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Health Assessment > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Pregnant Women

A

-Enlarged uterus
-Intestines displaced upwards and to right

Bowel sounds diminished (decreased Motility may cause constipation)

Skin changes-striae, linea nigra

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2
Q

Infants & Children

A

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

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3
Q

The Older Adult

A

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

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4
Q

Hematemesis

A

Blood in vomit
-occurs with stomach or duodenal ulcers and esophageal varices. Consider food poisoning, bacterial or viral gastroenteritis

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5
Q

Melena

A

dark red stool, internal bleeding

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6
Q

hematochezia

A

Bright red stool
From fresh blood in stool (GI bleed)

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7
Q

THRUSH

A

infection of the tongue-hard to swallow

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8
Q

Dysphagia

A

difficulty swallowing

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9
Q

Pyrosis

A

heart burn

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10
Q

Eructation

A

belching

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11
Q

Visceral pain

A

from an organ causes dull, general, poorly localized.

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12
Q

Parietal pain

A

from inflammation of overlying peritoneum is sharp.
precisely localized aggravated by movement. Or referred from a disorder at another site

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13
Q

Stool Color

A

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)

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14
Q

Order of Assessment-Abdominal

A

Inspection

Auscultation -Normally you inspect, palpate, percuss and auscultate but in the abdomen you auscultate second because palpation and percussion increase peristalsis.

Percussion

Palpation

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15
Q

Skin

A

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

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16
Q

Inspection- Contour

A
  1. Flat
  2. Rounded - slightly distended
  3. Scaphoid - Sunken anterior wall –thin patients
  4. Protuberant - Distended
    *if distended, measure the girth around umbilicus
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17
Q

Auscultation-Bowel Sounds

A

Present
Hyperactive – increased motility
Hypoactive – following surgery or inflammation

Absent-Absence is established only after 5 min

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18
Q

Borborygmus

A

stomach growling-hyperperistalsis

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19
Q

Bruits

A

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.

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20
Q

Percussion

A

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

21
Q

Hyperresonance

A

a lot of gas
with gaseous distention

22
Q

Costovertebral Angle Tenderness

A

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

23
Q

Palpation

A

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

24
Q

Muscle guarding

A

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

25
Q

Tenderness

A

Mild tenderness in LLQ is normal (sigmoid colon)

26
Q

Large mass

A

note location, size, shape, consistency (soft, firm), surface (smooth, nodular) mobility, pulsatile

27
Q

Palpate-Liver

A

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

28
Q

Palpation: Spleen

A

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

29
Q

Palpation-Kidneys

A

‘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.

30
Q

Palpation-Aorta

A

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

31
Q

Ascites

A

big belly

could be from alcohol

32
Q

Rebound tenderness (Blumberg’s sign)

A

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

33
Q

Murphy Sign- (for gallbladder)

A

inspiratory Arrest (STOP TALKING BREATH BECAUSE OF PAIN
(inflammation of gallbladder)
More accurate in younger people

33
Q

Cholecystitis

A

inflammation of gallbladder

34
Q

McBurney’s point tenderness

A

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

35
Q

Iliopsoas muscle test

A

lift right leg up flexing at the hip and push down on thigh

36
Q

Obturator test

A

flex right hip and knee, hold ankle and rotate leg internally and externally

37
Q

Alvarado Score-also called MANTRELS score

A

> /= 7 indicates Appendicitis

38
Q

Hepatomegaly

A

swelling of liver

Causes: cirrhosis, portal obstruction, hepatitis

39
Q

Splenomegaly

A

enlarged spleen
-Occurs with acute infection, mono

40
Q

Aortic Aneurysms

A

95% are below renal arteries and extend to umbilicus???

80% palpable during routine exam

41
Q

Abnormal Findings-Distention

A

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

42
Q

DX tests

A

Xray to see if accumulation of fluid and gas proximal (above) obstruction

labs for signs of dehydration

43
Q

Pancreatitis

A

Pain radiating to back and left scapula

Non stop vomitting

44
Q

Gastric Ulcer

A

Pain is dull
Brought on by food
Radiates to back

45
Q

Duodenal ulcer

A

Dull, aching gnawing pain
Doesn’t radiate
Relieved by food

46
Q

Gastroenteritis

A

Small Intestine-
Diffuse abdominal pain
nausea and vomiting

47
Q

Epigastria

A

protrusion of abdominal structures through epigastrium in midline (linea abla) easier to feel than see

Health Assessment (9 decks)

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