Abdomen 1 Flashcards
How are the 9 regions of the abdomen split?
- 2 sagittal (vertical)
2. 2 transverse (horizontal) planes
Where are the sagittal planes?
through the 2 midclavicular points
What are the transverses planes?
have the subcostal plane lying at the inferior borders of the 10th costal cartilage and the transtubercular plane passing through the iliac tubercles
Where does the iliac tubercles lie?
on the lateral aspect of the iliac crest about 5 cm posterior to the anterior superior iliac spine (ASIS)
What is it possible to substitute the subcostal plane for?
transpyloric plane
Where was the transpyloric plane?
at the level of L1 vertebra and passes through the tips of the right and left 9th costal cartilages, but both these structures are not easily palpable
What is the transpyloric plane lie midway between?
between the superior border of the manubrium of sternum and symphysis pubis of the pelvis
Where are the tips of the 9th costal cartilage?
at the intersection of the costal margin with the lateral border of the rectus abdominis muscle
How is the abdomen divided into quadrants?
- vertical (mid-sagittal) plane
- transverse plane (transumbilical plane) through the umbilicus
What are the stages for the physical examination?
- Inspection
- Palpation
- Percussion
4, Auscultation. - Exposure
What position should the patient lie in?
supine position
How should the head be during the examination?
raised slightly by adjusting the headrest of the couch or by adding a pillow under the head - helps to relax the abdominal musculature
What area of the abdomen exposed?
from the xiphisternal joint to the pubic symphysis
Why would a physician do the auscultation before any platoon or percussion?
in order to prevent the bowel sounds being disturbed by deep palpation
Why do you inspect first? What are you looking for?
- visually inspect the
1. shape of the abdomen
2. skin abnormalities
3. surgical scars
4. masses
5. hernias
6. movements of the abdominal wall with respiration
7. for any asymmetry
What is the normal abdomen shape?
flat and symmetrical
What is the respiration like at rest?
diaphragmatic
What happens to the organs in the abdomen during inspiration?
- abdominal wall moves out
2. liver, spleen and the kidneys move downwards -umbilicus is usually inverted
What happens to the umbilicus in obesity?
Sunken
What could indicate an umbilical hernia?
Distended and everted umbilicus
What could indicate portal hypertension or an obstructed inferior vena cava?
Abnormally enlarged veins on the anterior abdominal wall
What may cause diffuse abdominal swelling?
- Ascites (fluid collection in peritoneal cavity)
2. intestinal obstruction.
What could asymmetry of the abdominal wall be due to?
localised mass
How could light palpitation of the abdomen be facilitated?
if the patient is asked to flex the hip & knee joints to relax the anterior abdominal wall muscles
How do you perform light palpitation?
in each abdominal region with the palmar surface of the fingers acting together
What should the palm of the hand be doing in light palpitation?
moulding over the abdominal surface while the fingers flex at the metacarpophalangeal joints - not press too deep
What are you looking for in light palpitation?
tender areas and any lumps in the abdominal wall structure in each region
What do you ask the patient to show you in light palpitation?
to show you where any pain is present, and to report any tenderness during palpation: observe the patient’s face for any discomfort
In what shape do you do light palpitation?
S
How do you do deep palpitation?
place the palmar surface of the fingers acting together over the abdominal wall and apply a firm and steady pressure
Do you used two hand for deep palpation?
Yes
-may use both hands where the upper hand (usually the left hand) is used to exert pressure, while the lower hand is used to feel the organs or masses much deeper in the abdominal cavity
When is the lateral surface (radial) of the forefinger most sensitive?
For palpation of edges of organs (liver, spleen) or masses
What is tenderness during palpation a sign of?
underlying pathology
What would tenderness with minimal pressure over a wider area of the abdomen be due to?
- peritonitis
2. in some cases is due to anxiety of the patient
What is voluntary guarding?
The abdominal wall tends to contract voluntarily when palpation causes pain (guarding of abdomen)
What is involuntary guarding?
When there is inflammation of the parietal peritoneum, the abdominal wall muscles undergo a reflex contraction (rigidity of abdomen)
What happens in rigidity of abdomen?
the abdominal wall may not show any movements with respiration, and may show a board like rigidity
What is rebound tenderness?
In patients with generalised or localised peritonitis, if the abdominal wall is compressed slowly, and then released suddenly they will experience a sharp stabbing pain
What is the aim of auscultation?
etect bowel sounds and vascular bruits
Where do most of the sounds originate from?
- stomach
- some form large and small intestines
How do you carry out auscultation?
apply the diaphragm of stethoscope to the abdominal wall firmly but with gentle pressure
How are normal bowel sound heard?
as gurgling noises due to the peristalsis of the gastrointestinal tract
Are bowels sounds localised?
bowel sounds can be heard all over the abdomen (bowel sounds are poorly localised)
What is the result of bowel sounds being poorly localised?
sufficient to listen to them in one or two places on the abdomen rather than in all regions
How long do you listen to bowel sounds?
listen for about 60 seconds but you should listen for at least 3-4 minutes before coming to any conclusion that bowel sounds are absent
When would bowel sounds be absent?
- paralytic ileus
2. peritonitis
How are bowel sounds heard in intestinal obstruction?
high pitched and frequent
What are bruits?
abnormal sounds created by turbulent blood flow in an artery affected by aneurysm or obstruction
At what locations will you listen for bruits?
- Abdominal aorta– just above and left of the umbilicus
- Superior mesenteric or coeliac arteries – epigastrium
- Renal arteries - 2- 3 cm super and lateral to the umbilicus
- Liver tumours – over the liver
- Iliac arteries – in the iliac fossa
