Abdomen Flashcards
Pregnant Women
-Enlarged uterus
-Intestines displaced upwards and to right
Bowel sounds diminished (decreased Motility may cause constipation)
Skin changes-striae, linea nigra
Infants & Children
Umbilicus is prominent
Liver takes up more space at birth, and may be palpable
Urinary bladder located higher in abdomen
Less muscular-organs more easily palpated
Abdominal breathing
Umbilical hernia-disappears by 1year
Diastasis recti (separation of rectus muscle/bulge midline); disappears early childhood
Auscultation-no vascular sounds should be heard (may hear bowel sounds in chest)
CHILD
The Older Adult
After middle age:
Females w\ fat accumulation due to estrogen
Males w\ fat deposits
Gallstone occurrence
Gastric acid secretion decreases
Salivation, decrease taste
Esophageal emptying delayed
Can cause problems with vitamin absorption
Liver size decreases by 25% from ages 20-70
Constipation
Causes:
physical activity
Inadequate intake of fluid and fiber
Medication side effects
IBS
Hematemesis
Blood in vomit
-occurs with stomach or duodenal ulcers and esophageal varices. Consider food poisoning, bacterial or viral gastroenteritis
Melena
dark red stool, internal bleeding
hematochezia
Bright red stool
From fresh blood in stool (GI bleed)
THRUSH
infection of the tongue-hard to swallow
Dysphagia
difficulty swallowing
Pyrosis
heart burn
Eructation
belching
Visceral pain
from an organ causes dull, general, poorly localized.
Parietal pain
from inflammation of overlying peritoneum is sharp.
precisely localized aggravated by movement. Or referred from a disorder at another site
Stool Color
Black stools may be tarry due to occult blood (melena) from GI bleeding or non-tarry from iron supplements.
Gray stool can occur with hepatitis.
Red blood occurs with lower GI bleeding or hemorrhoids (hematochezia)
Order of Assessment-Abdominal
Inspection
Auscultation -Normally you inspect, palpate, percuss and auscultate but in the abdomen you auscultate second because palpation and percussion increase peristalsis.
Percussion
Palpation
Skin
red inflammation, yellow jaundice, is it glistening or taut
are there striae which are broken collagen fiber from quick weight gain also known as stretch marks
Inspection- Contour
- Flat
- Rounded - slightly distended
- Scaphoid - Sunken anterior wall –thin patients
- Protuberant - Distended
*if distended, measure the girth around umbilicus
Auscultation-Bowel Sounds
Present
Hyperactive – increased motility
Hypoactive – following surgery or inflammation
Absent-Absence is established only after 5 min
Borborygmus
stomach growling-hyperperistalsis
Bruits
in the aortic, renal, iliac, and femoral arteries (not normally heard)
Bruits-sound of turbulent blood flow
Check especially in people with HTN
occurs with stenosis or occlusion of an artery. Pulsatile blowing sounds.
Percussion
Done to assess density of abdominal contents and locate organs and screen for abnormalities
Performed lightly at first, clockwise motion
Tympany-sound of air (due to air in intestines)-predominate sound heard!
Dullness
over full bladder, fluid, mass, or adipose tissue
Hyperresonance
a lot of gas
with gaseous distention
Costovertebral Angle Tenderness
Done to assess kidneys
Done over 12th rib and costo vertebral angle on back
Flat hand on back, thumped with fisted hand
Pain will occur w\ inflammation of the kidney
Palpation
Light & Deep palpation – bend legs at knee if more comfortable for the patient
Palpate for masses, tenderness, organ enlargement, and ascites –fluid in abdominal (usually found on people who have a liver disease)
Light palpation;
Purpose – to form an overall impression of skin surface and superficial musculature. Fingers close together, gentle rotary motion, depress 1 cm
Deep Palpation;
Press 5-8 cm (2-3 in)
Note consistency , size , and abnormalities of organs.
Bimanual technique for obese abdomen – place 2 hands on top of one another, the top hand does the pushing, the bottom hand is relaxed
Muscle guarding
Voluntary – cold, tense, ticklish. Will relax with exhalation
Involuntary is constant, board like hardness (rigidity) of muscles, it is protective with acute inflammation of the peritoneum, more pain when intraabdominal pressure increases
Tenderness
Mild tenderness in LLQ is normal (sigmoid colon)
Large mass
note location, size, shape, consistency (soft, firm), surface (smooth, nodular) mobility, pulsatile
Palpate-Liver
Place left hand posteriorly parallel to and supporting 11th & 12th ribs on right.
Place right hand in upper quadrant well below area of liver dullness.
Have the patient take deep breath and feel liver margin for smoothness, firm sharp edge, usually don’t feel it
If you can palpate it, you will feel it 1-2cm below the right costal margin (enlarged)
Hooking Technique: alternative to above. Hook hands under costal margin and patient takes a deep breath
Palpation: Spleen
Not normally able to be palpated unless 3x’s its normal size
If enlarged-moves down toward midline (normally in mid-axillary line)
Seldom palpable in normal adults. Causes include COPD, and deep inspiratory descent of the diaphragm.
Place your left hand behind the abdomen at the 11th or 12th ribs and lift. Right hand will be pointed obliquely on LUQ fingers pointing to the left axilla. Push deeply under the left costal margin and ask the patient to take a deep breath.
DO NOT CONTINUE TO PALPATE AN ENLARGED SPLEEN
Enlarged with Mono, HIV, Trauma, Malaria
Palpation-Kidneys
‘Duck Bill’ hand position
Place left hand posteriorly just below the right 12th rib. Lift upwards trying to displace the right kidney anteriorly.
Palpate deeply with right hand on anterior abdominal wall.
Have the patient take a deep breath.
Feel for lower pole of kidney as it descends and try to capture it between your hands.
Have the patient release breath. Slowly release the kidney and feel it slide back into place.
Try the same on the left kidney, but is seldom palpable.
Palpation-Aorta
if cm is higher than 4, could be aorta aneurism
Press deeply in upper abdomen slightly left of midline with thumbs and finger
Width of pulsations – normally 2.5-4 cm – aneurysm will push fingers apart
Ascites
big belly
could be from alcohol
Rebound tenderness (Blumberg’s sign)
Rebound tenderness, choose site remote from painful area, hold hand 90 degrees/perpendicular, push down slowly then lift up quickly.
Very reliable for peritoneal inflammation
Murphy Sign- (for gallbladder)
inspiratory Arrest (STOP TALKING BREATH BECAUSE OF PAIN
(inflammation of gallbladder)
More accurate in younger people
Cholecystitis
inflammation of gallbladder
McBurney’s point tenderness
might be appendix issue
Iliopsoas muscle test - lift right leg up flexing at hip and push down on the thigh
Obturator test – flex right hip and knee, hold ankle and rotate leg internally and externally
Iliopsoas muscle test
lift right leg up flexing at the hip and push down on thigh
Obturator test
flex right hip and knee, hold ankle and rotate leg internally and externally
Alvarado Score-also called MANTRELS score
> /= 7 indicates Appendicitis
Hepatomegaly
swelling of liver
Causes: cirrhosis, portal obstruction, hepatitis
Splenomegaly
enlarged spleen
-Occurs with acute infection, mono
Aortic Aneurysms
95% are below renal arteries and extend to umbilicus???
80% palpable during routine exam
Abnormal Findings-Distention
Obesity – uniformly rounded, umbilicus sunken, normal BS, percussion tympany with scattered dullness, palpation normal
Air or gas – single round curve in lower half of abdomen toward midline, tympany over large area
Ascites – single curve, everted umbilicus, bulging flanks when supine, BS diminished over fluid, percussion is dull over fluid, palpation - skin is taut
Ovarian cyst – curve in lower half of abdomen toward midline, everted umbilicus
Pregnancy – single curve, umbilicus protruding, breast engorged, BS may be diminished, may hear fetal heart tones
Feces – localized distention, normal bowels sounds, Tympany predominates with dullness over feces, ropelike mass palpated
Tumor – localized distention, normal bowel sounds, percussion is dull over mass if it reaches skin surface, palpation – define borders, distinguish from organs
DX tests
Xray to see if accumulation of fluid and gas proximal (above) obstruction
labs for signs of dehydration
Pancreatitis
Pain radiating to back and left scapula
Non stop vomitting
Gastric Ulcer
Pain is dull
Brought on by food
Radiates to back
Duodenal ulcer
Dull, aching gnawing pain
Doesn’t radiate
Relieved by food
Gastroenteritis
Small Intestine-
Diffuse abdominal pain
nausea and vomiting
Epigastria
protrusion of abdominal structures through epigastrium in midline (linea abla) easier to feel than see
