Abdomen Flashcards by McKenzie Kipe

parietal peritoneum

lines internal surface of the abdominal wall

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visceral peritoneum

lines organs within the abdominal cavity

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Retroperitoneal organs

Kidneys
Ascending and descending colon (portions)
Pancreas
Duodenum (portions)
Aorta
Vena cava
Periaortic lymph nodes

-Will present with back pain if there is a problem with these

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appendicitis pain

epigastric pain that goes through to the back, does not wrap around
-visceral at first from distention of inflamed appendix - periumbilical then changes to pain in RLQ from inflammation of adjacent parietal peritoneum

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visceral pain innervation

autonomic

Ex) liver when stretched

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parietal pain innervation

skeletal

-Steady, aching pain - usually more sever than visceral pain and precisely localized over structure

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referred pain

often develops as initial pain as initial pain becomes more intense
described as radiating or traveling from initial site

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direct tenderness

when you push something it hurts

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guarding

voluntary and involuntary

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rebound tenderness

tenderness is when you let go, not when you push in

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referred tenderness

when you push on some place, another place hurts

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position for abdominal exam

Patient should be lying supine on table
Hands at sides
Head against table
Knees bent with feet on table
Drape above and below abdomen
Respect patient’s comfort and modesty
Keep the patient warm

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Order of abdominal exam

inspection
auscultation
percussion
palpation

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Inspection of abdomen

skin (scars, striae, varicosities, rashes/lesions)
umbilicus
contour (round, flat, protuberant, distended, symmetry, visible masses)
Peristalsis
pulsations

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mary joseph nodule

-aka sister mary joseph sign

palpable nodule bulgin into umbilicus due to metastasis of cancer in pelvis or abdomen

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cause of protuberant abdomen

sticks out farther than usual

- could be due to excess subcutaneous fat, loss of muscle tone, buildup of substances

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distention of abdomen

air or fluid in abdominal space

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Auscultation for bowel sounds

(diaphragm)

Borborygmi – prolonged growling
Obstructive bowel sounds
Absent bowel sounds: wait, wait, wait!

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typical quadrant to listen for bowel sounds

LLQ

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percussion of abdomen

Percuss all four quadrants
-Tympany vs dullness
-Distinguish gas from liquid from solid contents
-Assess for peritoneal tenderness
Percuss abdominal organs
-Liver
-Spleen
-Gastric air bubble
-Bladder

fluid sounds more dull than air filled spaces
all four quadrants should be slightly tympanic

palpation of the abdomen

Light palpation
-In all 4 quadrants
-Assess for guarding, tenderness, obvious masses
Deep palpation
-In all 4 quadrants
-Assess for tenderness, masses, organs
Assess for rebound tenderness or peritoneal inflammation
Palpate abdominal organs: liver, spleen, kidneys, aorta, bladder
Be systematic and thorough

What is normally palpable

sigmoid colon (LLQ)
Liver edge (RUQ)
Abdominal aorta (above umbilicus)
Spleen (if enlarged) (LUQ)
Kidneys (if enlarged) (either/both flanks)

Percussion of liver

Liver span: R MCL nipple to umbilicus, normally 6-12cm

- tenderness

Palpation of liver

RUQ, on patient’s right

- liver border at/below costal margin

percussion of spleen

- LUQ below costal margin in Traube’s space | - Splenic percussion sign @ L ant axillary line

palpation of spleen

- LUQ, on patient's right | - patient in RLD position

Palpation of kidneys

- left kidney from patient's left or right side | - right kidney from patient's right side

CVA tenderness

pain with percussion suggests inflammation (pyelonephritis)

Auscultation of aorta

listening for bruits with bell

palpation of aorta

- mid abdomen for pulsations | - measure size (normal <3cm)

Percussion of bladder

dullness above pubic symphysis

palpation of bladder

- if distended above pubic symphysis, smooth and round - tenderness may indicate infection - beware of full bladder

inguinal lymph nodes

- superficial and deep nodes; only superficial are palpable - superficial inguinal nodes; - -horizontal group (drains superficial portions of lower abdomen, et.) - -vertical group (drains region of leg)

Murphy's sign

- Palpate deeply in RUQ - Ask pt to inhale fully - Positive Murphy’s sign = ARREST OF BREATHING and sharp increase in tenderness as inflamed gallbladder bumps into examiner’s hand - Note that tenderness alone does not equal a positive Murphy’s sign, but should be noted - Test for acute cholecystitis

Acute abdomen: peritoneal inflammaiton

- Appendicitis and other causes of acute peritonitis can be evaluated with several special techniques - -Rovsing’s sign (referred rebound tenderness) - -Psoas sign - -Obturator sign - Rebound tenderness, jar tenderness (smacking the side of the bed or asking if they experience pain going over bumps in the car), involuntary guarding, and other signs will likely be present in patients with acute abdomen

ascites

- Ascites can be present in a distended abdomen from many different causes - Abdomen will be dull to percussion - Special techniques can be used to confirm ascites - -Fluid wave test - -Shifting dullness

Fluid wave

- Ask the patient to press the hand down the midline of the abdomen and tap the side of the abdomen - A positive fluid wave will be felt on the opposite hand

Shifting dullness

- Percuss abdomen with patient supine, and then with patient lying on one side - In ascites, dullness shifts to the dependent position and tympany shifts to the top (air is lighter than fluid)

the ticklish patient

- Never take your hand off the abdomen - Have warm hands and firm touch - No sudden moves - Distract patient with conversation - Put patient’s own hand against abdomen, put your hand over theirs to palpate

Examining a child's abdomen

- If child is apprehensive, it’s mostly an indirect exam - Ask child to hop up and down or skip - Ask them to show you their belly button - Have parent do the palpation - Use stethoscope to palpate

GU and Rectal Exams

- Part of the abdominal examination - Generally performed after abdominal exam - GU and pelvic problems often present with abdominal symptoms

pain

a patient's experience, what they tell you

tenderness

objective measurement of the patients experience of pain

Pleurisy or acute MI Referred Pain

chest, spine, or pelvis

Pancreatic or duodenal Referred Pain

back

Biliary tree referred pain

right shoulder or right posterior chest

Auscultate for Bruits

(bell) - Aorta - Renal - Iliac - Femoral

shifting dullness or flank dullness can mean?

ascites