July 7, 2009 | In: GENERAL TOPICS
PHYSICAL EXAMINATION
7. Are vital signs important?
Show answer
Yes. They are vital. If heart rate and blood pressure are on the wrong side of 100 (heart rate > 100 beats/min, systolic blood pressure < 100 mmHg), watch out! Tachypnea (respiratory rate >16) reflects either pain or systemic acidosis. Fever may develop late, particularly in the immunosuppressed patient who may be afebrile in the face of florid peritonitis.
8. What is rebound?
Show answer
The peritoneum is well innervated and exquisitely sensitive. It is not necessary to hurt the patient to elicit peritoneal signs. Depress the abdomen gently and release. If the patient winces, the peritoneum is inflamed (rebound tenderness).
9. What is mittelschmerz?
Show answer
Mittelschmerz is pain in the middle of the menstrual cycle. Ovulation frequently is associated with intraperitoneal bleeding. Blood irritates the sensitive peritoneum and hurts.
10. What do bowel sounds mean?
Show answer
If something hurts (e.g., a sprained ankle), the patient tends not to use it. Inflamed bowel is quiet. Bowel contents squeezed through a partial obstruction produce high-pitched tinkles. Bowel sounds are notoriously unreliable, however.
11. Explain the significance of abdominal distention.
Show answer
Distention may derive from either intraenteric or extraenteric gas or fluid (worst of all, blood). Abdominal distention is always significant and bad.
12. Is abdominal palpation important?
Show answer
Yes. Remember, the patient is (or should be) the surgeon’s friend. There is no need to cause pain. Palpation guides the surgeon to the anatomic zone of most tenderness (usually the diseased area). It is best to start palpation in an area that does not hurt. Rectal (test stool for blood) and pelvic examinations localize pathology further.
13. What is Kehr’s sign?
Show answer
The diaphragm and the back of the left shoulder enjoy parallel innervation. Concurrent left upper quadrant and left shoulder pain indicate diaphragmatic irritation from a ruptured spleen or subdiaphragmatic abscess.
14. What is a psoas sign?
Show answer
Irritation of the retroperitoneal psoas muscle by an inflamed retrocecal appendix causes pain on flexion of the right hip or extension of the thigh.
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