Abdominal Assessment Flashcards
(60 cards)
1
Q
Mild, Moderate and Life-Threatening Abdominal Conditions
A
Mild - flatulence, indigestion, constipation, diarrhoea, food poisoning
Moderate - appendicitis, gallstones, kidney stones, irritable bowel syndrome (IBS), period pain
Life threatening - Peritonitis, AAA
2
Q
5 Categories of Diagnosis
A
- Gastrointestinal (GI)
- Gynaecological
- Medical
- Urological
- Vascular
3
Q
Environmental Factors
A
- Evidence of smoking indicates potential peptic ulcers, cancers. Liver damage.
- Medications pertinent to GI/urinary conditions
- Receptacles containing vomit eg coffee grounds meaning bleeding
- Long term alcohol use - liver, kidney and digestive tract damage
- Smells suggesting gastrointestinal, urinary upsets UTI, or diarrhoea
4
Q
ABCDE Assessment; A
A
Patency of airway can be affected by the risk of aspiration of gastric contents. Obstruction of airway can be caused by vomiting, bleeding (oesophageal varices and ruptured peptic ulcers).
5
Q
ABCD Assessment; B
A
Note: pain will increase resp rate. Hypoventilation can be caused by vomiting and excessive loss of gastric HCl.
Can you smell hepatic foetor on their breath (indicative liver disease and smells like pear drops)
Possible damage to diaphragm can result in contents of gastric space entering the thoracic space eg hiatus hernia.
6
Q
ABCD Assessment; C
A
- Are they complaining of blood in their urine (haematuria), stool (melena), vomit (haematemesis)
- Damage trauma to the spleen, liver and underlying blood vessels lead to exsanguination of the patient. Consider MOI.
- Do they appear jaundices (assc w/ increased levels of bilirubin circulating due to liver conditions and haemolytic anaemia infection)
- Is the pt severely dehydrated?
- Positioning eg pancreatitis can’t lay flat, can’t get comfortable or limit movements at all
7
Q
ABCD Assessment; E
A
- Look for scars, pulsations (aneurysm), masses, distension, striae (stretch marks), hernia, bruising.
- Look for bruising patterns i.e. seat belt.
- When assessing trauma look for 3 anatomical areas; abdominal cavity, pelvis, retro-peritoneal area
8
Q
Signs of Haematemesis (Different Types)
A
- Dark coffee grounds - blood that’s been partially digested by gastric juices after being in the stomach for some time
- Fresh haematemesis (bright red blood) will be due to recent bleeding eg oesophagus, mouth, respiratory system.
9
Q
Causes of Haematemesis
A
- Causes; blood-thinning medications (anti-coagulants), digestive tract cancers, oesophageal varices, peptic ulcers
10
Q
Haematuria (At the start)
A
The blood can occur at the start of micturition (the action urinating) this is assc w/ urethral disease while haematuria that occurs at the end of micturition then it may be due to the prostate or bladder
11
Q
Haematuria (Causes)
A
- Other cause includes glomerulonephritis (inflammation of the glomerulus in the kidney’s nephron) which may be due to infection or long term use of non-steroidal anti-inflammatory drugs (NSAID).
- Cancer anywhere along the urinary tract, kidney and bladder stone and the use of medication that thins blood are causative factors
12
Q
Melena (where, how much is lost through it?)
A
Usually occurs because of upper gastrointestinal bleeding, seldom due to the small intestines/ascending colon.
Melaena signifies 60ml of blood in the gastrointestinal tract (oesophagus, stomach or duodenum)
13
Q
Melena (what is it, causes)
A
- Seen as black tarry stools with an offensive smell.
- Haematochezia can be described as red or maroon coloured stools due to fresh blood assc w/ rectal bleeding
- Causes include; peptic ulcers, gastritis, oesophageal/gastric varices, reflux oesophagitis or tears due to retching and vomiting
14
Q
Dehydration (Signs and Symptoms, other causes)
A
- Dry parched mouth, dry tongue. Eyes should be glistening
- Skin turgor losing causes tenting. Should take 1-2 seconds to spring back.
- Note other causes of dehydration; diabetes, diarrhoea, emesis, fever, hypovolaemia, weight loss, connective tissue disorders
15
Q
GI Problems (6)
A
- Abdominal pain
- Appetite or weight changes
- PR bleeding, melena
- Changes in bowel habits; diarrhoea, constipation
- Mouth ulcers, dysphagia, indigestion, dyspepsia
- Pruritus, dark urine, pale stools
16
Q
GU Problems
A
- Fever
- Loin pain, dysuria, haematuria
- Menses
- Menarche (the first appearance of menstruation)
- Menopause
- Painful intercourse, dyspareunia
- Urethral or vaginal discharge
17
Q
Abdominal Assessment PMH
A
- Hx of GI/GU problems? ulcers, gallbladder disease, inflammatory bowel disease, jaundice, hepatitis, UTI’s, renal colic, gout, analgesic use, hypertension, GI bleeding.
- Recent surgery?
- Consider menstrual cycle in women
18
Q
Abdominal SH/FMH
A
- Alcoholism
- Colon Cancer
- Crohns disease
- Diabetes
- IBS
- Jaundice
- Polyps
- Stomach ulcers
- Ulcerative colitis
19
Q
Questions If Vomiting w/ Abdo Pain
A
- Did the vomiting precede the pain
- Did they feel nauseous before they vomited?
- Frq - how many times have they vomited?
- Consistency/character of vomit; watery, bile, faecal, blood, coffee dreg particles
20
Q
Question to Ask Elderly Pt’s
A
- Has the pt recently changed their lifestyle? giving up smoking can cause constipations
- Is their abdomen distended?
- Does the pt have an absolute constipation assc w/ ‘colicky’ pain
21
Q
GI Bleed Risk Factors
A
- Hx of NSAID use
- Does the pt take beta blockers or calcium channel blockers (masks tachycardia in shocked pt’s)
- Does the pt take iron tablet/had food that dye’s stool?
- Hx of anti-coagulant or anti-plantlet therapy?
- Hx of liver disease/abdominal surgery or alcohol use?
22
Q
Suspected GI Bleed Thoughts/Questions
A
- Did the haematemesis present after an increase in intra-abdominal pressure (from retching/couching), did you have several episodes of non-bloody emesis?
- What is the character and quantity of blood loss?
- Does the visible bleed originate from the upper or lower GI tract?
- When did the bleeding begin?
- Unexplained syncope?
23
Q
Effect of Drugs and Medication
A
- Some medication will cause GI issues eg antibiotics causing diarrhoea, pain killers causing constipation.
- Does the pt have treatment that affects other systems? eg furosemide causes XS urinating, antibiotics leading to thrush
- Are they using steroidal or NSAID’s, contraceptive pill?
- Recent dietary changes? Change to high fibre diet can present w/ a swollen abdomen and excessive flatulence
24
Q
Overview - how pt should be for assesment
A
Pt should be lying flat, arms at their sides, using the Inspection, Auscultation, Palpation, Percussion. (Palpating will affect bowel sounds)
25
Inspection
- Symmetrical?
- No protrusions? Bulges may be due to distension of the bladder above the level of the symphysis pubis, if low on abdomen may be due to hernia.
- The bulge or mass may pulsate suggesting AAA
- Examine for rashes, dilated veins, jaundice
26
5 F's (Causes of Distension)
*Flatus* - or gas in intestinal tract
*Faeces* - can be palpated on lower left quadrant, should be soft on palpation
*Foetus* - Requires hx of activity, contraception and menstrual cycle
*Fat* -
*Fluid* - ascites, ovarian cyst
27
What is the Cough Test?
Ask pt to cough; if it causes pain, flinching, move hands to protect. All positive signs for peritonitis
28
Trauma Signs
**Cullen’s sign** - bruising around the umbilicus
**Grey Turners sign** - bruising along the flank due to retroperitoneal bleeding. (indicative of blunt force haemorrhage, aortic leaking, pancreatic or renal bleeding)
29
What can Auscultation tell you?
Information about bowel sounds, movement of fluid and gases.
30
What Does Abscent Bowel Sounds Mean?
Absent Bowel Sounds - Also known as ileus (where the intestinal muscle ceases movement and bowels remain in situ, presenting the same problems found with a bowel obstruction). Various conditions can lead to this but important to evaluate considering the accumulation of gas, secretions and intestinal contents can rupture the bowel wall. Absent sounds often indicate constipation.
31
How often to Auscultate
Auscultate on each section for 15 seconds on a 4th of each quadrant overall for 2 minutes for all 4
32
Meaning of Hypoactive Bowel Sounds
Indicates a slowing of intestinal activity. Normal when asleep. May suggest bowel obstruction, peritonitis. Narcotics can slow bowel movements.
33
Meaning of Hyperactive Bowel Signs
Increased intestinal activity (loud and high-pitched). Assc w/ progressive bowel obstruction, large amounts of fluid and gas accumulation in the bowel. Also assc w/ diarrhoea, hunger.
34
Auscultation w/ Liver Disease
- Auscultate at the **hepatic bruits** listening for the renal, iliac and femoral arteries as well as the aorta. Renal artery stenosis may be the cause of hypertension.
- Auscultate for flow bruits over the femoral arteries, as pts with intermittent claudication (leg cramp caused by artery obstruction) may have become narrowed due to **atheroma**
35
How to Palpate
- Initially lightly palpate (1-2cm). Merely flex your fingers to press your fingertips into their abdomen
- The abdomen should be soft to touch with no tenderness
- Then palpate deeper at 4-6cm (depending on obesity level)
36
Tenderness and Rebound Tenderness Meaning
**Tenderness** - this can be superficial, deep or rebound
**Rebound Tenderness** - occurs from movement of inflamed viscera of peritonitis against parietal peritoneum. Quickly release skin to test for this.
37
Meaning of Guarding and Rigidity
**Guarding** - reflex contraction of the abdominal muscles as you palpate
**Rigidity** *-* sustained tension of abdominal muscles which become hard and inflexible (indicative of **peritonitis**)
38
Identifying Pulsatile Masses
- Should identify which organs are enlarged or tender, masses and whether these are solid or pulsatile
- Locating pulsatile masses while palpating requires careful consideration for the need of deep palpation. This can lead to damage to weak arterial walls and contained masses becoming an exsanguinating haemorrhage
- Palpation of a suspected peritonitis can cause pain and a rupture of an inflamed organ
39
Purpose of Percussion
Purpose is to discover borders between organs, their size, density and location. If they contain air or fluid.
40
Wave/Fluid Thrill Test
- To do a fluid wave/fluid thrill test you’ll need the assistance of a colleague. Pt should be lying flat, while a colleague presses down on the midline of the abdomen
- The Paramedic then places one hand on one side of the pts abdomen and taps or flicks the other side with their other hand. The fluid wave or thrill should feel similar to a tap or ripple.
41
What are Hollow, Dull Organs? What Organs can you Percuss
- Hollow organs produce tympany like the sound of a drum. Solid organs produce dull sounds
- Dullness may be due to faces, fluid or a solid mass eg dullness over ovaries = ovarian cyst
- Can percuss the stomach to ascertain if there is air in it
- Can percuss the size of the liver and spleen
- Percuss several directions away from tympany or resonance to outline edges
- In LUQ, a large dull area suggests splenomegaly
42
NICE Guidelines of What to Take In
- Cholelithiasis and cholecystitis
- Constipation
- D&V
- Diverticular disease
- Faecal incontinence
- GORD/Barret's Oesophagus
- Haemorrhoids/other anal problems
- Hernia
- Inflammatory bowel disease
- IBS
- Lower gastrointestinal lesions
- Oesophageal/pancreatic/stomach cancer
- Pancreatitis
- Upper GI bleeding
43
Right Upper Quadrant (RUQ)
- **Cholecystitis**
- Duodenal ulcer
- **Hepatitis**
- **Appendicitis**
44
Epigastric
- Pancreatitis
- MI
- Peptic ulcer
- Cholecystitis
- Perforated oesophagus
45
Left Upper Quadrant (LUQ)
- Ruptured spleen
- Gastric ulcer
- Aortic aneurism
- Perforated colon
- Pyelonephritis
46
Right Lower Quadrant (RLQ)
- Appendicitis
- Salpingitis
- Ovarian Cysts
- Ectopic pregnancy
- Kidney/Ureteric stone
- Strangulated hernia
- Chron’s diseas
47
Umbilical
- Intestinal obstruction
- Pancreatitis
- Early appendicitis
- Mesenteric thrombosis
- Aortic aneurysm
- Diverticulitis
48
Left Lower Quadrant
- Sigmoid diverticulitis
- Salpingitis
- Ovarian abscess
- Ectopic pregnancy
- Strangulated hernia
- Perforated colon
- Chron’s disease
- Ulcerative colitis
- Renal/ureteric stone
49
What is Cholecystitis
Inflammation of the gallbladder. Pain present in upper right quadrant or epigastric pain.
50
Cholecystitis; Signs and Symptoms
- Diarrhoea
- Fever
- Nausea and/or vomiting
- RUQ pain
- Pain is constant and severe
- May occur after eating greasy or fatty foods
- Pain may radiate to the right flank or right scapular regions
51
What is Appendicitis
Inflammation of the appendix. Pain starts in the umbilicus to the right lower quadrant. Coughing increases (pattern more common in elderly people)
52
Appendicitis; Signs and Symptoms
- Constipation
- Diarrhoea
- Early voluntary guarding may be replaced by involuntary muscular rigidity
- Loss of appetite
- Localised tenderness
- Nausea
- Right sided rectal tenderness
- Vomiting
53
What is an Ectopic Pregnancy?
Egg is implanted outside the uterus. Pt can show general signs of pregnancy eg missed periods, enlarged/tender breasts. The egg expands, putting pressure on the tubes, can rupture which can be life threatening.
54
Ectopic Pregnancy; Signs and Symptoms
- Early symptoms of pregnancy
- Hypotension
- Light headedness, transient LOC, syncope
- Pain in lower back
- Pelvic pain (typically severe, sharp)
- Pay have shoulder tip pain
- Spotting or abnormal bleeding; lighter/heavier/prolonged. Often darker and watery
55
Causes of Intestinal and Bowel Obstruction
Causes may be mechanical or due to compromised blood supply. History is important.
56
Small Bowel Obstruction; Signs and Symptoms:
- Abdominal distension
- Central colicky pain
- History of abdominal surgery with assc scars
- Vomiting
57
Large Bowel Obstruction (tense and tympanic on percussion)
- Absent bowel sounds
- Abdominal distention (tense and tympanic on percussion)
- Changes in bowel habit and bleeding per rectum may suggest carcinoma
- Constipation
- Vomiting is more likely to be a late sign
58
What is Pancreatitis?
Acute inflammation of the pancreas. Usually presents with epigastric pain/tenderness radiating through back and vomiting. In the case of gallstones, there may be jaundice.
59
What is Pancreatitis Caused by?
- Alcohol
- Gallstones
- Idiopathic
- Trauma-related, generally blunt
60
Trauma
- Care should be taken not to put dressings that will stick to abdominal organs though covering the wound will stop infection.
- Don’t remove impaled objects
- Asses for signs of shock.
- Assess for potential damage to diaphragm or vascular damage
- Do not push eviscerated organs into the abdominal cavity, cover and keep moist and warm
- Signs and Symptoms of shock must be considered, as internal haemorrhage can be masked until the signs of decompensation are observed
