Abdominal Assessment 2

Question 1

approach to exam of abdomen

Answer 1

Empty bladder (full bladder alters percussion); Expose abdomen—xyphoid to iliac crests; Observe facial features; want pt supine

Question 2

Sequence change of abdomen exam—

Answer 2

inspect, auscultate, percuss, palpate last; because you don’t want to alter bowel sounds

Question 3

F’s of abdominal distention

Answer 3

(why is abdomen distended?) 1. fat 2. fluid 3. feces 4. fetus 5. flatus 6. fibroid 7. full bladder 8. false pregnancy 9. fatal tumor

Question 4

inspection of abdomen

Answer 4

Contour; Scars, Striae, Rashes, Lesions; Umbilical area—discharge, irritation; Epigastric pulsation; Hernia; Veins; Flank area

Question 5

contour

Answer 5

symmetry, flat, rounded, protruding, scaphoid, sunken, F’s of abdominal distention (look for rounded or concave)

Question 6

Epigastric pulsation

Answer 6

pronounces pulse

Question 7

hernia

Answer 7

(damage of muscle cell wall, so weaken wall causes protrusion) umbilical, inguinal, incisional

Question 8

veins inspection

Answer 8

spider around umbilicus shows liver failure

Question 9

flank area

Answer 9

—ecchymoses; gray turner’s sign -pancreatitis, or extra parietal bleeding

Question 10

cullen’s sign

Answer 10

bluish color around umbilicus, illeuspancreatitis, intra parietal blood

Question 11

auscultation

Answer 11

Diaphragm all four quadrants; Assess for bowel motility & peristalsis - High-pitched gurgles, 5-30 per minute or one every 5-15 seconds, Increased over ileocecal valve after eating, Listen 5 minutes before stating absent sounds

Question 12

auscultation should start

Answer 12

where illeical value is, RLQ where hear bowel sounds the loudest, move clockwise

Question 13

normal amount of bowel sounds per minute

Answer 13

5-30 every minute

Question 14

hyperactive bowel sounds

Answer 14

greater than 30/min; Borborygmi

Question 15

Borborygmi—

Answer 15

excessive sounds, hear without stethoscope (stomach growling)

Question 16

hyperactive bowel sounds

Answer 16

less than 5/min, widely separated; Paralytic ileus; decrease peristalsis so decrease blood, fluid, slowing of bowel

Question 17

Paralytic ileus—

Answer 17

pinging, high pitched sound

Question 18

if twinkling bowel sound

Answer 18

illeus is developing, will show up on xray, often missed in the hospital

Question 19

Vascular sounds—

Answer 19

bruits; Aorta, Renal artery, Iliac artery, Femoral artery (turbulent blood flow)

Question 20

Venous Hums—

Answer 20

increase portal circulation, heard best over RUQ (liver)

Question 21

auscultate over liver and spleen for

Answer 21

friction rub

Question 22

for percussion ask pt

Answer 22

if they have any pain and do that area first

Question 23

when percussing start with

Answer 23

at 3rd intercostal space and go down

Question 24

scratch test

Answer 24

gently scratch and once the sound is louder know at the border of the liver

Question 25

percussion

Answer 25

Assess for fluid, air, organs (size & tenderness), or masses; Tympany in varying degrees is most common finding; Dullness is heard over organs, masses, fluid

Question 26

liver span -

Answer 26

use MCL—upper border 5-7th ICS and lower border just at costal margin; Usually 6-12 cm

Question 27

Costovertebral angle—

Answer 27

kidney tenderness; in lower back over kidneys (Pt sitting up right, used for kidney stones)

Question 28

light palpation

Answer 28

(1-2 cm) to assess superficial and surface characteristic and areas of tenderness—use one hand

Question 29

deep palpation

Answer 29

(4-6 cm) to assess organs, masses and deeper pain—use two hands; can actually feel liver, feeling for smoothness and checking for masses/ tenderness

Question 30

observe _____ palpating

Answer 30

face

Question 31

don’t palpate on

Answer 31

organ transplant pt, child, tumor, or severe injury, can cause more damage

Question 32

start palpations

Answer 32

RLQ then work around in circular motion

Question 33

what can’t you palpate

Answer 33

left kidney

Question 34

palpate bladder for

Answer 34

fullness

Question 35

after palpating abdomen

Answer 35

palpate for aorta

Question 36

if pt in pain when palpating

Answer 36

then pillows beneath knees, take deep breaths when exhale then palpate

Question 37

Palpation Considerations

Answer 37

Bladder distention, Peritonitis (surgical pts/ dialysis pts), McBurney’s point, Murphy’s sign, Rebound tenderness, Ascities (free fluid - fluid overload), Referred pain, Abdominal Reflexes

Question 38

common labs

Answer 38

basic metabolic channels, glucose, BUN, scope, CT scan, MRI, electroyltes, colon scope, A1c, peptic ulcers - H pylori, EKG

Question 39

common abnormalities

Answer 39

Abdominal Aortic Aneurysm, Appendicitis, Cancer, Cholecystitis, Hepatitis, Cirrhosis, Diverticulitis, Hernias, Inflammatory diseases, Pancreatitis, Ulcer