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PA: Exam 2 > 7.14 Abdomen > Flashcards

7.14 Abdomen Flashcards

1
Q

7 Organs of the abdomen

A 
o	Gallbladder
o	Spleen
o	Pancreas (not palpable or visible)
o	Stomach
o	Small intestine
o	Large intestine
o	Appendix
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2
Q

Gallbladder (2 characteristics)

A

o Clinically: Cannot feel it separately from liver

o Just lateral to midclavicular line, under liver

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3
Q

Where is the staomch

A

o Just below diaphragm

o Between liver and spleen

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4
Q

Where are ulcers, gastritis?

A

o Usually in the LUQ of stomach

o Tender when pressed

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5
Q

Small intestine
o Location
o Where where you commonly find pain?

A

o All 4 quardrants

o Umbilical pain (around belly button)

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6
Q

Large intestine location

A

o All 4 quadrants

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7
Q

Appendix location

A

o Near illiocecal junction

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8
Q

Three “related organs of the abdomen”:

A

o Ovaries
o Bladder
o Kidneys

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9
Q

Palpating ovaries (2):

A

o Only palpable bimanually, with one hand inside the vagina.

o Not palpable in post menopausal women

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10
Q

Bladder - part of abdomen?

A

o Pelvic organ

o Only rises into abdomen when filled or distended

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11
Q

Kidneys (3 characteristics)

A

o Posterior abdominal organs
o Protected by ribs
o R kidney pushed down a little bit by the liver, palpable in some people

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12
Q

Aorta

A

o Can see, palpate pulsations in abdomen as it descends

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13
Q

Four things to ask about appetite

A

o Planned / unplanned weight loss?
o Dieting?
o Excessive gas or flatus
o Abdominal fullness or early satiety

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14
Q

Abdominal fullness or early satiety

A

Associated with cancers

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15
Q

When do hollow organs become painful? (2)

A

o Forceful constriction

o Distention

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16
Q

When do solid organs become painful?
o 3 descriptions of pain
o 1 other characteristic

A

When they swell against their capsules
o Gnawing, cramping or aching
o Difficult to localize (eg hepatitis)

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17
Q

What is parietal pain?

A

o Inflammation from the hollow or solid organs that affect the parietal peritoneum.
o More severe, usually easily localized (appendicitis)

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18
Q

What is referred pain?

A

o Originates at different site, but shares same innervation from the same spinal level
o When pt gives history of abdominal pain, the pain’s location may not necessarily be over involved organ.

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19
Q

What are two examples of referred pain?

A

o Gallbladder pain at shoulder

o GERD and heart pain

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20
Q

Shared pain presentation of GERD and heart pain

A

o Down left arm
o Underneath sternum
o Occasionally up into jaw.

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21
Q

_____ refers to vomit

A

Emesis

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22
Q

______ refers to dry heaves, which are _______.

A

Retching (spasmodic movement of the chest and diaphragm like vomiting, but no stomach contents are passed)

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23
Q

Hematochezia

A
  • blood in stool

* Old blood from stomach

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24
Q

Melena

A
  • Black tarry stool

* Old blood from colon

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25
Q

What is the difference between Hematochezia and Melena?

A

o Hematochezia = blood in stool from stomach

o Melena = blood in stool from colon. Tarry.

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26
Q

What does white or gray stool indicate?

A

Gall bladder disease

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27
Q

What does iceteic mean?

A

Yellow

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28
Q

Top two causes of pancreatitis

A
  • # 1 cause: Gallstones

* #2 cause: Alcohol (chronic or binge)

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29
Q

What discomfort might arise from a past surgery?

A

Adhesions that may grow together

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30
Q

Kidney pain v. Uretal pain

A
  • Kidney infection: Pain is primarily in back
  • Kidney stone: Uretal pain
    o Goes down into groin
    o Colicky pain
    o Makes patient want to move around constantly
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31
Q

“Colicky” pain refers to ________

A

SHARP pain.

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32
Q

“Scathoid” means ________

A

Concave

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33
Q

Pubic hair shape

A

o Men: Diamond shape (up to belly button)

o Women: Pubic triangle

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34
Q

What is an incisional hernia?

A

Muscle has been cut in hernia, organ pushes thru weak wall.

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35
Q

Three causes of pulsation or movement (3)

A
  • Inflammation
  • Hernea
  • Fat tumors in subcutaneous fat
36
Q

What part of the stethoscope do you use to auscultate bowel sounds?

A

Diaphragm

37
Q

Normal amount of bowel sounds

A

5-30 / minute

38
Q

When will you hear hyperactive bowel sounds? (2)

A
  • Diarrhea

* Early obstruction (before illius stops, you’ll have hyperactive bowel sounds as it’s trying to push thru the area.)

39
Q

When will you hear hypoactive bowel sounds?

A
  • Peritonitis

* peritonic ilius.

40
Q

In order to declare that there are no bowel sounds, how long do you have to wait?

A

3-5 minutes

41
Q

Borborygmi (3)

A

o Prolonged gurgles of peristalsis
o Can be auscultated without stethoscope
o Can be normal finding, OR something more serious.

42
Q

3 causes of bruits

A

o Due to any stenosis
o Due to AAA: Aortic Abdominal Aneurism
o Epigastric systolic bruit may be normal finding in a thin person. (If you’re only hearing it systolically, it’s ok.)

43
Q

2 characteristics of bruits caused by STENOSIS

A
  • Plaque or other narrowing

* More common when aorta branches

44
Q

3 characteristics of bruits caused by AAA

A

“Aortic abdominal aneurism”
• More common than aneurisms at other places in aorta.
• 95% of aortic aneurisms are below the renal arteries and above the iliac arteries
• Risks: Above 50, family history, smokers.

45
Q

When is Epigastric systolic bruit ok?

A

If you’re only hearing it on Systole (common in thin people)

46
Q

What should you percuss for in the stomach (2)?

A

Tympani and dullness. Tympani should predominate.

47
Q

Causes of percussed stomach dullness (6)

A 
o	Mass or enlarged organ
o	Fluid
o	Feces
o	Fetus
o	Fibroid
o	Superpubic dullness due to a full bladder.
48
Q

Why would someone have fluid in the abdomen?

A

o CHF
o Liver failure
o Kidney failure

49
Q

How would percussion sound if there were fluid in the abdomen?

A

Would sound tympanic in center, dull on the flanks (because fluid is affected by gravity)

50
Q

How would you test if the dullness sound in abdomen was from feces?

A

• Test with Ultrasound, Flat plate on the abdomen

51
Q

Span of liver increases with (2):

A
  • Hepatitis

* CHF (engorgement of liver)

52
Q

How to measure liver (3)

A
  • First, percuss from resonance to dullness down right midclavicular line (start around nipple)
  • Then, percuss from tympani to dullness (start around belly button)
  • Measure midclavicular when you can, sternal when you can’t.
53
Q

What is the normal liver span?

A

o should be 6-12 cm on right side

o 4-8cm on sternal border

54
Q

What causes the span of the liver to decrease?

A

Cirrhosis

55
Q

Why would you do a liver scratch test?

A

Can help define liver borders when abdomen is distended or muscles are tense

56
Q

Liver scratch test - method

A
  • Place stethoscope over liver
  • Start in RLQ, scratch with finger tip or tongue blade upward
  • When sound becomes magnified, you’ve crossed from hollow organ to solid (liver edge)
57
Q

What can you learn from a liver scratch test?

A

If liver is enlarged.

58
Q

How to assess for an enlarged spleen.
o Where?
o Normal vs abnormal findings

A

o Go to midaxillary line.
• Percuss at side, should be tympanic
• Ask pt to take a deep breath, percuss again.

Should still be tympanic again. If it goes to dull, it may be due to enlarged spleen.

59
Q

How big must a spleen be before it is palpable?

A

3x normal size

60
Q

Three causes of spleen enlargement:

A

o Malaria
o Mono
o Cirrhosis

61
Q

What does “CVA” stand for?

A

Costovertebral

62
Q

What do you say if all the organs are of normal size?

A

“No organomegaly”

63
Q

Where should you always start abdominal palpations?

A

Iliocecal junction

64
Q

What is the purpose of gentle probing?

A

o To reassure and relax patient
o To note any pain or discomfort
o Identify any superficial organs or masses

65
Q

Voluntary verses involuntary guarding

A

o Voluntary: When patient consciously flinches when you touch pt
o Involuntary: Muscles spasm when you touch patient – patient can’t control reaction.

66
Q

What do you do if patient is ticklish?

A

You can have him or her touch abdomen first

67
Q

Breathing techniques to relax the patient during abdominal exam

A
  • Tell patient to breathe out deeply

* Tell patient to breathe through mouth with jaw dropped open.

68
Q

What would cause pain in RLQ?

A

Appendicitis

69
Q

What would cause pain in the LLQ?

A

Diverticulitis (50+)

70
Q

What is rebound tenderness? What is the likely cause?

A
  • Press in and it’s a little uncomfortable, when you release it hurts more.
  • Likely peritoneal irritation.
71
Q

When is the liver normally palpable?

A

When you take a deep breath

72
Q

When should you use the hook method in finding the liver?

A
  • Fat people
  • Pregnant people
  • If pt has Ascities (fluid in peritoneal cavity)
73
Q

What do you say if the kidney is palpable

A

Catch the kidney

74
Q

If kidney is palpable, you worry about _______.

A

Adrenal tumors.

75
Q

In order to catch the kidney, must palpate where? How do you position hands

A

Lateral to muscle, hands like a duck bill

76
Q

How do you palpate aortic pulsation? What are you doing?

A
  • Either use 2 hands, or 1 hand with opposing thumb

* Checking width of pulsations

77
Q

Aneurism statistics (2)
o How many aneurisms are below renal arteries?
o How many aneurisms are palpable?

A

o 95% of aneurisms are below renal arteries. You don’t want to miss it.
o 80% of aneurisms are palpable

78
Q

Normal aortic pulsation width. When is there a serious problem?

A

o 3-5 cm

o When aorta is really wide

79
Q

Causes of liver cancer

A

o Cirrhosis

o Hepatitis C

80
Q

Murphy’s sign
o What happens?
o What does this indicate?

A

o Murphy’s sign: If you palpate their liver and they refuse to breathe out because it’s so painful
o That means it’s their gallbladder.

81
Q

What does “friable” mean? What organ does this apply to?

A

o Can bleed easily - just touching it can break it

o Enlarged spleen

82
Q

What do you do to assess ascites?

A

o Percuss abdomen for areas of tympany and dullness

o Push in a semi circle under diaphragm

83
Q

Four signs of appendicitis

A

o Rebound tenderness
o Rosing’s sign
o Psoas sign
o Obturator sign

84
Q

What is Rovsing’s sign?

A

• Palpate elsewhere in peritoneal cavity, and it hurts most over appendix.

85
Q

What is Psoas sign?

A
  • Psoas muscle goes from stomach up to groin

* It will hurt in groin area if you have pt lift leg against pressure

86
Q

What is the obturator sign?

A

• Externally rotate the hip, it will irritate the appendix.

87
Q

How do you assess enlarged gallbladder or cystitis?

A

o Murphy’s sign – it’s so painful they stop mid-breath.

PA: Exam 2 (10 decks)

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