abdo Flashcards
what to look for on inspection in an abdominal exam
skin abnormalities
surgical scars
masses
hernia
asymmetry
movement of abdominal wall - pulsation
stomas
patients position for examination
lying flat on couch
exposure of patient
waist upwards
what does the umbilicus look like in obesity
sunken
what does a distended and everted umbilicus indicate
umbilical hernia
what type of respiration is observed during rest
diaphragmatic respiration
what to remember whilst palpating the abdomen
- warn patient that it may feel uncomfortable - esp when doing deeper palpation (if they have pain anywhere start palpating in the furthest away region)
- look at patients face to check for pain
- palpate in an S shape
what to remember during liver and spleen palpation
ask patient to take a deep breath through their mouth- begin to palpate as they breath in
(keep hand still during inspiration)
INspiration –> push IN
what does a palpable liver indicate
hepatomegaly
where do you begin for liver and spleen palpation
right iliac fossa
what type of organ is the spleen
intraperitoneal organ
what section of the abdomen is the spleen in
left hypochondrium
what level is the spleen at
height of ribs 9-11
what does a palpable spleen indicate
splenomegaly
causes of splenomegaly
portal hypertension secondary to liver cirrhosis
glandular fever
infection
haemolytic anemia
congestive heart failure
splenic metastases
cause of bilaterally enlarged kidney
polycystic kidney disease
amyloidosis
cause of unilaterally enlarged kidney
renal tumour
what does tenderness during palpation suggest
peritonitis
anxiety
what is it called when patient contracts voluntarily when palpation causes pain
guarding
what are the signs and causes of rigidity
signs: reflex contraction / involuntary guarding, abdominal wall may not show any movements during respiration
cause: inflammation of parietal peritoneum
what are the signs and causes of rebound tenderness
signs: sharp stabbing pain when abdominal wall is compressed slowly then released
cause: generalised or local peritonitis
how should an abdominal aortic pulse auscultation look in a healthy individual
Pulsatile: hands move superiorly with each pulsation
how would an abdominal aortic aneurysm present during abdominal aorta palpation
hands move outwards with pulsation –> “expansile, pulsating mass”
at what level does the abdominal aorta bifurcate
L4
at what level is the transpyloric plane, and what organs are found at that level
L1
pylorus of stomach
neck of pancreas
fundus of gallbladder
renal hilum
duodenojejunal flexure
end of spinal chord
(horizontal plane at the level of the tips of right and left 9th costal cartilages)
at what level is the subcostal plane, and what organs are found at that level
L3
origin of inferior mesenteric artery
(horizontal plane across right and left costal margins at mid axillary line)
at what level is the supracristal plane, and what organs are found at that level
L4
bifurcation of aorta
at what level is the intertubercular plane, and what organs are found at that level
L5
tubercle of crest of ilium
at what level is the interspinous plane, what organs are found at that level, and what boundary does it mark
S2
- horizontal plane through the ASIS’s
- marks boundary of the umbilical region (superior) and hypogastric region (inferior)
what to ask patient to do when percussing liver
ask them to hold their breath in full expiration
surface markings of the liver
- right 5th rib at midclavicular line
- lower end of sternum
- left 5th ICS at midclavicular line
- costal margin at the right midaxillary line
where does the sound change from resonant to dull in percussion of the spleen
anterior axillary line
where do you percuss for splenic enlargement, during both expiration and full inspiration
along the anterior axillary line, at the 10th intercostal space (between 10th and 11th ribs)
what is ascites
accumulation of fluid in the peritoneal cavity due to liver cirrhosis
explain the cause of ascites
- decreased metabolism of aldosterone and ADH by the liver –> causes retention of salt and water
- decreased production of albumin by the liver –> reduces oncotic pressure –> leakage of fluid into peritoneal space
5 causes of abdominal distention
fat
foetus
flatus
faeces
fluid
what to remember during assessing for shifting dullness
- keep hand on the flank after percussing from midline to flank, whilst the patient moves to opposite side
- wait for 10 seconds for fluid to shift before palpating
what confirms ascites during shifting dullness examination
area of dullness becomes resonant
what causes normal gurgling bowel sounds
peristalsis
what to remember to say during auscultation of abdomen
tell you examiner that you would listen for 3-4 minutes before concluding that bowel sounds are absent
what does absent bowel sounds indicate
paralytic ileus
peritonitis
what sort of bowel sounds does intestinal obstruction cause
high pitched
frequent
3 regions where urinary tract stones reside
across sacroiliac joint
pelvic ureteric junction
vesico-ureteric junction
gold standard imaging for urinary tract stones
USS
treatment for large urinary tract stones (>5mm)
stenting
or
lithotripsy
where in the abdomen can you hear vascular bruit
1) abdominal aorta - just above umbilicus
2) SMA / coeliac arteries - epigastrium
3) renal arteries - 2/3cm superior and lateral to umbilicus
4) liver tumours - over liver
5) iliac arteries - in iliac fossa
at what position is the male nipple
4th intercostal space
slightly lateral to mid clavicular line
position of gall bladder
tip of right 9th costal cartilage
(tip of 9th costal cartilage lies on the transpyloric plane, and is at the junction of the costal margin and lateral border or rectus abdominis
surface marking of liver
- right 5th rib at midclavicular line
- costal margin at right mid axillary line
- lower end of sternum
- left 5th intercostal space at mid clavicular line
name the 3 borders of the liver
upper border:
right dome of diaphragm
(right 5th rib and costal cartilage –> lower end of sternum)
oblique border:
right costal margin
(right mid axillary line –> tip of right 9th costal cartilage –> tip of left 8th costal cartilage –> left 5th intercostal space in mid clavicular line)
right border:
costal margin at right mid axillary line –> right 5th rib at mid clavicular line
which line runs along the lateral border of rectus abdominis
right mid clavicular line
the gall bladder is at the intersect of which 2 lines
transpyloric plane and right mid clavicular line
surface marking of spleen
between left lateral border of erector spinae muscles
and left mid axillary line
from left ribs 9-11
surface marking of kidney and ureters
Mark the position of the transpyloric plane on the anterior abdominal wall - extrapolate this plane to the posterior abdominal wall.
• Runs through the L1 vertebra.
• Mark the position of the T12 vertebral level (Midpoint between the inferior angle of the scapula and the highest point of the iliac crest at the scapular line.
• From T12 count downwards to L1 vertebrae.
The medial border (hila) of kidneys - 4-5cm from the posterior median line (Kidney is 9-12cm long and 5-7cm broad).
• Superior poles - 12th ribs
• Inferior poles -> 3-4cm above the iliac crests, below 12th rib
Ureter:
1) 5cm lateral to the posterior median line at L1 level
2) Posterior superior iliac spine
list the retroperitoneal structures
- Suprarenal (adrenal) gland
- Aorta/IVC
- Duodenum (second and third part)
- Pancreas (but not the tail),
- Ureters
- Colon (ascending and descending)
- Kidneys
- oesophagus
- Rectum
how many places do you auscultate for bowel sounds
3
how to place hands for abdominal aortic pulse
use both hands and pads of fingers
pressing deeply into the abdominal wall
fingers should be pointed towards the epigastrium, whilst the ulnar borders lie parallel to the right and left costal margin
