abdominal assessment and management

Question 1

why do we need to assess an abdomen

Answer 1

gi/gu problems

Question 2

what are we assessing abdo for

Answer 2

pain
swelling
abnormalities

Question 3

how to we assess abdomen

Answer 3

IAPP
inspection
auscultation
percussion
palpation

Question 4

what do we ask for history take

Answer 4

• nausea
• haemetemesis (vommiting blood)
• anorexia (not eating)
• type of pain (SOCRATES)
• pain on passing urine
• migration of pain
• weightloss
• haematuria (blood on urine)
• diarrhoea
• pale/yellow bowel movement
• painless jaundice
• anuria (no urine)
• absence of passing uring/ bowel opening
• jaundice
• malaena (black tar stools)
• vomitting

Question 5

what to assess on hands

Answer 5

• Leukonychia
• Koilonychia
• Splinter haemorrhages
• Finger clubbing
• Pallor
• Palmar erythema
• Dupytren’s Contracture

Question 6

what to assess on arms

Answer 6

• Pulses
• Track marks
• Excoriations
• Asterixis
• Bruises
• Scarring

Question 7

what to assess on face

Answer 7

• Xanthelasma
• Jaundice
• Conjunctival pallor
• Corneal arcus
• Oral candida
• Angular stomatitis
• Mouth ulcers
• Poor dentition
  *

Question 8

what to assess on neck

Answer 8

• JVD
• Supraclavicar lymph node swelling (Virchow’s node)
• Swelling
  *

Question 9

what to assess on chest

Answer 9

• Spider Naevi
• Gynaecomastia
• Hair loss
• Pectus carinatum
• Pectus excavatum

Question 10

what position do we want to the patient to be during abdo ax

Answer 10

supine

Question 11

what organs are in the right upper quadrant

Answer 11

Ascending colon
Duodenum Gallbladder
Kidney (right)
Liver
Head of pancreas
Transverse colon
Ureter (right)

Question 12

what organs are in the left upper quadrant

Answer 12

Descending Colon
Kidney (left)
Pancreas (Body and tail)
Spleen
Stomach
Transverse colon
Ureter (leff)

Question 13

what organs are in the right lower quadrant

Answer 13

Appendix
Ascending colon
Bladder
Caecum
Rectum
Ovary, uterus, and fallopian tube (female)
Prostate and spermatic cord (male)
Small intestine
Ureter (right)

Question 14

what organs are in the left lower quadrant

Answer 14

Bladder
Descending colon
Ovary, uterus, and fallopian tube (female)
Prostate and spermatic cord (male)
Small intestine
Sigmoid colon
Ureter (left)

Question 15

what to inspect for abdo assessment

Answer 15

fat
fluid
flatus (farts)
faeces
fetus
mass

varicose veins
cullens sign - bruising to bellybutton
grey turners sign- bruising to side
scars
distension
stretch marks
stoma
hernia (how long, pain)
spider nevi- high levels of oestrogen

Question 16

what to listen for in auscultation in abdo assessment

Answer 16

bowel sounds
four quadrants

listen for bruits

Question 17

what do bowel sounds mean

Answer 17

• Normal bowel sounds:typically described as gurgling
• Tinkling bowel sounds:typically associated with bowel obstruction.
• Absent bowel sounds:suggests ileus which is a disruption of the normal propulsive ability of the intestine due to a malfunction of peristalsis. Causes of ileus include electrolyte abnormalities and recent abdominal surgery.
• To be able to confidently state that a patient has ‘absent bowel sounds’ you need to auscultate for at least 3 minutes (this is unlikely to be the case in an OSCE given the time restraints).

Question 18

where do you listen for bruits and what do they mean

Answer 18

Aortic bruits:auscultate 1-2 cm superior to the umbilicus, a bruit here may be associated with an abdominal aortic aneurysm.
Renal bruits:auscultate 1-2 cm superior to the umbilicus and slightly lateral to the midline on each side. A bruit in this location may be associated with renal artery stenosis.

Question 19

what do you percussion for in abdo ax

Answer 19

percuss nine areas
hyper/hyporesonance

liver
start at right iliac and move up until it is dull
carry and and move into ribe in the intercostal space- when hyper again you are at lung

spleen
start at right iliac and move across the abdomen and up but should not hear spleen

shifting dullness
ascites is fluid in the abdomen- shifting dullness would indicate this
start on ummbilical region and go sideways and if there is dullness turn patient onto RHS and percuss again and fluid will have moved onto right hip and laft side will not be dull

renal angle
percussion of kidneys (sit at bottom of ribs at back) see if it worsens pain- place hand and hit hand

Question 20

what do we need to think about palpation for abdominal ax

Answer 20

9 areas
wave hand
tenderness, masses, hernias, distended bladded

one hand then two handed more firmly

palpate liver edge and spleen
start at right iliac fossa and ask patient to take deep breaths- feel it when they breath in and move up one cm each time

Question 21

additional tests for abdominal ax

Answer 21

murpheys (gallbladder, deep breath)
psoas
rosvings
obturator
heelstrike
rebound tenderness
guarding (protecting against pain)
dre

Question 22

what are the choles

Answer 22

severe upper right abdo pain
fluctuating but always present
occulsion of the cystic duct of the gall bladder
left untreatd can result in sepsis

Question 23

what is UGIB and LGIB

Answer 23

upper GI bleed and lower GI bleed

Question 24

signs and symptoms of UGIB and LGIB

Answer 24

malaena or haematemesis

Question 25

what to think about with UGIB and LGIB

Answer 25

* blood loss * fluid replacement * may need resus depending on severity * oesophageal varices

Question 26

what can cause lower GI bleeding

Answer 26

* Diverticulosis (colonic wall protrusion at the site of penetrating vessels; over time mucosa overlying the vessel can be injured and rupture leading to bleeding) [diverticulosis] * Angiodysplasia * Infectious colitis * Ischemic colitis * Inflammatory bowel disease * Colon cancer * Hemorrhoids * Anal fissures * Rectal varices * Dieulafoy lesion (more rarely found outside of the stomach, but can be found throughout GI tract) * Radiation-induced damage following treatment of abdominal or pelvic cancers * Post-surgical (post-polypectomy bleeding, post-biopsy bleeding)

Question 27

what can cause upper GI bleeding

Answer 27

* Peptic ulcer disease (can be secondary to excess gastric acid, H. pylori infection, NSAID overuse, or physiologic stress) * Esophagitis * Gastritis and Duodenitis * Varices * Portal hypertensive gastropathy (PHG) * Angiodysplasia * Dieulafoy lesion (bleeding dilated vessel that erodes through the gastrointestinal epithelium but has no primary ulceration; can be at any location along the GI tract[1] * Gastric antral valvular ectasia (GAVE; also known as watermelon stomach) * Mallory-Weiss tears * Cameron lesions (bleeding ulcers occurring at the site of a hiatal hernia[2] * Aortoenteric fistulas * Foreign body ingestion * Post-surgical bleeds (post-anastomotic bleeding, post-polypectomy bleeding, post-sphincterotomy bleeding) * Upper GI tumors * Hemobilia (bleeding from the biliary tract) * Hemosuccus pancreaticus (bleeding from the pancreatic duct)

Question 28

what ligament is the split between upper and lower GI bleed

Answer 28

ligament of treitz

Question 29

what is the cause of appendicitis

Answer 29

Appendicitis is primarily caused by obstruction of the appendiceal lumen leading to inflammation. The obstruction can be due to various factors such as appendicoliths, appendiceal tumors, intestinal parasites, or hypertrophied lymphatic tissues. These mechanical obstructions result in the development of acute appendicitis. It is important to note that the underlying causes of luminal obstructions may vary among different age groups, highlighting the need for age-specific considerations when evaluating and managing appendicitis. Most commonly in 5-45 but can occur at any age.

Question 30

where does the pain go in appendicitis

Answer 30

starts in umbilicus and migrates to McBurneys point (3/4 the way between right iliac and belly button)

Question 31

tests for appendicitis

Answer 31

rebound tenderness, rosvings sign, psoas sign, obturator sign, heel strike tenderness

Question 32

signs of appendicitis

Answer 32

Within hours, the pain travels to your lower right-hand side, where the appendix is usually located, and becomes constant and severe. Pressing on this area, coughing or walking may make the pain worse. If you have appendicitis, you may also have other symptoms, including: feeling sick (nausea) being sick loss of appetite constipation or diarrhoea a high temperature and a flushed face

Question 33

what do you need to remember with AAA

Answer 33

do not poke it paramedic backup be prepared for an arrest drive fast SKRTTTTTT