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632 Advanced Anesthesia Health Assessment > Abdominal Assessment > Flashcards

Abdominal Assessment Flashcards

1
Q

What landmarks are used to identify the abdomen?

A
  • Superiorly by the inferior dome of the diaphragm (5th ICS)
  • Posteriorly by the lumbar vertebrae
  • Anteriorlaterally by rectus abdominis, transversus abdominis, internal & external oblique
  • Inferiorly by the pelvic brim
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2
Q

Several organs are often palpable in the abdominal pelvic cavity except:

A

The stomach and much of the liver and spleen

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3
Q

A careful history alone can diagnosis 76% of abdominal cases. What questions should you ask?

A

“OLD CARTS”

  • Onset
  • Location
  • Duration
  • Characteristics
  • Aggravating symptoms
  • Relieving symptoms
  • Time
  • Severity

Also: is it migrating, & past medical, surgical, & social history

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4
Q

Visceral Pain

A

Typically, nonspecific & difficult to localize

- Palpable near the midline at levels that vary according to the structure

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5
Q

What characteristics might describe visceral pain associated w/ ischemia?

A
  • gnawing, cramping, or aching varying in quality
  • as the pain progresses systemic symptoms may follow:
    • sweating, pallor, N/V, restlessness
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6
Q

Examples of RUQ visceral pain

A
  • Hepatitis (including alcoholic hepatitis) or biliary pathology from liver distention
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7
Q

What is an example of periumbilical visceral pain?

A
  • Suggestive of early acute appendicitis from distention of an inflamed appendix
  • Gradually changes to parietal pain in the RLQ from inflammation of the adjacent parietal peritoneum
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8
Q

What should you suspect if the visceral pain is disproportionate to physical findings?

A

Intestinal mesenteric ischemia

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9
Q

What is the cause of somatic/parietal pain?

A

Originates from inflammation of the parietal peritoneum, peritonitis, which can be localized or diffuse

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10
Q

What are the presentation differences of parietal pain compared to visceral?

A
  • Parietal is a steady, aching pain, usually more severe than visceral pain
  • More precisely localized over the involved structure
  • Typically aggravated by movement or coughing
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11
Q

Common associated gastrointestinal symptoms include:

A
  • indigestion
  • nausea
  • vomiting (including blood (hematemesis),
  • loss of appetite (anorexia)
  • early satiety
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12
Q

Referred pain

A

Felt in more distant sites that are innervated at approximately the same spinal levels as the disordered structures
- Often develops as the initial pain becomes more intense & seems to radiate or travel from the initial site

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13
Q

Pain of duodenal or pancreatic origin will have referred pain to where?

A

The back, pain from the biliary tree, to the right scapular region or the right posterior thorax

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14
Q

Pain from pleurisy or inferior wall myocardial infarction will have referred pain to where?

A

The epigastric area

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15
Q

How is discomfort defined?

A

A subjective negative feeling that is nonpainful (can include various symptoms such as bloating, nausea, upper abdominal fullness, & heartburn)

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16
Q

Which neuropeptides are interconnected to pain, bowel dysfunction, & stress

A

5-hydroxytryptophan and substance P

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17
Q

Your elderly patient states they cannot tolerate to stand up what should you take from this statement?

A
  • Elderly patients tend to have diminished sensitivity to abdominal pain
  • Possible appendicitis
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18
Q

Dyspepsia

A

Chronic or recurrent discomfort or pain centered in the upper abdomen, characterized by epigastric pain or burning (or both) & postprandial fullness or early satiety (or both)

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19
Q

Abdominal clinical exam should include:

A
  • Make the patient comfortable in the supine position
  • Keep arms at the side so the abdominal wall doesn’t stretch & tighten
  • Appropriate draping
  • Before: ask the patient. to point to any area of pain so that you can examine thses areas LAST
  • Stand on the patient’s right side and use a systematic approach: auscultation, percussion, & palpation
  • Watch the patient’s face for any signs of pain or discomfort
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20
Q

Signs of peritonitis:

A
  • Guarding
  • Rigidity
  • Rebound tenderness
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21
Q

Key components of Liver & Spleen exam:

A
  • Estimate the liver size along right MID-CLAVICULAR line by percussion
  • Palpate & characterize the liver edge
  • Percuss for splenic enlargement along Traube’s space
  • Palpate for the splenic edge w/ the patient supine & in the R. lateral decubitus position.
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22
Q

What are the hallmark signs of Cushing syndrome

A

Pink-purple striae

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23
Q

Dilated veins suggest in the abdomen suggest?

A

Portal hypertension from cirrhosis (caput medusae) or inferior vena cava obstruction

24
Q

When might you see ecchymosis of the abdominal wall?

A

Intraperitoneal or retroperitoneal hemorrhage

25
Q

Bulging flanks are seen in _______.

A

Ascites

26
Q

Suprapubic bulge is a sign of _______ , _______, & _______.

A
  • Distended bladder
  • Pregnant uterus
  • Ventral, femoral, or inguinal hernias
27
Q

Abdominal asymmetry suggests what 3 things?

A
  1. hernia
  2. enlarged organ
  3. a mass
28
Q

What is the maximum you should auscultate the abdomen?

A

5 minutes

5-35 = normal range

29
Q

Tympany during percussion predominates what?

A

Hollow or gas in the GI tract

30
Q

Scattered areas of dullness are from what?

A

From fluid and feces

- sometimes even a full bladder

31
Q

Guarding

A

Voluntary contraction of the abdominal wall, often accompanied by a grimace

32
Q

Rigidity

A

An involuntary reflex contraction of the abdominal wall from peritoneal inflammation that persists over several examinations

33
Q

Rebound tenderness

A

Refers to pain expressed by the patient after the examiner presses down on an area of tenderness & suddenly removes the hand.
- To assess ask the patient “which hurts more”

34
Q

An palpable liver edge below the ribs is suggestive of what?

A

Enlarged liver & cirrhosis (increased span/size of liver dullness)

35
Q

Decreased dullness in alive is = to what?

A

Liver is small or free air BELOW the diaphragm (tympany)

36
Q

What causes Liver dullness displaced downward by the low diaphragm. Size remains normal.

A

COPD

37
Q

Firmness or hardness of the liver, bluntness or rounding of its edge & surface irregularity are suspicious for what?

A

Liver disease

38
Q

You palpate a firm oval mass below the liver edge and an area that is dull to percussion what are you suspicious of?

A

An obstructed distended gallbladder that may have merged with the liver.

39
Q

Traube’s space

A

Check for a splenic percussion sign (CASTELL sign)

  • Percuss the lowest costal interspace in the LEFT ANTERIOR axillary line
  • This area is usually tympanitic
  • Usually does not cross midaxillary line
40
Q

Causes of splenomegaly:

A
  1. Portal hypertension
  2. Hematologic malignancies
  3. HIV infection
  4. Infiltrative disease like amyloidosis
  5. Splenic infarct or hematoma
41
Q

Where should you palpate a AAA

A

Press firmly deep in the epigastrium, slightly to the left of the midline

42
Q

Age 50 a normal aorta =

A

< 3 cm wide

43
Q

Risks factors for AAA:

A
  • Age > 65 years
  • History of smoking
  • Male
  • 1st degree relative w/ a history of AAA repair
44
Q

Rupture is 15x’s more likely in the AAAs is ______.

A

> 4 cm

45
Q

Ascites

A

A protuberant abdomen with bulging flanks is suspicious for ascites

46
Q

What is the difference between ascitic fluid vs gas

A

Ascites - sinks with gravity
- dullness appears in the dependent areas of the abdomen
Gas filled loops of bowel = rise

47
Q

Ascites may signal decreased osmotic pressure in:

A
  • Nephrotic syndrome
  • Malnutrition
  • Ovarian cancer
48
Q

What is a common cause of RLQ abdominal pain?

A

Appendicitis

49
Q

What are some of the signs to test for appendicitis?

A
  • McBurney point
  • Rovsing sign (indirect tenderness from pushing down on the LLQ)
  • psoas sign & obturator sign (involve movement of the thighs & hip)
50
Q

Acute cholecystitis

A

RUQ pain, but does not have any tenderness on palpation in the RUQ
- Perform the test for Murphy sign

51
Q

Ventral hernias

A

Defect in the abdominal wall that allows tissue to budge through (exclusive of groin hernias)
- ask the patient to raise both legs off the table or perform a Valsalva maneuver to increase intraabdominal pressure

52
Q

Which hernias merit prompt surgical evaluation?

A

Strangulated inguinal, femoral, or scrotal hernias are an emergency.

53
Q

Acute diverticulitis

A

Confined inflammatory process, usually in the LLQ that involves the SIGMOID colon.
- may be suprapubic or right-sided pain

54
Q

A hepatic bruit is suggestive of ?

A

Carcinoma of the liver or cirrhosis

55
Q

Arterial bruits with both systolic & diastolic components suggest ?

A

Partial occlusion of the aorta or large arteries

56
Q

Bruits in the epigastrium are suspicious for ?

A

Renal artery stenosis or renovascular hypertension

57
Q

Acute Salpingitis

A

Frequently bilateral, w/ tenderness usually just above the inguinal ligaments.

  • Rebound tenderness & rigidity may be present.
  • Motion of the cervix & uterus causes pain during a pelvic exam

632 Advanced Anesthesia Health Assessment (12 decks)

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