Flashcards in L6 Abdominal Exam Deck (47)
What is the order of examination?
Inspection, auscultation, percussion and palpation
What is the main concern when a patient has a hernia?
Incarcerations or strangulations
Herniation of abdominal contents through a defective umbilical ring
Spontaneously resolves between 1-2
Herniation of abdominal contents through a previous incision site
Laxity of the linea alba that leads to separation of the rectus abdominis muscles and the abdominal contents form a midline ridge
When is diastasis recti most obvious?
When the patient flexes the neck by "lifting their head up"
Accumulation of fluid in the peritoneal cavity, usually secondary to cirrhosis
See bulging flanks
Visible waves of movement seen beneath the skin
When do you see peristaltic waves?
Intestinal obstruction (seen in thin people)
When do you see increased pulsation?
Abdominal aortic aneurysm
What skin markings do you look for?
Color, rashes/lesions, scars, striae, dilated veins
When can ecchymosis be seen?
Intraperitoneal or retroperitoneal hemorrhage
When are pink-purple striae seen?
What do prominent veins suggest?
Portal hypertension from cirrhosis
When portal hypertension promotes collateral venous circulation radiating from the umbilicus to the abdominal wall
Abnormal auscultation sounds
High-pitched tinkling, hyperactive or hypoactive
Normal auscultation sounds
Clicks, gurgles, borboygmi
Prolonged gurgles of hyperperistalsis, "stomach growling"
What is associated with high-pitched tinkling bowel sounds?
Intestinal obstruction interrupting the normal flow of contents
The sound is from intestinal fluid and air under tension in a dilated bowel
What are reasons for hyperactive bowel sounds?
Diarrhea (gastroenteritis) or early peritonitis
What are reasons for hypoactive bowel sounds?
Ileus (little to no bowel activity), peritonitis (may be hyperactive at first but lessens due to progressively severe inflammation and my progress to ileus)
What does percussing tympani suggest?
This predominates because of gas in the GI tract
What does percussing dullness suggest?
Underlying mass, enlarged organs or scattered areas of fluid/feces
Distended abdomen that is tympanic throughout
Intestinal obstruction or paralytic ileus
Protuberant abdomen with bulging flanks and dullness
Evaluate for ascites (free fluid sinks to dependent part of abdominal cavity where gas-filled loops of bowel float to the top)
Where do you measure the vertical span of the liver?
Midclavicular line (6-12 cm)
What happens when the spleen enlarges?
It expands anteriorly, downward and medially
When can fullness be percussed in the bladder?
Over 400-600 mL
When is the bladder tender?