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Health Assessment final > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What should be included in the ROS?

A

When’s the last time you went to the bathroom?
- What’s normal for you?
When was the last time you ate?
Nausea/vomiting/diarrhea/constipation/abnormality in stool?
Pain?
Food allergies? What’s your diet like?
Last menstrual cycle/any chance you could be pregnant?
Have you had any abdominal surgeries?
When was your last colonoscopy? (Geared towards >50)
Colace or other medications that can affect GI? Iron supplements?
On any daily narcotics that could cause constipation?
Proton pump inhibitors?
GERD? IBS/IBD?

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2
Q

How is the abdomen divided during examination?

A

4 quadrants:

RUQ, RLQ, LUQ, LLQ

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3
Q

What organs are located in the RUQ?

A 
Liver
Gallbladder
Head of pancreas
Right kidney
Right adrenal
Hepatic flexure of colon
Part of ascending and transverse colon
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4
Q

What organs are located in the RLQ?

A 
Cecum
Appendix
Right ovary and tube
Right ureter
Right spermatic cord
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5
Q

What organs are located in the LUQ?

A 
Stomach
Spleen
Left lobe of liver
Body of pancreas
Left kidney
Left adrenal
Splenic flexure of colon
Part of transverse and descending colon
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6
Q

What organs are located in the LLQ?

A 
Part of descending colon
Sigmoid colon
Left ovary and tube
Left ureter
Left spermatic cord
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7
Q

Which is the largest and most palpable organ?

A

Liver

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8
Q

Where is the liver located?

A

The superior portion is about 5th ICS right side (RUQ)

Inferior portion sits around the right costal margin

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9
Q

Where is the stomach located?

A

Upper portion is around 5th or 6th ICS

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10
Q

Where is the pancreas located?

A

Behind the stomach

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11
Q

Where is the small intestine located?

A

R&LLQ

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12
Q

Where do the lower bowels dump into?

A

Cecum

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13
Q

What is usually in the cecum?

A

Liquid

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14
Q

Where is the appendix located?

A

RLQ

Sits by ascending colon

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15
Q

What does the transverse colon do?

A

Absorb water

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16
Q

Is the stool hard or soft in the descending/sigmoid colon and why?

A

Soft because water is absorbed

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17
Q

Where is the bladder located?

A

Suprapubic region

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18
Q

How many mL can the bladder hold before one feels the need to urinate

A

400-600 mL

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19
Q

How much fluid can the bladder hold?

A

~1L

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20
Q

Where is the uterus located?

A

Suprapubic region

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21
Q

What is peritonitis?

A

When the lining of the abdominal cavity is enflamed

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22
Q

What can cause peritonitis?

A

Ruptured appendix/ small/large intestines

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23
Q

What are general guidelines for abdomen assessment?

A 
Good lighting
Have pt empty bladder
Warm hands, stethoscope
Short fingernails
Warm room
Adequate covering
No shivering
Exposure from xiphoid process to the symphysis pubis
Ask if they have pain in the abd and point
- Examine tender areas last!!!
Watch pts face as you examine.
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24
Q

What is the sequence during the abd examination?

A

Inspection
Auscultation
Percussion
Palpation

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25
Q

What can happen if you palpate before you listen?

A

Peristalsis disruption

26
Q

How do you inspect the abdomen?

A

Have pt supine with one pillow under head, arms at sides, breath through mouth.

27
Q

What people have protuberant bellies?

A

Pregnant woman
Some alcoholics - some with liver disease develop ascites
Tumor or fatal growth

28
Q

What can cause distension?

A 
Six “F”’s 
Fluid
Fat
Flatulence
Feces
Fetus
Fatal growths
29
Q

What should you inspect the abdomen for?

A 
Contour
Distension
Umbilicus (contour, location, signs of hernia or inflammation)
Skin (scars, striae, dilated veins)
Symmetry of organs
30
Q

How does a tumor affect movement of the abdomen?

A

That section of the abdomen won’t move

31
Q

How can a bruit form in the abdomen?

A

Atherosclerosis

Abdominal aneurysm

32
Q

How do you auscultate the abdomen?

A

Listen with diaphragm in all 4 quadrants for 15 seconds
Make sure to hear bowel sounds in at least 1 quadrant
If you don’t hear during the first round, listen again
If you don’t hear this time, it’s considered absent bowel sounds -> will have other signs and symptoms/complaints (nausea, vomiting, bloating)

33
Q

What is borborygmi

A

String of bowel sounds

Can be normal of a sign of obstruction

34
Q

What types of sounds can indicate an early intestinal obstruction?

A

High pitched, tinkling, & splashing

35
Q

How can bowel sounds be categorized?

A

Normal, absent, hypoactive, or hyperactive

36
Q

When do you see hypoactive bowel sounds?

A

Seen in someone out of surgery

Someone on narcotics

37
Q

When do you see hyperactive bowel sounds?

A

Obstruction

38
Q

What are signs of peritonitis?

A

Guarding
Pain
Rebound tenderness

39
Q

Where is a venous hum heard?

A

Liver or upper abdomen

40
Q

What does a venous hum indicate?

A

Liver disease, hepatic cirrhosis

41
Q

What does it mean when you hear a friction rub over the spleen

A

Inflammation, or infarction

42
Q

What does it means when you hear a friction rub over the liver?

A

Primary or metastatic tumor. Causes grating sound.

43
Q

What is the sequence for listening for a bruit in the umbilicus region?

A

Aorta -> right renal artery -> left renal artery -> go below umbilicus -> right iliac artery -> left iliac artery -> right femoral artery -> left femoral artery

44
Q

How do you percuss the abdomen?

A

Percuss in all 4 quadrants

45
Q

When is dullness heard?

A

When percussing over dense abdominal organs, feces, or fluid

46
Q

When is tympany heard?

A

When percussing over air filled structures

Heard over most of the abdomen because stomach & bowel contain air & gas.

47
Q

How do you measure for the liver border?

A

Right MCL
Percuss down from breast - will hear resonance over lungs
Mark with pen when you hit dullness (around 5th or 6th ICS)
Go to umbilicus and MCL and start percussing up until you hear dullness - mark with pen
Measure
Normal size is 6-12 cm

48
Q

Where does the inferior portion of the liver sit?

A

Right costal margin

49
Q

How do you percuss the kidneys?

A

Take hand and put upside down over kidney
Tap with other hand
Percussing for tenderness, not sound

50
Q

What is rebound tenderness?

A

Not hurting when you press in and hurting when you let go

51
Q

When can rebound tenderness be present?

A

Peritonitis

52
Q

What is the process of palpating?

A

Light palpation then deep palpation

53
Q

What is a positive Rovsing sign?

A

When you press on LLQ and pain is increased on RLQ

54
Q

What could a + Rovsing sign indicate?

A

Appendicitis

55
Q

What is McBurney’s Point and where is it?

A

Point where the appendix is on the body

⅓ up from right superior iliac crescent to umbilicus

56
Q

What is a + Murphy’s sign?

A

Intense pain when you hook fingers under right costal margin of right costal angle

57
Q

What can a + Murphy’s sign indicate?

A

Cholecystitis

58
Q

Where is the gallbladder located?

A

RUQ

59
Q

How do you palpate for the liver?

A 
Stand to the right of the pt
Put left hand under small of back
Go up under right costal margin and put fingers under there
Have pt take deep breath
Run fingers along right costal margin
Cirrhosis of liver will feel ridgey
60
Q

How do you palpate for the kidneys?

A

Go to umbilicus and over to the side
Feel from front and back sides
Left hand underneath pt and right hand pressing down

61
Q

What does the CVA test look for?

A

Pyelonephritis, kidney tenderness

Health Assessment final (6 decks)

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