Abdomen Flashcards
What are the 4 quadrants of the abdomen
Right upper
Left upper
Right lower
Left lower
Point 2/3 of the way between the umbilicus and the anterior superior illiac spine -> where the appendix sits (on the right side)
McBurney’s point
Where do you palpate the aorta?
Epigastric region around the midline in between the RUQ and LUQ
On what line of the chest does the gallbladder lie?
Right mid-clavicular line
Which renal artery is longer
Right
What are the retroperitoneal organs?
Pancreas Kidneys Ureters Aorta Vena cava
What is the main artery that bleeds during an ulcer
Gastroduodenal artery
What is the correct order to perform the abdominal exam?
Least invasive to most invasive:
Inspection, Auscultation, Percussion, Palpation
Protruding belly button
Herniated umbilicus
Stretch marks, red lines on the belly
Striae
Bulging stomach, may be due to ascites
Rotund
Abdominal varicies, part of the hepatic portal, highly indicative of liver failure
Caput Medusa
Stretching of the linea alba leading to rectus separation into two halves; common in premature neonates and in pregnant women
Diastasis Recti
Normal amount of bowel sounds per minute
5-35
Stomach & intestines stopped moving; often result of anesthetics or gall stones; belly becomes rotund because they are trapping air in the GI tract
Ileus
Causes of increased bowel sounds
Gastroenteritis, hunger, early obstruction -
Causes of decreased bowel sounds
Peritonitis, adynamic ileus, late obstruction
What are the expected percussion sounds in the following areas?
- Over most of abdomen?
- Over bladder?
- Over liver?
- Over stomach?
- Over spleen?
- Over most of abdomen if patient is very constipated?
- Over most of abdomen? = Tympanic
- Over bladder? = Flat or dull
- Over liver? = Dull
- Over stomach? = Empty is tympanic; Full is dull
- Over spleen? = Dull
- Over most of abdomen if patient is very constipated? = Dull
Where do you percuss for the spleen
Left axillary line, 10th ICS
What does positive CVA tenderness suggest
Pyelonephritis
What area do you palpate last?
The area in pain
Poorly localized periumbilical pain followed by right lower quadrant pain that is aggravated by any movement or cough
Acute appendicitis
Appendix sits slightly below/behind the secum and is located closer to the rectum
Retro-cecal appendix
Withdrawl pain or pain with any jarring movements
Rebound tenderness
Pain in the RLQ during LLQ palpation and during LLQ withdrawal (referred rebound tenderness); very specific for appendicitis
Rovsing’s Sign
Movement of the leg (especially using the psoas muscle) illiciting extreme pain in appendicitis
Psoas Sign
Bending the knee to 90 degrees then rotating it in medially; causes extreme pain with appendicitis
Obturator sign
Inspiratory arrest due to pain with pressure and inhalation, positive test implies cholecystitis
Murphy’s sign
Shifting dullness is a test for…
Ascites
Fluid wave is a test for…
Ascites
Flank pain that radiates around the front to the testicle/labia is due to
Ureteral stone
Translocation of a structure or viscous from its normal position in the body to an abnormal position in the body through a natural boundary
Hernia
Part of the stomach herniated into the chest cavity through the esophageal hiatus; most are sliding
Hiatal Hernia
Hernia also known as a herniated disk
Herniated Nucleus Pulposus
Ventral Hernias can be…
Epigastric, Umbilical, or Incisional
Inguinal Hernia can be…
Direct, Indirect, Femoral
What are the 2 types of hiatal hernias
Sliding & Paraesophageal (rolling)
Protrusion of a peritoneal-lined sac through some defect in the abdominal wall
Ventral hernia
Defect, weakness, or disruption of the linea alba with protrusion of peritoneal contents
Epigastric hernia
Usually due to a congenital fascial defect around the umbilicus
Umbilical hernia
Result of defect/weakness at the site of a surgical repair
Incisional hernia
What is the most common external abdominal hernia
Indirect inguinal hernia
Which type of hernia has the highest risk of incarcaration and strangulation
Femoral hernia
Classification of a hernia that is freely mobile; contents of hernia sac return to abdominal cavity spontaneously or with manual pressure
Reducible
Classification of a hernia that is not reducible but no signs of comprimise
Incarcerated
Classification of a hernia that has the blood supply cut off; contents becoming ischemic; NOT reducibl
Strangulated
A strangulated hernia is a medical emergency. What is it at risk for?
Risk of Perforation, Gangrene, Sepsis, & Death
Signs of compromise with a hernia include…
Redness, pain, inflammation, color change (blue, purple), fever, signs of sepsis/gangreene
