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Abdominal Assessment Flashcards

1
Q

Three abdominal regions

A

Epigastric
umbilical
Hypogastric/Supragastric

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2
Q

RUQ Structures

A
  • Liver
  • Gallbladder
  • Duodenum
  • Head of pancreas
  • Right Kidney and adrena
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3
Q

LUQ Structures

A

*Stomach
* Spleen
* Left lobe of liver
* Pancreas
* Left kidney and adrenal
* Splenic flexure of colon
* Part of transverse and
descending colon

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4
Q

RLQ Structures

A
  • Cecum
  • Appendix
  • Right Ovary and tube
  • Right Ureter
  • Right Spermatic cord
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5
Q

LLQ Structures

A

Part of descending colon
* Sigmoid colon
* Left ovary and tube
* Left ureter
* Left spermatic cord

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6
Q

Midline Structures

A

*Aorta
* Uterus
* Bladder

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7
Q

4 Steps of abdominal assessment
(overview)

A

-Inspection
- Auscultation
- Percussion
- Palpation

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8
Q

Patient prep for abdominal assessment

A
  • Supine position, pillow under the head, arms at the
    sides
  • Draping the patient
  • — Raise the gown to just below the nipple line above the xiphoid process
  • Level of the symphysis pubis
  • Empty bladder
  • Warm hands and stethoscope
  • Nails short
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9
Q

Abdomen Development
**Infant and children

A

Umbilicus is prominent
* Liver takes up more space at birth, may be palpable
* Urinary bladder located higher in abdomen
* Less muscular-organs more easily palpated

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10
Q

Abdominal development
**Pregnant

A

Enlarged uterus
* Intestines displaced upwards and to right
* Bowel sounds diminished
* Motility may cause constipation
* Skin changes-striae, Linea nigra

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11
Q

Inspection

(What am I looking for in the abdomen?)

A

Temp- diaphoretic?
Color- bruises, erythema, jaundice, rashes
Scars
Striae-stretch marks
Dilated veins
Symmetry/umbilicus- Inverted?
Pulsations/movement
Visible organs/masses
Hair distribution

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12
Q

Auscultation sounds (what does it sound like?)
**Diaphragm

A

(high pitched sounds)

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13
Q

Auscultation sound-
Assessment

How do I do it? Frequency of bowel sounds?

A

Bowel sounds:
-Start in RLQ at ileocecal valve area-bowel …….sounds are normally always present here.
- Auscultate all 4 quadrants
- Note frequency and character
usually 5 - 30 per minute
- Occur every 5-20 seconds.

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14
Q

Auscultation sounds (what does it sound like?)
**Bowel

A

high pitched, gurgling, and irregular

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15
Q

Types of bowel sounds

A
  • Present (positive bowel sounds)
  • Hyperactive
  • Hypoactive
  • Absent: established after 5 minutes of
    continuous listening
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16
Q

Borborygmus
(Bowel sound)

A

stomach
growling-hyperperistalsis

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17
Q

Abdominal: Auscultate for Vascular sounds
(Types of sounds)

A
  • Bruits in the aortic, renal, iliac, and
    femoral arteries (not normally heard)
  • Check especially in people
    with HTN
  • Occurs with stenosis or
    occlusion of an artery
  • Pulsatile blowing sounds
  • Abdominal Aortic Aneurysm (AAA)
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18
Q

Abdominal inspection (shape)

A

Contour
Flat
Rounded: slightly distended
Scaphoid: concave, Sunken
Protuberant: distended

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19
Q

Developmental Considerations:
Children

A

Potbelly, flat while supine
Liver palpable

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20
Q

Developmental Considerations:
Adult after middle age

A

Females with fat accumulation
Males w fat deposits
Gallstones
Gastric acid secretion
Decreased salivation/taste
Esophageal emptying delayed
Liver-size decreases
Constipation

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21
Q
A
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22
Q

Vascular sounds
(what is it?)

A

Turbulent blood flow
(not normal)

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23
Q

Why do we percuss the abdomen?

A

Looking for solids
Organs like the Liver/spleen
Fluid collection
Masses
Distinguish the tympany vs dullness

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24
Q

What is tympany

A

it’s heard over abdominal areas that may be filled with abdominal air/gas (stomach for example)

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25
What is dullness?
it's heard over solid organs, fluid collection, or areas of consolidations (such as tumor or mass)
26
What does dullness help indicate?
helps estimate liver size; can indicate ovarian tumor, distended bladder, ascites, fluid, mass, or adipose tissue
27
What is hyperresonance?
Distended abdomen
28
Costovertebral Angle Tenderness (CVA)
used for indirect percussion to assess kidneys done over 12th rib and CVA on back - place palm of one hand on patient back, thump with fisted hand -- pain with inflammation of kidney -- causes: renal colic, pyelonephritis
29
What is palpation and what is it used for? (in this class instance - light palpation)
to assess surface characteristics feel for organs, enlarged organs, masses, tenderness, fluid and ascites
30
What are the two types of palpation
light: abdominal tenderness, muscular resistance, superficial organs and masses deep: advanced
30
Characteristics of light palpation
How to: use the finger pads and gently press down about 1cm or 1/2 inch gently press down and use light circular motions to palpate for: - texture - masses - moisture - pulsations - temperature - tenderness
31
Deep Palpation characteristics (advanced assessment - do we need to know this?)
assess and feel for the location and size of internal organs, masses, and tenderness may be done using one or two hands -- 5-6cm or 2-3 inches if pain reported in an area - gently palpate last
32
Advanced assessment - deep palpation: bimanual technique
one hand over the other, push down obese patient uses bimanual
33
Abdominal masses may be characterized by: | Different types of masses... ## Footnote Physiological, inflammatory, vascular, neoplasitc,obstructive
physiological: pregnant uterus inflammatory: diverticulitis vascular: AAA neoplastic: colon cancer obstructive: distended bladder or dilated loop of bowel
34
Abnormal findings in palpation
guarding, rigidity, rebound tenderness (when pain is felt when moving hand away), peritonitis
35
Peritonitis indications
positive cough test, involuntary guarding, rigidity, rebound tenderness and percussion tenderness
36
Palpation of the liver
place left hand posteriorly parallel to and supporting 11th and 12th ribs on right place right hand in upper quadrant below area of liver dullness have patient take a deep breath, feel liver margin for smoothness, firm sharp edge
37
Hooking technique - advanced assessment
alternative to liver palpation hook hands under costal margin as patient takes a deep breath
38
Palpation of the kidneys - advanced
usually not palpable unless enlarged! right kidney: usually inferior pole of the right kidney - place left hand underneath patient's back - have patient take a deep breath - palpate with right hand on anterior abdominal wall - feel for lower pole of kidney - have patient release breath - slowly release kidney *left kidney is rarely palpable*
39
Palpation of the spleen
*spleen is not normally palpable; is palpable when enlarged* an enlarged spleen expands anteriorly, downward and medially - it replaces tympany of stomach and colon with dullness have patient take a deep breath, feel the edge of spleen with fingertips
40
Abnormal assessment finding - appendicitis
localized tenderness in RLQ, right flank rebound tenderness inflamed peritoneum Rovsing sign - indirect tenderness Psoas sign - irritation to the iliopsoas muscles
41
What is the Rovsing sign
when you palpate the LLQ and the patient has pain on the RLQ
42
Abnormal assessment findings - umbilical hernia
protrusion of intestine through weakness in umbilical ring
43
Abnormal assessment findings - incisional hernia
bulge near operative scar
44
Abnormal assessment findings - epigastric hernia
protrusion of abdominal structures through epigastrium
45
Abnormal assessment findings - hepatomegaly
enlarged liver causes: hepatitis, cirrhosis, portal obstruction/HTN
46
Abnormal assessment findings - cholecystitis
RUQ pain, Murphy sign Murphy sign - pain on inspiration from palpation of gallbladder
47
Abnormal assessment findings - splenomegaly
Enlarged spleen causes: inflammation, HIV, splenic infarct, Mono, trauma, malaria
48
Abnormal assessment findings - pancreatitis
LUQ pain, radiates to back, mid-epigastrium, left scapula aggravated by eating, severe nausea and vomiting
49
Abnormal assessment findings - gastric ulcer
ask if they take anything to help? stomach pain is dull, brought on by food; radiates to back
50
Abnormal assessment findings - gastritis
inflammation of stomach lining gnawing or burning feeling in the upper abdomen; LUQ
51
Abnormal assessment findings - gastroenteritis
Small intestine Diffuse abdominal pain; ask for pain rating on pain scale caused by Norovirus nausea and vomiting
52
Abnormal assessment findings - ascites
fluid accumulation rigid/taut increased girth fluid shift can be very hard depending on amount of fluid and tightness measure to see if abdomen is growing in size can trigger other conditions in patient ask: are you in pain? how long? have you sought help for this before?
53
Abnormal assessment findings - distended abdomen
can be caused by: obesity, pregnancy, ovarian cyst, ascites, tumor, stool, gas/air
54
Abnormal assessment findings - distended abdomen - the F's (she listed in class)
Fluid Feces Full bladder Flatulence Fetus Fatal tumor Fatal feces Fat
55
Abnormal assessment findings - intestinal obstruction
fever, vomiting absent stool/gas passage pain above obstruction hyperactive bowel sounds initially, then hypoactive or absent abdomen tender to touch distended abdomen abdominal surgery
56
Abnormal assessment findings - large bowel obstruction
bloating, gradual onset of pain can rupture internally -- feces in abdominal cavity vomiting hypoactive bowel sounds
57
5 questions to ask patient beginning of abdominal assessment
1. Have you recently had any nausea or vomiting? 2. Have you had any abdominal surgery? 3. What is your dietary pattern like? How often do you eat meals? 4. Are you currently having any abdominal pain/tenderness? 5. When was your last bowel movement? Color/form
58
Describe Bruits and the cause
Turbulent sounding caused by stenosis of the Aorta
59
Palpation- expected findings
Nontender with relaxed muscles

NUR 502 (13 decks)

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