Abdomen Assessment Flashcards
MMSE (minimental state examination )
30 max ::: LT 23=cog impairment orientation registration attention and calculation recall language
thready vs bounding
barely felt and easily obliterated
easilty felt and hard to oblit
Percussion sounds
Tympany dull Resonance hyper" Flatness
Tympany
loud, high pitch, drumlike
heard over air filled viscera
Dull percussion
soft to moderate medium pitch, thud like
over fluid, organs, fat or distended bladder
Resonacnce
moderate to loud, hollow, low pitch
Hyperresonance
soft, booming, low pitch
flatness percussion
loud, dull, high ptich
Pallor
pale
cyanosis
blusih discoloration
AST and ALT aspartate/alanine aminotransferase
large amounts in liver and heart
LT but sig amounts in muscle, kidneys pancreas, brain
NH4 test
severe liver damage and at hepatic portal from AA breakdown
bilirubin test
heme catalysois from marrow liver spleen –>jaundice in skin and sclera
liver biopsy
determine cell morpho and abnormalitys
Liver and spleen ultrasound
for structure, size, and position
Hepatobilliary iminodiacetic acid scan (HIDA)
tracking bile production from liver to SI to ID gall, bile duct, liver problems
Amalyse lipase enymes indicate what
obstuction and acinar cell damage –> obstruc inflam early cancer
Esophagogastroduodenoscopy test
endoscope to assess mucose of upper GI, remove foreing bodies polyps and diagnosis
Stool analysis to ID what
volume, oder, shape, color, consistancy, mucus, pathogens and substances
Fecal Occult blood test (FOBT)
hidden blood in shit as first sign of colon cancer
Liver loci
most of RUQ
Gallbladder loci
RUQ
Pancreas loci
UQs touches lower spleen and bottom sits in duodenum
stomach loci
somewhere
Spleen loci
LUQ to epigastric region under cage ()
(Veriform) appendix
9 cm RLQ
2 in under McBurny’s point
McBurny’s point
Ileocecal valve here between umbilical and pelvis at ()
Kidney loci
Either side of T12 to L3
R kidnet is 1-2 cm lower than L bc of libver
BUN test
blood urea test: [NH4] for kidney function
Creatinine
end product of muscle metab
GFR
glomerulaer filtration rate= blood that passes glom in 1 min
Ab major arteries
Aorta Renals Iliacs Femorals
Liver HH foci
▲weight ▲appitite/tolerance dysphagia (diff swallowing) Nausia/vomiting Indigestion/Hearburn Ab/Pelvic pain Constipation/Diarrhea (narrow stools =obstuction) Gas Urination ▲skin travel
Pyrosis
burning sensation in epigastic area radiating to thraot
Exact sequence of Ab assessment
Inspection
Ausculation
Indirect Percussion
Paplpation (light then deep)
9 quadrent system
LR hypochondriac mid=epigastric region
RL lumbar mid=umbilical region
LR Iliac mid: hypogastric
Organs in RUQ
Duodenum Gall liver pancreas head R kidney/adrenal hepatic flexure of colon part of asc/trans colon
LUQ organs
L lobe of liver stomach spleen body of panc L kid/adrenal splenic flexure of colon part of trans/desc colon
RLQ organs
Cecum Appendix R ovary/tube R ureter R spermatic cord part of ascending colon
LLQ organs
part of desc colon sigmoid colon L ovary/tube left ureter L spermatic cord
Midline organs
Aorta
uterus
bladder
Abnormal ab inspection
↑peristalic waves/pulsations
distension
hernia
↑ peri waves →
seen with obstruction
Ab pulastions →
aortic aneurysm
aneurysm
wakening and outpouching of artery
AB distension
fluid, fat, gas, fibroids baby
Asceites
fluid accumulation in peritoneal cavity
Diastasis recti
spliting of rectus abdominis muscuiles at midline (linea alba)
hernias
weaking of ab wall
loops of intestines and tissues pass into the peritoneuam
classifed by loci: inguinal, epigastric, ubmilical, incisional, Diastasis recti
Cullen’s sign
ecchymosis arround the umbilicus → intra-ab bleeding
ecchymosis
superficial bleeding under skin
Bowel Ausc
Start at McBurny’s point in RLQ to RUQ around
Normal clicks and gurges #
5-34
abnormal bowl asuc
hyperactive
hypoactive
no soiunds
Hyperactive bowel
loud high pitched sounds
in people with diarrhea, laxatives, gastroenteritis, and early obstruction
hypoactive bowel
slow ↓sounds
in epople with constipation, obstruction, medicatsions
no bowel sounds
may → paralytic ileus after surgery, bowel obstruction
Vascular bowl sounds
Use bell over 4 major arteries for no bruits
Bruits in bowels
liver disease or portal distension
Bruits
Turbulent, blowing sounds over partially or totally obstructed artery caused by buildup of plaque
Venous hum in bowel
continues medium pitched sound caused by bruits
Friction rub
grating sounds heard over inflamed organs with serous surfaces commonly over the RUQ liver or LUQ spleen
Ab Percussion
Indirect percussion for note and quality of sounds
Normally tympani in the 4 quadrants and dullness over organs
abnormal tympany over bowels can →
distension
abnomrnal dullness over bowels →
↑tissue density like organ enlargement or mass
pain in percussion →
peritoneal infammation
Splenic enlargement
expands ant, inf, and medially. replaces tymp of stomach and colon with dullness
3x to palpate
Palpation of ab
Light digs 1/2 deep and deep digs 1.5-2” deep
Paplate clockwise look for pain
Ab palp abnormals
Tenderness
Light: nodule or mass felt
Deep: mases enlarged organs
Rebound tenderness
indicative of peritoneal inflammation
check by slowly pressing on tender area and quickly let go
Bladder palpation
lightly palp for distended bladder between symphysis pubis and umbilicus. note size and loci
Bladder palp normal vs abnormal
N: empty not palp
Partially filled is firm and smooth
A: smooth round and firm mass extending as far up as the umbilicus
Tenderness may → bladder infection
Aceites
abnormal fluid accumulation, detectable after 500 mL with percussion , fluid waves and ultrasound
dull percussion laterally to fluid tympany at mid ab
Paracentesis
procedure to remove fluid from peritoneal cavity by needle insertion into the cavity. Usually done when person is respiratory distress or ad pain
