Abdomen Flashcards
1
Q
Abdominal quadrants and how to go about it
A
- RLQ
- RUQ
- LUQ
- LLQ
- move once you hear gurgling
2
Q
inspection of abdomen
A
- abd
- contour: flat, convex, concave, distended (look eye level with stomach)
- symmetry
- umbilicus: inward or outward
- skin
- lesions
- scars
- silver stria/stretch marks
- dilated veins
- jaundice, cyanosis, ascites(liver doesn’t fxn well so distended stomach so skin is thin)
- movement of the abdominal wall
- pulsation and movement
- v/ minimal
- presence or absence of pulse
- might not see it
3
Q
laying down stomachs can look
A
- flat
- scaphoid (j)
- rounded
- protuberant (obese, pregnant)
4
Q
auscultation
A
- BEFORE PALPATION
- Bowel Sounds
- Note characteristics
- Begin listening in RLQ—
location of ileocecal valve
- Observe if they are:
- Normal
- Hypoactive: slow
- Hyperactive: fast
- Must listen for FIVE FULL
MINUTES to declare absent
bowel sounds – usually leads to surgery
5
Q
auscultation – vascular sounds
A
- Bruits
- Use firmer pressure
- Check over:
- Aorta
- Renal arteries
- Iliac
- Femoral arteries
- Usually, no sound is present
- 4% to 20% of healthy people may have a normal bruit originating from the celiac artery
6
Q
When auscultating bowel sounds, where do you begin?
A
- RLQ
7
Q
percussion
A
- lay hand flat and tap nail
- General Tympany
- All 4 quadrants
- Move clockwise
- Liver Span
- Maps out the boundary of the liver
- Percuss from lungs down to dullness and mark the spot
- Percuss up from abd tympany and mark the spot.
- Measure the distance which = liver span
- NO LONGER considered accurate
8
Q
percussion cont
A
- Costovertebral Angle
Tenderness- Fist percussion that causes the tissues to vibrate instead of producing a sound
- 12th rib at costovertebral angle
- Normally feels a thud but no pain
9
Q
abd light palpation
A
- Begin with light palpation
- Depress skin 1⁄2 inch, make rotary motion, lift fingers, and move clockwise to the next location
- Objective here is to form
overall impression of skin surface - Examine identified tender
areas last
10
Q
abd deep palpation
A
- Deep palpation
- Use same techniques with depth of 1-3 inches
- Move clockwise & explore the entire abd
- Rebound Tenderness
- Bloomberg’s sign: Indicative of inflammation somewhere in the abd
- Use techniques in a four quadrants
- Apply firm pressure for 4 seconds then release
- Observe patient’s response to see if this elicited pain/tenderness
11
Q
liver
A
- Largest solid organ
- Located below diaphragm in RUQ
- Extends just below right costal margin
- If palpable, has soft consistency
- Use “hooking technique” or push deeply down and under the right costal margin with the non-dominant hand placed behind
12
Q
spleen
A
- Approximately 7 cm wide
- Located above left kidney, just below diaphragm at level of 11th to 12 the ribs
- Located posterior to left mid-axillary line and posterior and lateral to stomach
- Normally NOT palpable
- Must be enlarged three times normal size to be palpable
13
Q
kidneys
A
- Right kidney slightly lower - bottom portion may be palpated anteriorly
- Use “duck-bill” position at right flank & press hands together firmly as
patient takes a deep breath - Left kidney not normally palpable
14
Q
uterus and ovaries
A
- Uterus
- When pregnant, palpable above level of symphysis pubis in the midline
- Ovaries
- Located in RLQ and LLQ
- Normally palpated only during bimanual exam of internal genitalia
15
Q
sigmoid colon
A
- located in LLQ
- often felt as firm structure on palpation
