Abdomen Flashcards
Anatomical quadrants
RLQ: Appendix, cecum/ascending colon, right kidney (lower pole), right ovary and tube, right ureter, right spermatic cord
RUQ: Pylorus, duodenum, ascending/transverse colon, GB, liver, pancreas (head), right adrenal gland, right kidney (upper pole), right ureter
LUQ: Stomach, transverse/descending colon, left adrenal gland, left kidney (upper pole), left ureter, pancreas (body/tail), spleen
LLQ: Descending/sigmoid colon, left kidney (lower pole), left ovary and tube, left ureter, left spermatic cord
Solid and hollow abdominal viscera
Solid viscera: MAINTAIN their shape consistency (liver, pancreas, spleen, adrenal glands, kidneys, uterus, ovaries)
Hollow viscera: CHANGE their shape consistency depending on the contents (stomach, GB, SI, colon, urinary bladder)
Palpation depends on (1) location, (2) consistency, and (3) size; Normally not palpable: pancreas, spleen, stomach, GB, SI
Subjective assessment: CC/HPI
Acute, chronic, focused, or injury/accident; related to ADLs?
Recent weight gain/loss
Indigestion or esophageal burning is indicative of GERD; S/S: Hoarseness, laryngitis, chronic dry cough, asthma, lump in throat, halitosis, dysphagia, alcohol intake, pregnancy
N/V/D; diarrhea (indicative of IBS, infectious gastroenteritis); chronic constipation (laxative overuse)
Appetite status/changes/dietary recall
Abdominal/flank pain, location?
GU: Urinary output (polyuria, strong stream indicative of enlarged prostate, dysuria, foley)
GI: Bowel elimination pattern (stool frequency/description)
Yellowing of skin/whites of eyes; itchiness, dark urine, tea-color/clay/tar stools (indicative of liver disease)
PMHX
Abdominal surgery/trauma/injury/meds.; pain/treatment?
Lab work or GI studies
Abdominal infections/UTIs (older adults)
Abdominal conditions (GERD, GB disease, peptic ulcer disease)
Pregnancies (C-section)
Hep. A, B, C, viral hep. (gray-color stools)
FHX
Stomach/colon/liver CA
Abdominal pain, appendicitis, colitis, bleeding, hemorrhoids
GI conditions (IBS)
Nutritional habits
Lifestyle and health practices
Smoking
Alcohol use (SBIRT)
Fluid intake (volume); nutritional status (diet; fiber, sat. fat)
Antacid use
Exercise and activity; health practices
Stress
Home environment
Sleep
Relationships
Abdominal pain locations
- Visceral pain: occurs when (1) hollow viscera become extended and contract forcefully or (2) the capsules of solid viscera are stretched completely (Pain: dull, aching, burning, cramping, colicky)
- Parietal pain: inflammation of the parietal peritoneum; tends to be more localized, severe, and steady (appendicitis, peritonitis)
- Referred pain: occurs at distance sites that are innervated; cholecystitis can occur on the right shoulder/mid-back; kidney pain can occur on flanks/lower-back
Objective assessment: order of techniques
- Inspection
- Auscultation
- Percussion
- Palpation
Objective assessment: preparation
Empty bladder
Remove clothes, gown (drape for privacy)
Lie supine with arms folded across chest or resting by sides
Slow, deep breathes through mouth (ask to voice tenderness/discomfort)
Equipment: Small pillow, ruler/tape measure, stethoscope, marking pen, specimen containers
Objective physical assessment
VS, pain?; measurements (Wt., ht., BMI)
Void measurements (I&O, stool kit, urinalysis/dip stick, stoma?)
General routine assessment:
- Observe coloration/vascularization, scars/keloid formations, rashes/lesions on abdominal skin
- Observe umbilicus
- Observe abdominal contour/symmetry, aortic pulsations/peristaltic waves
- Auscultate bowel sounds
- Percuss and palpate quadrants
Focused speciality assessment:
- Inspection
- Auscultate for vascular sounds (venous hum/friction rub)
- Percuss size of liver (use scratch test if needed)/spleen
- Blunt percussion of liver and kidneys
- Deeply palpate viscera (aorta, liver, spleen, kidneys, urinary bladder) and masses, for shifting/dullness
- Assess rebound tenderness
- Perform hypersensitivity test
- Test for cholecystitis
Assessments for appendicitis
Rebound tenderness: Pain or tenderness that occurs upon release of pressure on abdomen
Assessments:
1. Psoas sign: irritation to the iliopsoas muscle of hip flexors in RLQ indicative of appendicitis (performed by extension/flexion of right leg)
- Obturator sign: irritation to the obturator muscle in RLQ indicative of appendicitis (performed by flexion and interal/external rotation of knee)
- Blumberg sign: positive rebound tenderness indicative of appendicitis (performed by deeply palpating McBurney’s point; between umbilicus and iliac crest)
- Rovsing sign: referred RLQ pain upon rebound pressure of LLQ, indicative of appendicitis
Inspection
General survey, head-to-toe scan (observe overall skin coloration, striae, scars/keloid/lesions/rashes, stomas)
Abdomen: size/symmetry/contour/shape; condition of skin (color/lesions/veins/hair distribution/hernias), movements (respirations/peristalsis waves)
Umbilicus: position/contour/movements/herniation
Observe aortic pulsation
Assess nonverbal gestures for pain/discomfort
Contour/shapes
Flat
Scaphoid (may be abnormal)
Rounded
Distended/protuberant (d/t 6 F’s: Fat, feces, fetus, fibroid, fluid, flatulence/gas)
Auscultation of bowel sounds
Auscultate same quadrant for at least 5 min. to determine absence of bowel sounds (approx. 1/breath sound)
Post-op BS resume gradually over first 24-48 hr.
Bowel sounds:
1. Hyperactive: high-pitched, stomach gurgling indicative of rapid peristalsis (gastroenteritis, D/, BEFORE bowel obstruction); Borborygmus: rumbling/gurgling noise made by the movement of fluid and gas in the intestines
- Hypoactive: quiet/faint, almost non-existent indicative of diminished bowel motility (post-op, N/V, LATE bowel obstruction)
- Decreased/absent: absence of bowel motility (emergency; ruptured appendix)
Auscultation of vascular sounds
- Bruit: suggests occlusion of blood vessel (use bell to auscultate abdominal aorta, renal, iliac, umbilicus, femoral arteries)
- Venous hums: suggests portal vein HTN (s/t cirrhosis; use bell to auscultate epigastric area)
- Friction rub: high-pitched sound (use diaphragm to listen over right costal margin/liver, spleen/left flank)
