Abdominal Assessment Flashcards
What are the four main components to this assessment
Inspection, Auscultation, palpation, percussion
What does the end of bed assessment involve assessing?
How does the patient look, hydration status, body mass, fever, pain, environment e.g vomit bowls
What should we start with in the physical assessment
Hands
What can clubbing be an Indication of?
Inflammatory bowels disease, coeliac disease and cirrhosis
What can koilonychia be an indication of
Anaemia
What can palmar erythema show
Possible pregnancy or liver disease
What can needle use marks show?
Recent blood tests, or IV and recreational drug use
What can depuytrens be an indication of?
Thickening of the palmar fascia which can be associated with alcohol excess or family history
What can a liver flap or Astérix show?
Hepatic encephalopathy due to build up of ammonia in the brain - get them to hold out their hands for 15 seconds
After three hands where do we inspect next?
Head and neck
When looking at the face what are we looking for?
Jaundice which may be an indication of a build up of bilirubin and pallor which may indicate GI bleeding
How do we test conjunctival pallor?
Ask the patient to pull their lower eye lid down and look up, if it is white it may indicate anemia
What can blue lips Indicate?
Lack of oxygen - cyanosis
Why should you also check their tongue
For grossitis - indication of herpes or anaemia
What should you inspect and look for on the body
Scars, bruising, cullens, hernias, masses, pulsations, spider Nivea, caput medusa and distension
How many quadrants are there that you must listen to?
4
What is the normal sound that should come from auscultation
Gurgling
What is the next step after auscultation
Palpation
What areas do you assess last
The ones where the patient said are painful
What are we looking for when we palpate lightly
If there is any tenderness, rebound tenderness, guarding (involuntary tension in the abdominal muscles), masses
What do we do after we have palpated lightly
Palpate all 9 areas deeply
What else can you do other than palpate the liver?
Percuss the liver but the note changes in sound
Where do you begin the palpitation in the liver?
Begin in the right illiac fossa using the flat edge of your hand, press your hand into the abdomen as you ask your patent to take a deep breath.
Feel for a step as the liver edge passes below your hand.
When does the spleen become palpable ?
When it’s 3 times its normal size
How do you palpate the spleen?
Starting at the right iliac fossa align your fingers in the same direction as the left costa margin, press your hand into the abdomen as you ask the patient to take a deep breath. Feel for the splenic edge as it passes under your hand. If you cannot feel anything repeat the process with your hand 1 or 2 cm closer to the left hypochondria.
How do you palpate the gall bladder
The gall bladder is not normally palpable, place your hand in the right coastal margin, mid clavicular line
Ask the patient to take a deep breath, as the gallbladder is pushed down the patient may suddenly develop pain. If this happens and the patient doesn’t feel any discomfort on the left side of the abdomen then they are Murphy’s sign positive which suggests cholecytisis
What are the tests for appendicitis?
Rovsings sign, the psoas sign, obturator sign
What is the last step after palpitation
Percussion
What is the percussion technique?
Place your non dominant hand on the patients abdomen, position your middle finger over the area you want to percuss firmly pressed against the abdomen.
With your dominant hands middle finger strike the middle phalanx of the other hands middle finger.
The striking finger should be removed quickly.
Dull sounds suggest a solid organ or obstruction if you hear it over an organ where a hollow organ is expected.
What are we constantly checking about the arms and legs
The temperature
