Abdomen Flashcards
What should be included in the ROS?
When’s the last time you went to the bathroom?
- What’s normal for you?
When was the last time you ate?
Nausea/vomiting/diarrhea/constipation/abnormality in stool?
Pain?
Food allergies? What’s your diet like?
Last menstrual cycle/any chance you could be pregnant?
Have you had any abdominal surgeries?
When was your last colonoscopy? (Geared towards >50)
Colace or other medications that can affect GI? Iron supplements?
On any daily narcotics that could cause constipation?
Proton pump inhibitors?
GERD? IBS/IBD?
How is the abdomen divided during examination?
4 quadrants:
RUQ, RLQ, LUQ, LLQ
What organs are located in the RUQ?
Liver Gallbladder Head of pancreas Right kidney Right adrenal Hepatic flexure of colon Part of ascending and transverse colon
What organs are located in the RLQ?
Cecum Appendix Right ovary and tube Right ureter Right spermatic cord
What organs are located in the LUQ?
Stomach Spleen Left lobe of liver Body of pancreas Left kidney Left adrenal Splenic flexure of colon Part of transverse and descending colon
What organs are located in the LLQ?
Part of descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord
Which is the largest and most palpable organ?
Liver
Where is the liver located?
The superior portion is about 5th ICS right side (RUQ)
Inferior portion sits around the right costal margin
Where is the stomach located?
Upper portion is around 5th or 6th ICS
Where is the pancreas located?
Behind the stomach
Where is the small intestine located?
R&LLQ
Where do the lower bowels dump into?
Cecum
What is usually in the cecum?
Liquid
Where is the appendix located?
RLQ
Sits by ascending colon
What does the transverse colon do?
Absorb water
Is the stool hard or soft in the descending/sigmoid colon and why?
Soft because water is absorbed
Where is the bladder located?
Suprapubic region
How many mL can the bladder hold before one feels the need to urinate
400-600 mL
How much fluid can the bladder hold?
~1L
Where is the uterus located?
Suprapubic region
What is peritonitis?
When the lining of the abdominal cavity is enflamed
What can cause peritonitis?
Ruptured appendix/ small/large intestines
What are general guidelines for abdomen assessment?
Good lighting Have pt empty bladder Warm hands, stethoscope Short fingernails Warm room Adequate covering No shivering Exposure from xiphoid process to the symphysis pubis Ask if they have pain in the abd and point - Examine tender areas last!!! Watch pts face as you examine.
What is the sequence during the abd examination?
Inspection
Auscultation
Percussion
Palpation
What can happen if you palpate before you listen?
Peristalsis disruption
How do you inspect the abdomen?
Have pt supine with one pillow under head, arms at sides, breath through mouth.
What people have protuberant bellies?
Pregnant woman
Some alcoholics - some with liver disease develop ascites
Tumor or fatal growth
What can cause distension?
Six “F”’s Fluid Fat Flatulence Feces Fetus Fatal growths
What should you inspect the abdomen for?
Contour Distension Umbilicus (contour, location, signs of hernia or inflammation) Skin (scars, striae, dilated veins) Symmetry of organs
How does a tumor affect movement of the abdomen?
That section of the abdomen won’t move
How can a bruit form in the abdomen?
Atherosclerosis
Abdominal aneurysm
How do you auscultate the abdomen?
Listen with diaphragm in all 4 quadrants for 15 seconds
Make sure to hear bowel sounds in at least 1 quadrant
If you don’t hear during the first round, listen again
If you don’t hear this time, it’s considered absent bowel sounds -> will have other signs and symptoms/complaints (nausea, vomiting, bloating)
What is borborygmi
String of bowel sounds
Can be normal of a sign of obstruction
What types of sounds can indicate an early intestinal obstruction?
High pitched, tinkling, & splashing
How can bowel sounds be categorized?
Normal, absent, hypoactive, or hyperactive
When do you see hypoactive bowel sounds?
Seen in someone out of surgery
Someone on narcotics
When do you see hyperactive bowel sounds?
Obstruction
What are signs of peritonitis?
Guarding
Pain
Rebound tenderness
Where is a venous hum heard?
Liver or upper abdomen
What does a venous hum indicate?
Liver disease, hepatic cirrhosis
What does it mean when you hear a friction rub over the spleen
Inflammation, or infarction
What does it means when you hear a friction rub over the liver?
Primary or metastatic tumor. Causes grating sound.
What is the sequence for listening for a bruit in the umbilicus region?
Aorta -> right renal artery -> left renal artery -> go below umbilicus -> right iliac artery -> left iliac artery -> right femoral artery -> left femoral artery
How do you percuss the abdomen?
Percuss in all 4 quadrants
When is dullness heard?
When percussing over dense abdominal organs, feces, or fluid
When is tympany heard?
When percussing over air filled structures
Heard over most of the abdomen because stomach & bowel contain air & gas.
How do you measure for the liver border?
Right MCL
Percuss down from breast - will hear resonance over lungs
Mark with pen when you hit dullness (around 5th or 6th ICS)
Go to umbilicus and MCL and start percussing up until you hear dullness - mark with pen
Measure
Normal size is 6-12 cm
Where does the inferior portion of the liver sit?
Right costal margin
How do you percuss the kidneys?
Take hand and put upside down over kidney
Tap with other hand
Percussing for tenderness, not sound
What is rebound tenderness?
Not hurting when you press in and hurting when you let go
When can rebound tenderness be present?
Peritonitis
What is the process of palpating?
Light palpation then deep palpation
What is a positive Rovsing sign?
When you press on LLQ and pain is increased on RLQ
What could a + Rovsing sign indicate?
Appendicitis
What is McBurney’s Point and where is it?
Point where the appendix is on the body
⅓ up from right superior iliac crescent to umbilicus
What is a + Murphy’s sign?
Intense pain when you hook fingers under right costal margin of right costal angle
What can a + Murphy’s sign indicate?
Cholecystitis
Where is the gallbladder located?
RUQ
How do you palpate for the liver?
Stand to the right of the pt Put left hand under small of back Go up under right costal margin and put fingers under there Have pt take deep breath Run fingers along right costal margin Cirrhosis of liver will feel ridgey
How do you palpate for the kidneys?
Go to umbilicus and over to the side
Feel from front and back sides
Left hand underneath pt and right hand pressing down
What does the CVA test look for?
Pyelonephritis, kidney tenderness
