Question 1

What is the difference between acute abdominal pain and acute abdomen?

Accepted Answer

Acute abdominal pain is defined as pain lasting less than seven days and can have many causes. Acute abdomen, by contrast, refers to the abrupt onset of severe pain with features suggesting a surgically intervenable process. Understanding this distinction is critical because acute abdomen requires urgent surgical evaluation, while acute abdominal pain requires systematic diagnostic assessment.

Question 2

How should you position and prepare a patient before beginning an abdominal examination?

Accepted Answer

Request the patient to change into a gown and wash your hands thoroughly. Have the patient lie down and observe their position, noting if they prefer to lie still with flexed hips and knees, which may indicate peritonitis. Place a drape over the lower body below the pubic symphysis and raise the gown just below the breasts to expose the abdomen for examination.

Question 3

What is the systematic sequence for performing an abdominal examination?

Accepted Answer

Follow an organized approach involving inspection, auscultation, percussion, and palpation. Begin with inspection, noting distension and skin changes. Then auscultate the left lower quadrant for bowel sounds. Follow with light and moderate percussion over the four quadrants. Finally, perform palpation starting remotely from the site of tenderness, moving systematically toward the tender region while thinking about underlying anatomy.

Question 4

What maneuvers help localize peritoneal pain during abdominal examination?

Accepted Answer

Ask the patient to point to the painful area, then instruct them to cough purposefully. If coughing is difficult, gently bump the examination table. Both maneuvers help localize peritoneal pain by reproducing discomfort. Light percussion over the four quadrants can also distinguish peritoneal pain from visceral pain and help identify abnormal findings.

Question 5

What is Murphy's sign and when should it be tested?

Accepted Answer

Murphy's sign is a maneuver used to detect acute cholecystitis in patients with right upper quadrant pain. Palpate the patient in the right mid-clavicular line just below the liver edge and ask them to take a deep breath while applying deep pressure. Pain accompanied by cessation of inspiration suggests acute cholecystitis and indicates the need for further imaging.

Question 6

How do you perform Rovsing's sign to assess for appendicitis?

Accepted Answer

Rovsing's sign is performed by deeply palpating the left lower quadrant. If the patient refers pain to the right lower quadrant during this maneuver, acute appendicitis is suspected. This indirect palpation technique helps identify peritoneal irritation in the right lower quadrant without directly pressing on the inflamed appendix.

Question 7

What does the Carnett test distinguish in abdominal pain assessment?

Accepted Answer

The Carnett test distinguishes between abdominal wall pathology and intraperitoneal pathology. While supine, palpate the point of maximum pain with moderate pressure, then ask the patient to raise their shoulders as if doing a sit-up to contract abdominal wall muscles. Increased pain suggests abdominal wall pathology, while attenuated pain suggests intraperitoneal pathology.

בדיקת בטן 4: הערכת כאבי בטן חריפה - חידון הערכה