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CLIN MED - SPRING EXAM 2 > Abdominal Assessment > Flashcards

Abdominal Assessment Flashcards

1
Q

What should we ask the patient to do before performing an abdominal assessment?

A
  • empty bladder
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2
Q

What position does the patient start in for an abdominal assessment?

A
  • supine with UEs next to side unless otherwise noted
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3
Q

What side of the patient should we stand on as clinicans?

A
  • right side and in position to observe facial reactions
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4
Q

What asymmetries are we observing for with an abdominal assessment?

A
  • surface contour; any distention could be bowel obstruction, mass, etc
  • swelling or ascites - possible indicated by inverted umbilicus
  • umbilicus should be in midline
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5
Q

What kind of discolorations are we observing for with an abdominal assessment?

A
  • jaundice with liver dysfunction
  • ecchymosis indicating bleeding
  • vein distention indicating liver or vena cava obstruction
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6
Q

What markings should we take note of with an abdominal assessment?

A
  • scars
  • rashes
  • stretch marks
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7
Q

What can a pulsatile mass indicate with abdominal assessment?

A

abdominal aortic aneurysm but not unusual on lean individuals

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8
Q

What is peristalsis?

A

a wavelike motion that may indicate intestinal obstruction

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9
Q

What can sudden bulging with lifting the head or a cough indicate?

A

could indicate a hernia

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10
Q

What should we perform first in our abdominal assessment?

A

auscultations

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11
Q

Why should auscultations be performed first in our abdominal assessment?

A

to avoid altering bowel sounds

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12
Q

How long do we use the stethoscope to auscultate in each quadant?

A

2 minutes

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13
Q

What should we find for bowel sounds that are normal?

A

high pitched clicks and gurgling ever 5-10 seconds

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14
Q

What are ABNORMAL bowel sounds with auscultation?

A
  • none= bowel obstruction particularly with cramping
  • MORE = overactivity such as with lactose intolerance
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15
Q

Where is the abdominal aorta?

A
  • just left to midline and umbilicus at peri-stenal line
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16
Q

What indicates turbulent blood flow of the AA?

A

Bruits

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17
Q

How should we percuss during an abdominal assessment?

A
  • hyperextend and apply firm pressure with the non-dominant and distal aspect of the middle finger
  • avoid contact with any other part of the hand
  • position dominant hand close to surface with wrist extended
  • strike the non-dominant middle finger quickly and sharply with the flexed dominant middle finger
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18
Q

How many times can we strike with percussions during an abdominal assessment?

A

twice

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19
Q

What are “normal sounds” with percussions during an abdominal assessment?

A
  • tympanic or hollow sound over stomach and bowels or more air filled organs unless one is full
  • deep resonance or lasting sound over thorax and lung
  • dullness over more solid or full organs or even tumors
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20
Q

What organs should produce a dull sound with percussions?

A
  • liver
  • heart
  • diaphragm
  • spleen
  • etc.
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21
Q

Where is the stomach located (for percussion of the stomach)?

A
  • close to left lower rib cage, just inferior to sternum
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22
Q

What sound should the stomach make?

A
  • tympanic or hollow sound if empty, otherwise dull if full
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23
Q

Where do we perform mid-clavicular percussion of the liver? What sounds should we expect?

A
  • just above the umbilicus, along right mid-clavicular line
  • progress superiorly
  • starts with tympany or hollow sound of bowel
  • changes to dullness at liver for ~ 2.5 - 5 inches
  • resonance of lung tissue begins superior to liver
24
Q

What is abnormal with mid-clavicular percussion of the liver?

A

Larger area of dullness

25
Q

Where do we perform anterior axillary line percussion of the spleen? What sounds should we expect?

A
  • starts at left lower rib cage anterior axillary line
  • tympany or hollowness should be produced
  • move posteriorly toward mid-axillary line, it should become dull
  • dullness should be present between 9th and 11th ribs
26
Q

What is ABNORMAL with anterior axillary line percussion of the spleen?

A
  • dullness noted more medially and inferiorly
  • more dullness while inspiring
27
Q

What is the Murphy Test?

A
  • kidney percussion in sitting or prone with a firm fist thumping on contralateral flat hand over costovertebral angle looking for pain
28
Q

How do we start palpations?

A

start with firm, light pressure in a slow circular fashion within each quadrant

29
Q

What kind of hand contact do we want with palpations during our abdominal assessment?

A
  • broad hand contact and possibly palpate through patients hand
30
Q

Where is our forearm during palpations of the abdomen?

A

in the same plane as the abdomen

31
Q

What should we do if no resistance or symptom provocation during palpations?

A

apply deeper pressure

32
Q

What are we looking for with palpation, other than pain?

A

masses and muscle guarding

33
Q

What is NORMAL for palpations?

A

pressure

34
Q

What is abnormal for palpations?

A
  • tenderness or muscle guarding
35
Q

What can tenderness or muscle guarding during palpation indicate?

A

swelling or dysfunction

36
Q

How should we confirm for a similar response if we find tenderness or muscle guarding with palpation?

A

with percussion or cough

37
Q

How do we assess for rebound tenderness?

A

applying pressure then quickly releasing

38
Q

What does crepitus or crunchiness indicate with palpation?

A

excess air

39
Q

Where are hernias common?

A

around umbilicus and inguinal areas, larger with trunk flexor activity such as crunch, cough, etc.

40
Q

What can also be palpated with our abdominal assessment?

A

mass or cyst

41
Q

What is gastritis?

A

Stomach inflammation over epigastric area, just inferior to sternum

42
Q

What is diverticulitis?

A

Intestinal inflammation in the left lower quadrant

43
Q

Where would we feel for appendicitis?

A

right lower quadrant between ASIS and umbilicus

44
Q

Where would we palpate for hepatitis (liver inflammation)?

A

right upper quadrant, ask the patient to exhale and slowly move deeper during inhalation
- inferior border is palpable

45
Q

Where would we palpate for panreatitis?

A

mid-clavicular line in right upper quadrant with max exhalation, press and hold deeper pressure while patient is inhaling

46
Q

Where do we palpate for the spleen?

A
  • left lower rib cage at anterior axillary line, ask patient to exhale and slowly move deeper during inhalation under the rib cage
47
Q

Is the spleen palpable if no pathology?

A

NO

48
Q

How do we palpate the abdominal aortic artery?

A
  • hook lying
  • utilize two index fingers
  • find pulse just to the left of the umbilicus or left peri-sternal line and assess up and down abdominal region
49
Q

What are we assessing about the aortic artery?

A
  • strength
  • width by slowly moving fingers apart
50
Q

What are the strength grades for pulses?

A

0 = absent
2+ = normal
4+ = bounding

51
Q

What is the normal width of the abdominal aortic artery?

A

~1 inch (2.54cm)

52
Q

What could we find that is ABNORMAL regarding the abdominal aortic artery?

A
  • ≥ 3 cm may indicate aneurysm then confirm with auscultation
  • provoke back pain
53
Q

What dermatomes can we assess during our abdominal assessment?

A

T7-12 dermatomes with light and sharp touch from xiphoid process to inguinal lig

54
Q

What are we assessing the superficial abdominal reflex for?

A

UMN lesion

55
Q

How do we assess the superficial abdominal reflex?

A
  • diagonally strike from umbilicus to outer border of each quadrant
  • umbilicus should move in the direction of the stroke

CLIN MED - SPRING EXAM 2 (4 decks)

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