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Med Screening > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

what in a pts hx indicates a need for an abdominal exam (9)

A

hemoptysis
n/v
change in bowel movements
- constipation or diarrhea
- blood in stool (melena or hematochezia)
- change in caliber of stool
change in urination
- pain, bloody urine, inc freq, dec stream
fatty food intolerance
drug use
sexual activity
hx of hepatitis
hx of hernia

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2
Q

what are the 4 components of an abdominal exam

A

inspection/observation
auscultation
percussion
palpation

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3
Q

where does stomach refer pain to

A

middle and lower T spine

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4
Q

where does small intestine refer pain to

A

middle T spine

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5
Q

where does the pancreas refer pain to

A

upper and lower T spine

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6
Q

where does gallbladder and liver refer pain to

A

right, middle, and lower T spine

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7
Q

where does common bile duct and large intestine refer pain to

A

middle lumbar spine

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8
Q

where does sigmoid colon refer paint o

A

upper sacral region
suprapubic region

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9
Q

where does kidney refer pain to

A

lumbar spine (ipsilateral flank)

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10
Q

where does ureter refer pain to

A

groin
medial and prox thigh
thoracolumbar region

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11
Q

where does urinary bladder refer pain to

A

sacral apex
thoracolumbar region

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12
Q

what are 2 considerations for abdominal exam

A

knees bent - keeps psoas relaxed
empty bladder - will be pressing

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13
Q

how should the borders of the 4 quadrants be drawn

A

vertical w xyphoid process to pubis
horizontal thru umbilicus

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14
Q

whats in the RUQ (8)

A

liver and gallbladder
pylorus
duodenum
head of pancreas
R adrenal gland
R kidney
hepatic flexure of colon
portion of ascending and transverse colon

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15
Q

what’s in the LUQ (8)

A

left lobe of liver
spleen
stomach
body of pancreas
L adrenal gland
L kidney
splenic flexure of colon
portions of transverse colon & descending colon

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16
Q

what’s in the RLQ (8)

A

R kidney (lower pole)
cecum and appendix
portion of ascending colon
bladder (if distended)
ovary and salpinx
uterus (if enlarged)
R spermatic cord
R ureter

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17
Q

what’s in the LLQ (8)

A

L kidney (lower pole)
sigmoid colon
portion of descending colon
bladder (if distended)
ovary and salpinx
uterus (if enlarged)
L spermatic cord
L ureter

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18
Q

what are the abdominal regions

A

epigastric
umbilical
hypogastric

borders
- at lower border of costal margin
- upper border of iliac crest

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19
Q

contents of epigastric region (4)

A

pyloric end of stomach
duodenum
pancreas
portion of liver

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20
Q

contents of periumbilical region (4)

A

omentum
mesentary
lower part of duodenum
jejunum and ileum

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21
Q

contents of suprapubic region (3)

A

ileum
bladder
uterus (if pregnant)

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22
Q

what do you inspect the abdomen for

A

shape
symmetry
color
scars

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23
Q

what are stria

A

white, silvery
- normal - associated w wt gain, wt loss
- ex: pregnancy, obesity, growth spurts

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24
Q

what are purple stretch marks

A

cushings syndrome
- can also see rashes

25
Q

r/i hernia

A

hold breath and lift head off table (contracting abs)
- that pressure will inc presentation of where hernia is

26
Q

what should be inspected

A

intestinal peristalsis
aortic pulsations
umbilicus
- displacement
- discoloration

27
Q

if intestinal peristalsis are present what does this make you worry about

A

intestinal obstruction

28
Q

if aortic pulsations are present what does this make you worry about

A

aortic aneurysm
inc pulse pressure

29
Q

what does + presence of umbilicus indicate

A

underlying mass

30
Q

what does + bluish discoloration around the umbilicus indicate

A

intraabdominal bleeding
cullen’s sign

31
Q

what does auscultation screen for

A

bowel and vascular sounds

32
Q

what will normal bowel sounds be auscultated as

A

normal peristalsis heard as clicks & gurgles
- occur ~5-35x/min

33
Q

if indicated, would listen to bowel sounds for 5min to appreciate:

A

inc bowel sounds occur w intestinal obstruction

dec bowel sounds occur w peritonitis or paralytic ileus (absent)

34
Q

what are you listening for when auscultating vascular sounds

A

bruits (murmurs) indicative of vascular dz
- HTN & aneurysm

areas of common involvement:
- mid epigastric
- RLQ and LLQ
- femoral regions

35
Q

what does the presence of auscultated rubs over liver and spleen indicate

A

inflammation possibly d/t infection, tumor, or infarction

36
Q

where is aorta auscultated

A

above, at, and below umbilicus

37
Q

what are the areas for vascular auscultation

A

aortic
renal (R and L)
iliac (R and L)

38
Q

when is percussion indicated

A

estimating liver and spleen size
- for suspected path
- for caution if manual techniques in area are intended

presence of fluid, air, or masses in the abdominal cavity

39
Q

what are the two basic sounds heard from percussion

A

tympanitic (drum-like)
- from percussing over air filled structures

dull sounds
- over solid structure (ie liver)
- over fluid (ie ascites)

40
Q

liver percussion technique

A

percuss up from RLQ in R midclavicular line up to 6th rib space
- listen for change from resonant to dull sound

41
Q

where do you percuss a spleen

A

slight posterior to L mid axillary line b/w 6th and 10th rib spaces

42
Q

how does percussion of spleen sound

A

dullness is faint
- bc more solid

may be tympanic during regular breathing but dull when breath hold or if enlargment is present

43
Q

what can cause a false positive result on a splenic percussion test

A

colonic distention or impaction

44
Q

when is fist percussion of the kidney indicated

A

used to assess for tenderness in flanks
- back pain that doesn’t change w mechanics
helps screen for possible kidney infection

45
Q

technique for fist percussion of kidney

A

place one hand over flank region (around floating rib areas)
- strike hand w fist of other hand

46
Q

what are the results of fist percussion of kidney

A

normal = pt should feel “thud” and not pain

need to correlate other hx and exam findings to inc specificity and r/i pyelonephritis

47
Q

what are general rules for abdominal palpation

A

ensure relaxation in abdomen & bladder emptied

palpate indicated areas of tenderness or pain last

48
Q

what are the types of palpation

A

light
deep
rebound

49
Q

when is light palpation indicated

A

identifying tenderness, muscular resistance, superficial masses and organs

50
Q

technique of light palpation

A

4 fingers flat on abdomen, depress ~1cm and move in small circles in 4Qs

51
Q

what should be noted from light palpation

A

areas of tenderness, firmness, rigidity, or masses

52
Q

when is deep palpation indicated

A

further delineate abdominal masses that may have been suspected on light palpation

53
Q

what should be noted from deep palpation

A

presence of masses if so:
- size
- shape
- consistency
- tenderness
- location

54
Q

when is rebound tenderness indicated

A

suspected peritoneal inflammation
reports of abdominal pain

55
Q

what can be an equally useful tool as a rebound tenderness assessment

A

light percussion

56
Q

positive sign of rebound tenderness

A

+ Blumberg sign
- sharp stabbing pain
- indicates peritoneal irritation

57
Q

positive sign in RLQ at McBurney’s point

A

McBurney sign
- sharp stabbing pain
- indicates appendicitis

58
Q

technique of rebound tenderness

A

hand at 90deg, fingers extended and press deeply into area prox to identified pain
- does it hurt on pressing in? or upon rapid withdrawal?

Med Screening (17 decks)

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