abdomen
● Inspection
○ Contour- flat, rounded, scaphoid, protuberant
○ Symmetry- tangential ligament
○ Normal- symmetric
○ Abnormal- bulges, masses, asymmetric shape, hernia, enlarged liver
● Umbilicus
○ Normal- midline, inverted no discoloration or inflammation/hernia
○ Abnormal- everted and ascites, mass, pregnancy,sunken, enlarged hernia
■ Cullen's sign- bluish periumbilical occurs with intra abd bleed
○ Infant
■ Umbilical cord- normal to be 2 inch thick
■ artery and vein
■ Hernia
● Skin
○ Symmetry- tumor, cysts, obstruction
○ Rectus abd muscle
■ Normal no ridge
○ Pigment and color
○ Scars
○ Infants
■ Round belly
■ Blood vessels and peristalsis
, ■ Diastasis recti may be noted
○ Pot Belly appearance in infants- malabsorption d/t celiac disease, cystic
fibrosis, constipation
○ Striae
■ Long stretch marks (pregnancy, cushing's, obesity, and ascites)
○ Pulsations
■ Marked aorta of AAA- HTN visible peristalsis, abd distention and
obstruction
○ Hair
■ Changes seen in endocrine or hormonal imbalance
○ Respiratory movement
■ 0 Abnormal - retractions- appendicitis, pancreatitis, biliary colic,
perf ulcer
○ Masses or nodules
○ Abn may indicate tumors
○ Umbilicus
■ Depressed or protruding, abn may be r/t hernia
■ Sisters mary joseph's nodule intra abd pressure
3. Identify the internal anatomy of the abdomen that can manifest as symptoms.
` AEIOU
■ Appendix
■ Ectopic
■ Inflammatory
■ Ovarian
■ Urinary
● Abdominal Wall Tenderness
○ Pain on palpation may arise from abdominal wall, parietal pain, peritoneum,
underlying visus
○ After finding tenderness apply hand over site have patient sit up with arms
crossed
○ If tenderness is increase it is AWT
■ Muscular strain
■ Viral myositis
■ Fibrositis
■ Nerve entrapment
■ Truma
.
, 4. Perform the special maneuvers for specific abdominal complaints that assist in
diagnosing.
● Rebound Tenderness - McBurney's point
○ Associated with peritoneal inflammation
○ Apply several sec of pressure and release quickly
○ Pain = + McB point associated with appendicitis
● Rovsing’s signs
○ Associated with peritoneal inflammation
○ Press deeply for 5 seconds in LLQ
○ Pain felt in RLT = appendicitis
● Murphy’s Point
○ Seen in cholecystitis
○ Palpate at inspiration at liver margin
○ Pain at inspiration = + murphy’s
● Iliopsoas muscle test
○ Associated with abdominal pain/ appendicitis
○ Irritation of the underlying lateral iliopsoas muscle
○ Place hand on R thiuigh and push down while raising leg
○ Pain in RLQ = + iliopsoas associated with appendicitis
● Obturator Test
○ Irritation of the obturator internus muscle
○ Flex r leg at hip and knee, rotate leg internally and externally
○ Pain in hypogastric area = + obstrutor sing with ruptured appendix
5. Review colorectal cancer risks and presentation
● Colorectal Cancer
○ Older age
○ AA highest incidence in the US
○ Jews of eastern european descent
○ Lifestyle: obesity, inactive lifestyle, smoking
○ Personal history
○ T2DM
● Risk factors
○ Strong family history of colorectal cancer
■ Cancer polyps in second degree of first degree relative
■ 2 or more first degree polyps
■ Need to know family history
