abdominal and renal lab Flashcards
whats the correct order of abdominal exam?
1) inspect
2) auscultate
3) percuss
4) palpate (superficial then deep)
striae
Stretch marks; linear changes associated
with rapid stretching of skin. Examples include
pregnancy and rapid weight gain.
Pathologic causes include Cushings Disease or
Syndrome (secondary to high dose steroids).
Hernia:
Ventral, Umbilical, surgical
Separation of muscle wall that permits
extravasation of abdominal contents. Appears as a
protuberant mass of the abdomen
-gentle pressure applied will reduce (return the
abdominal content) through a defect in the
abdominal wall musculature.
-localized tenderness worsened with lifting or using
surrounding muscles
Incarcerated hernia
inability to reduce without
surgery
Strangulated hernia:
compromise of the vascular
supply; surgical emergency
diastasis recti
separation of the rectus abdominis
muscle causing a midline ridge formed by
abdominal contents. ONLY appears when the
supine patient raises head above the shoulder.
Clinically benign. Common in obesity, chronic lung
disease and after repeated pregnancies.
ascites
accumulation of serous fluid in the
peritoneal cavity. Causes include CHF, liver disease
obstruction of inferior vena cava and portal
hypertension; abdomen appears uniformly
distended
bulging flanks
fluid causes distension of the flanks
when the patient is supine.
what test for ascites as the best specificity and the best sensitivity?
specificity= fluid wave sensitivity= shifting dullness
how do you perform a fluid wave two examiners?
Patient is supine; one person has hands over each
flank. Second person places the ulnar surface of
each hand over the patient’s umbilicus and along
the abdominal vertical midline. The first person
then uses one hand to tap the flank and assesses
for a moderate to strong wave on the opposite
side. (fig. 11-35 in Bates’)
how do you perform a fluid wave one examiner?
the patient places the ulnar surface
of one hand along the midline to act as a baffle.
The physician taps one flank and monitors for a
fluid wave on the opposite side.
what does the fluid wave test detect? what is the sensitivity and specificity?
detects large volumes of free
intrabdominal fluid. It has a specificity of 80-90%; a
positive finding rules in ascites. However, its
sensitivity is ~50%, so a negative test does not
exclude ascites (i.e. it is volume dependent).
what is the puddle sign?
This is an auscultatory percussion
sign that requires the patient to support
themselves on their hands and knees for 5 minutes.
how do you perform the puddle sign?
The operator then listens with the diaphragm while
flicking a finger over a localized flank area of the
abdomen starting at the lowest point and moving
over to the opposite flank.
what is a positive sign for puddle sign
A positive sign is a
sudden increase in intensity and clarity of the
sound, signaling that the stethoscope has passed
the edge of the peritoneal fluid.
what is the sensitivity of the puddle sign
The puddle sign has a sensitivity of ~40 – 50%
especially with small amounts of ascites.
Positioning the patient makes it very difficult to
evaluate.
how do you perform shifting dullness
percuss the abdomen to identify
the borders of the dullness. Reposition the patient
on their side and percuss again to the borders of
the dullness. With ascites, the border of dullness
shifts to the dependent side (with gravity).
icterus
aka jaundice is yellow integument
secondary to bile pigments (scleral icterus)
when would you see caput medusa?
portal HTN (congestion of superficial veins)
what are other PE findings associated with liver disease?
- asterixis (liver flap)
- palmar erythema
whats asterixis
Course flapping tremor when
the arms are outstretched and hands dorsiflexed.
Movements are jerky forward movements every 5-
10 seconds.
what is palmar erythema?
warm redness of the skin over
the palms and soles of the feet in the Caucasian
populations. Darker skin tones may change from a
tan color to a gray appearance. Other signs of liver
disease should also be assessed, as this can also be
a normal finding in some individuals.
what are signs of liver failure?
asterixis, jaundice, ascites,
palmar erythema, spider nevi
small bowel obstruction risk factors
findings vary depending
on the location of the obstruction within the gut.
Individuals at risk for obstruction or that have had
prior obstruction, abdominal surgery or radiation,
or abdominal comorbidities such as inflammatory
bowel disease, cancer, etc.
