21,25 HA Flashcards
What type of abdomen does Kelli have?
Protrudent
What type of abdomen caves in and ribs stick out. Can be associated with dehydration or malnutrition?
Scaphoid abdomen
Protrusion of abdominal visceral through abnormal opening in muscle wall.
Hernia
What nodule is hard in umbilicus that occurs with metastatic cancer of stomach, large intestine, ovary, or pancreas
Sister Mary Joseph nodule
An umbilical hernia should disappear by what age?
1
What are the 2 umbilical arteries and one vein surrounded by at birth?
Wharton’s jelly (mucoid connective tissue)
A separation of the rectus muscles with a visible bulge along the midline
diastasis reccti
What ethnicity is diastasis reccti common in and when does it usually disappear by?
African American infants
early childhood
What patient population might you see: decreased salivation (dry mouth), difficulty with
medication metabolism, decreased liver size:
Elderly
What other changes might you see in the GI system of the eldderly?
- Esophageal emptying is delayed.
- Gastric acid secretion decreases which may cause pernicious anemia
- Incidence of gallstones increases
- Liver size dereases
- Frequently report constipation
When your patient complains of pain in their abdomen, do you still palpate the area? If
so, is there a specific order to the palpitations?
Yes. Examine the tender area last
What is the purpose of palpating the abdomen?
To form an overall impression of the skin surface and superficial musculature
Occurs when the person is cold, tense, or ticklish. It is bilateral, and you will fell the muscles relax slightly during exhalation.
Voluntary guarding
A constant, boardlike hardness of the muscles. It is a protective mechanism accompanying acute inflammation of the peritoneum. May be unilateral, and the same area usually becomes painful when the person increases intra-abdominal pressure by attempting to sit up
Involuntary rigidity
What assessments do we do for an abdominal aortic aneurysm? Where are these
usually located?
Auscultate: bruits
Palpate: pulsating mass
Femoral pulse may be decreased
Located in upper abdomen just left of midline
What is a bruit in an aortic aneurysm going to sound like?
harsh, systolic, or continuous and accentuated with systole
What is the correct order of an abdominal assessment?
Inspect, Auscultate, Percuss, Palpate
What is pyelonephritis?
kidney infection
Gray fecal matter can be an indicator of what condition?
Jaundice/hepatitis
Black tarry stool with distinct malodor indicates…..
GI bleeding with blood partially digested
Black stool indicates?
Pale yellow, greasy stool?
Occult bleeding?
Black: ingesting iron or bismuth preparations
Pale yellow, greasy: Increased fat content (steatorrhea), as occurs with malabsorption
Occult: colon cancer
Why do we auscultate prior to percussion/ palpation?
Distortion of bowel sounds can occur with percussion and palpation. Bowel
sounds NOT vascular sounds can be distorted.
Percussion and palpation can increase…….
peristalsis
Where should we begin listening to bowel sounds?
RLQ at the ileocecal valve area
Marked pulsation of aorta occurs with……
widened pulse pressure and aortic aneuryism
What signs might signal there is an aortic aneurysm present?
Positive bruit, palpable pulsating mass, decreased femoral pulses
Signs that might signal an enlarged kidney
Percussion over the kidney is tympanitic because of the overriding bowel
Reasons the kidneys could be enlarged?
hydronephrosis, cyst, or neoplasm
Signs that might signal an enlarged spleen?
may have sharp edges, is firm and hard. Usually not tender on palpation unless peritoneum is also inflammed
What might cause the the spleen to become enlarged?
Mono (acute)
An enlarged, tender gallbladder suggests…..
acute cholecystitis
Signs of an enlarged tender gallbladder?
pain upon percussion and inspiratory arrest (Murphy sign)
When does an enlarged nontender gallbladder occur?
gallbladder is filled with stones or bile duct obstruction
The liver is normally NOT palpable. If it is, then your patient could be suffering from…?
Hepatomegaly
Accurate detection of liver borders is confused by
dullness above the 5th intercostal space, which occurs with lung disease
Accurate detection at the lower border is confused when dullness is
pushed up with ascites or pregnancy or with gas distention in the colon, which obscures the lower border
What is a tell-tale sign of pyelonephritis?
CVA (costovertebral tenderness) tenderness
How long do you auscultate for before determining there are absent bowel sounds?
5 minutes per quadrant
Loud, high pitched, rushing, tinkling sounds that signal increased motility
Hyperactive sounds
Common hyperactive bowel sound heard?
hyperperistalsis (borborygmus)
Will have this following abdominal surgery or with inflammation of the peritoneum
Hypoactive or absent bowel sounds
What are the 4 abdominal areas you listen for vascular sounds/bruits?
Aorta, left renal artery, iliac artery, femoral artery
What should we note on vascular sounds if any heard?
location, pitch, and timing
A pulsatile blowing sound and occurs with stenosis or occlusion of an artery
Systolic bruit
Urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia. Nontender enlargement. Commonly occurs in middle age males. Feels smooth, rubbery, or firm, with the median sulcus obliterated
BPH (Benign Prostatic Hypertrophy)
An exquisitely tender enlargement is acute, yielding a swollen, slightly assymetric gland. Dull aching pain in perineal and rectal area. Fever, chills, malaise occur.
Prostatitis
Pain or burning on urination; continuous pain in lower back, pelvis, and thighs. Often starts as a single hard nodule on the the posterior surface, producing asymmetry and a change in consistency.
Carcinoma on prostate
What are the preferred positions for a rectal exam in a male patient?
Side-lying or standing (bent over)
If examining females anus and genitalia how should we position her?
Lithotomy
In low risk male patients, a PSA and digital rectal exam should be performed starting at
what age?
50
In average risk adults how often should you get a colonoscopy?
every 10 years after age 50 (sigmoidoscopy= q 5yrs)
What can excessive fat occur from?
celiac disease, cystic fibrosis, chronic pancreatitis, and chron disease
Occurs with some medications, nutritional supplements, Chron disease and certain foods
Flatulence
A soft, movable mass discovered during a rectal exam could be a?
Polyp
A firm or hard mass with irregular shape or rolled edges may signify…..
carcinoma
Above anorectal junction is not palpable unless
thrombosed
Internal hemorrhoid
Pruritis Ani is caused by?
pinworm
A hair- containing cyst or sinus located int eh midline over the coccyx or lower sacrum. Often opens as a dimple with visible tuft of hair and possibly an erythematous halo. Is a congenital disorder, it is first diagnosed between 15 and 30.
Pilonidal Cyst or Sinus
A chronically inflamed GI tract (Crohn Disease, local irradiation) creates an abnormal passage from inner anus or rectum out to skin surrounding anus. The red raised tract opening may drain serosanguineous or purulent matter when pressure is applied. May heal with warm bath, high-fiber diet, and analgesics
Anorectal Fistula
How do you treat an anal fissure?
stool softeners, fiber, warm soaking baths, topical analgesics.
Result from increased portal venous pressure: as occurs with straining at stool, chronic constipation, pregnancy, obesity, chronic liver disease, or the low fiber diet
Hemorrhoids
What is a linear split in the perianal area called?
fissure
Complete rectal mucous membrane protrudes through the anus, appearing as a moist red doughnut with radiating lines. Occurs following a valsalva maneuver such as straining at stool or with exercise . Caused by weakened pelvic support muscles and requires surgery
Rectal Prolapse
What separates the internal and external anal sphincters and is palpable?
Intersphincteric groove
Folds of mucosa. These extend vertically down from the rectm
Anal columns (columns of Morgagni)
Is not palpable, but is visible on proctoscopy. Marks the end of the anal column
Anorectal junction (mucocutaneous junction, pectinate, or dentate line)
Protrusion of abdominal structures presents as a small fatty nodule at epigastrium in midline, through the linea alba. Usually one can feel it rather than observe it. May be palpable only when standing
Epigastric Hernia
A bulge near an old operative scar that may not shown when person is supine but is apparent when the person increases intra-abdominal pressure by a sit-up, standing or by Valsalva maneuver
Incisional Hernia
Intense perianal itching. Is found in children and institutionalized adults and by prolapsed hemorrhoids, anal fissure, dermatitis, chronic diarrhea, poor hygiene, and systemic diseases such as DM or IBS.
Pruritus Ani
Fever chills, malaise, urinary frequency and urgency, urethral discharge; dull, aching pain in perineal and rectal area. Tender enlargement is acute inflammation, yielding a swollen, slightly asymmetric gland.
Prostatitis
