Abdomen Flashcards
Identify the four quadrants of the abdomen and correlate to the structures underlying each area.
Quadrants:
RLQ: appendix, cecum, inferior ascending colon
RUQ: liver, gall bladder, hepatic flexure, superior ascending colon, right transverse colon
LUQ: left transverse colon, stomach, pancreas, spleen, superior descending colon, splenic flexure
LLQ: inferior descending colon, sigmoid colon, rectum
→ Separated by transumbilical line
Identify the nine regions of the abdomen and correlate to the structures underlying each area.
Regions:
Right hypochondriac, epigastric, left hypochondriac, right flank, umbilicus, left flank, right groin, hypogastric, left groin
→ Separated superiorly by subcostal plane and inferiorly by transtubercular plane and vertically by midclavicular lines
Discuss the proper sequence for the abdominal exam and explain why the exam order is important.
Inspection → Auscultation → Percussion → Palpation (IAPP)
Always perform auscultation of the abdomen before percussion and palpation because these maneuvers may alter the frequency and intensity of bowel sound
Define terms used to describe abdominal contour.
The expected contours can be described as flat, rounded, or scaphoid. A flat contour is common in well-muscled, athletic adults. The rounded or convex contour is characteristic of young children, but in adults it is the result of subcutaneous fat or poor muscle tone. The abdomen should be evenly rounded with the maximum height of convexity at the umbilicus. The scaphoid or concave contour is seen in thin adults.
List potential causes of abdominal distention and correlate the location of the distention to possible underlying disorder.
Generalized symmetric distention: obesity, enlarged organs, and fluid or
gas
Distention from the umbilicus to the symphysis: ovarian tumor, pregnancy, uterine fibroids, or a distended bladder
Distention above the umbilicus: tumor, pancreatic cyst, or gastric dilation
Asymmetric distention or protrusion: hernia, tumor, cysts, bowel obstruction, muscle or soft tissue hematoma, or enlargement of abdominal organs
Discuss the significance of visible abdominal surface motion from peristalsis or marked pulsation.
Surface motion from peristalsis, seen as a rippling movement across the abdomen, may be seen in thin individuals but can also be a sign of intestinal obstruction. Abdominal aortic pulsations seen in the upper midline are often visible in thin adults. Marked pulsations may occur as the result of increased pulse pressure or abdominal aortic aneurysm.
Explain the technique to properly inspect for abdominal masses or hernias.
Ask the patient to take a deep breath and hold it. The contour should remain smooth and symmetric. This maneuver lowers the diaphragm and compresses the organs of the abdominal cavity, which may cause previously unseen bulges or masses to appear. Next, ask the patient to raise his or her head from the table. This contracts the rectus abdominis muscles, which produces muscle prominence in thin or athletic adults. Superficial abdominal wall masses may become visible. If a hernia is present, the increased abdominal pressure may cause it to protrude.
Distinguish between reducible, non-reducible, incarcerated, and strangulated hernias and their clinical significance.
Most hernias are reducible, meaning that the contents of the hernia can be pushed back into place. If not, the hernia is nonreducible or incarcerated (blood supply to the protruded contents may become obstructed and require immediate surgery). A strangulated hernia is a life-threatening medical condition. Fatty tissue or a section of the small intestines pushes through a weakened area of the abdominal muscle. The surrounding muscle then clamps down around the tissue, cutting off the blood supply to the small intestine.
Discuss the cause, appearance, and significance of a diastasis recti.
Separation of the rectus abdominis muscles may become apparent when the patient raises his or her head from the table. Diastasis recti occurs more often in pregnancy and the postpartum period – little clinical significance. Appearance: enlargement (widening) of linea alba
Describe the character and frequency of normal bowel sounds.
Clicks and gurgles that occur irregularly and range from 5 to 35 per minute. Bowel sounds are generalized so most often they can be assessed adequately by listening in one place. Loud prolonged gurgles are called borborygmi (stomach growling). Will be absent if quiet for > 5 minutes in one area
Gastroenteritis, early intestinal obstruction, or hunger:
Increased bowel sounds
Mechanical bowel obstruction:
High-pitched tinkling sounds suggest intestinal fluid and air under pressure
Paralytic ileus or peritonitis:
Decreased bowel sounds
Describe the scratch technique for auscultating the liver borders and discuss when to use this technique.
If the abdomen is distended or the abdominal muscles tense, the usual techniques for determining the lower liver border may be unproductive, and the scratch test may be useful. Place the diaphragm of the stethoscope over the liver and with the finger of your other hand scratch the abdominal surface lightly, moving toward the liver border. When you encounter the liver, the sound you hear intensifies.
Describe the auscultatory characteristics of a liver or spleen friction rub and explain their potential causes/clinical significance.
Listen with the diaphragm for friction rubs over the liver and spleen. Friction rubs are high pitched and are heard in association with respiration. Although friction rubs in the abdomen are rare, they indicate inflammation of the peritoneal surface of the organ from tumor, infection, or infarct.
Discuss the expected percussion notes heard over the normal abdomen.
Tympany is the predominant sound because air is present in the stomach and intestines. Dullness is heard over organs and solid masses. A distended bladder produces dullness in the suprapubic area.
Describe the proper technique to assess and record the liver span by percussion. Identify the expected upper and lower anatomic borders of the liver and list the normal range for a liver span, measured at the midclavicular line and the midsternal line.
4-8MSL
6-12MCL
Begin liver percussion at the right midclavicular line over an area of tympany. Always begin with an area of tympany and proceed to an area of dullness because that sound change is easiest to detect. Percuss upward along the midclavicular line to determine the lower border of the liver. The area of liver dullness is usually heard at the costal margin or slightly below it. Mark the border with a marking pen. To determine the upper border of the liver, begin percussion on the right midclavicular line at an area of lung resonance around the third intercostal space. Continue downward until the percussion tone changes to one of dullness; this marks the upper border of the liver. Mark the location with the pen. The upper border is usually in the fifth intercostal space. Measure the distance between the marks to estimate the vertical span of the liver. The usual span is approximately 6 to 12 cm.
Describe two methods of assessing spleen size by percussion and describe normal and abnormal findings with each.
Traube space
Percuss the spleen just posterior to the midaxillary line on the left side . Percuss in several directions beginning at areas of lung resonance. You may hear a small area of splenic dullness from the sixth to the ninth rib.
Traube space is a semilunar region defined by the sixth rib superiorly, the midaxillary line laterally, and the left costal margin inferiorly. This area is typically tympanitic because it overlies the fundus of the stomach. With splenic enlargement, tympany changes to dullness as the spleen is brought forward and downward with inspiration (splenic percussion sign). However, a full stomach, feces-filled intestine, or left-sided pleural effusion may also produce dullness.
Light Palpation:
no more than 1 cm,
Moderate Palpation
1-4cm
