From the Guidelines
For COMLEX Level 2 testing on abdominal conditions, physical exam findings are crucial diagnostic tools, with Asterixis indicating hepatic encephalopathy, Cullen sign and Grey Turner sign suggesting retroperitoneal hemorrhage, and Murphy sign indicating gallbladder inflammation, as supported by 1.
Physical Exam Findings
- Asterixis: a flapping tremor of outstretched hands, indicates hepatic encephalopathy in liver disease
- Cullen sign (periumbilical bruising) and Grey Turner sign (flank bruising): suggest retroperitoneal hemorrhage, often seen in acute pancreatitis
- Fluid thrill or wave and shifting dullness: techniques to detect ascites, with the puddle maneuver being useful for small amounts of fluid
- Murphy sign: pain with deep inspiration during right upper quadrant palpation, indicates gallbladder inflammation
- Peritoneal signs: include rebound tenderness and guarding, suggesting peritoneal irritation from inflammation or infection
Laboratory Studies
- Elevated alkaline phosphatase: suggests biliary obstruction or bone disease
- Increased amylase and lipase: indicate pancreatic inflammation
- Bilirubin levels: help differentiate hepatocellular from obstructive jaundice
- Carcinoembryonic antigen: serves as a tumor marker for colorectal cancer monitoring
- C. difficile testing: essential for antibiotic-associated diarrhea
- H. pylori tests: diagnose gastric ulcer etiology
- Serum ascites-albumin gradient: differentiates portal hypertension from other causes of ascites
- Stool studies: identify infectious causes of diarrhea
- Antibody tests: help diagnose celiac disease
- Viral hepatitis panels: determine the specific virus causing hepatitis
Nutrition and Feeding Tubes
- Nutrition assessment: includes calculating basal energy expenditure and protein requirements
- Enteral feeding options: nasogastric, nasoduodenal tubes
- Parenteral nutrition: indications and management
- Calculating nutrition needs is crucial, as supported by 1, and should be based on individual patient requirements
Other Conditions
- Laxative abuse: presents with electrolyte abnormalities, dehydration, and metabolic alkalosis
- Infantile colic: manifests as paroxysmal crying in healthy infants, treated with reassurance and comfort measures
- Abdominal aortic aneurysms: present as pulsatile masses with risk of rupture, requiring surgical intervention based on size and symptoms, as supported by 1
- Abdominal trauma management: includes FAST exams and CT scans, with splenic lacerations potentially managed conservatively or surgically depending on hemodynamic stability and grade of injury, as supported by 1
From the Research
Physical Exam
- Asterixis: a type of negative myoclonus characterized by irregular lapses of posture of various body parts, initially described as a "liver flap" 2, 3
- Cullen sign: indicates hemorrhagic pancreatitis or other severe abdominal conditions
- Fluid thrill or wave: suggests ascites or fluid accumulation in the abdominal cavity
- Grey Turner sign: indicates retroperitoneal hemorrhage
- Murphy sign: suggests gallbladder disease or cholecystitis
- Peritoneal signs: indicate peritonitis or inflammation of the peritoneum
- Puddle maneuver: used to check for ascites
- Shifting dullness: suggests ascites or fluid accumulation in the abdominal cavity
Significant Findings
- Asterixis is an important sign in clinical neurology, with a rich history and unknown exact pathogenesis 2
- Asterixis has been associated with a wide range of potential causes, both in neurology and general medicine 3
- Alkaline phosphatase levels: elevated in bone or liver disease
- Amylase levels: elevated in pancreatitis
- Bilirubin levels: elevated in liver disease or hemolysis
- Carcinoembryonic antigen levels: elevated in certain types of cancer
- Clostridium difficile testing: used to diagnose C. difficile infection
- Helicobacter pylori stool antigen or breath tests: used to diagnose H. pylori infection
- Lipase levels: elevated in pancreatitis
- Serum ascites-albumin gradient: used to diagnose ascites
- Stool culture: used to diagnose bacterial infections
- Stool for ova and parasites: used to diagnose parasitic infections
- Tissue transglutaminase antibody or antimicrobial antibody levels: used to diagnose celiac disease or other autoimmune disorders
- Viral hepatitis panels: used to diagnose viral hepatitis
Other Conditions
- Laxative abuse: characterized by excessive use of laxatives, leading to electrolyte imbalances and other complications
- Infantile colic: characterized by excessive crying in infants, with unknown cause and various treatment options
- Pulsatile masses and AAAs: characterized by abnormal blood flow or aneurysms in the aorta, requiring prompt diagnosis and treatment
- Abdominal trauma: requires prompt evaluation and treatment, including management of spleen lacerations
- Nutrition and calculating nutrition needs: involves assessing individual nutritional requirements and developing a personalized plan
- Feeding tubes and TPN: used to provide nutrition to patients who are unable to eat or absorb nutrients through the digestive system 2, 3