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Year 3 - Paramedic Care of Minor Illnesses > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

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1
Q

How should the patient best position themselves for an abdominal assessment?

A

Lying flat

If the patient struggles with their legs being flat they can bend them

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2
Q

Why should the patient lie flat for an abdominal assessment?

A

Abdominal muscles are relaxed

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3
Q

What should you be mindful to ensure you are observing for throughout the entirety of an abdominal exam?

A

Any signs of pain or distress

If any part of the assessment is causing the patient pain or discomfort

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4
Q

How would you best wish the patient to be exposed for an abdominal exam?

A

Exposed from nipples to knees - allowing for a full view of the abdomen

However, the absence of a shirt will usually be sufficient

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5
Q

What could abdominal distention indicate?

A

Fluid
Faeces
Flatus
Fat
Foetus
Tumour

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6
Q

You note asymmetry of the contours of the abdomen, what could this indicate?

A

Organomegaly
Massess
Fluid

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7
Q

What is organomegaly?

A

general term for the enlargement of an organ

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8
Q

Why should you check for any scars on the patients abdomen?

A

Scars can indicate any previous pathology requiring surgery

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9
Q

What is Cullens sign?

A

superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region

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10
Q

What is Grey Turners sign?

A

Bruising evident on the flanks - between the last rib and the top of the hip

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11
Q

What can be observed in this photo?

A

Cullens sign - Bruising evident around the umbilical region

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12
Q

What can be observed in this photo?

A

Grey Turners sign - Bruising evident on the flanks

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13
Q

What are Cullens sign and Grey Turners sign both indicative of?

A

Pancreatitis

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14
Q

What can be observed in this photo?

A

Spider naevi

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15
Q

What are spider naevi?

A

Visible blood vessels underneath the skin

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16
Q

What do spider naevi often indicate?

A

Underlying disease, particularly alcoholic cirrhosis of the liver

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17
Q

Why are spider naevi sometimes observed in pregnant women?

A

In response to pharmacological agents often given in pregnancy

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18
Q

Caput medusae?

A

Due to portal hypertension

presents as a cluster of swollen veins in the abdomen, often concentrated around the belly button.

Increased pressure in portal vein caused by blood trying to get to the liver

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19
Q

Common cause of caput medusae?

A

The umbilical veins carry the blood to the heart but the increased pressure causes umbilical veins to become distended – liver cirrhosis

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20
Q

What can be observed in this photo?

A

Caput Medusae

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21
Q

When are stretch marks often observed?

A

Pregnancy and rapid weight gain

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22
Q

What can abnormal hair distribution be a sign of?

A

Endocrine problems
In females - polycystic ovarian syndrome (PCOS)

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23
Q

Where in the abdomen would you observe for pulsation?

A

Above the umbilical region from sideways on

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24
Q

When might you observe slight pulsation in the umbilical region?

A

Very thin people

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25
Q

What is a large visible pulsation in the umbilical region a sign of?

A

Abdominal aortic aneurysm (AAA)

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26
Q

What is a hernia?

A

occurs when an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall

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27
Q

Where are hernias most commonly seen?

A

Epigastric
Umbilical
Femoral (in females)
Inguinal (in males)

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28
Q

How do you assess a patient for hernias?

A

Firstly look with the patient lying down

Then ask the patient to stand up and cough

If a hernia is seen, attempt to push it back in, if there is pain or it will not go back in when pushed, the patient should be referred for investigation

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29
Q

Why do you ask the patient to cough when assessing for hernias?

A

Coughing helps exaggerate any hernias if present

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30
Q

Name abdominal region 1

A

Right hypochondriac

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31
Q

Name abdominal region 2

A

Epigastric region

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32
Q

Name abdominal region 3

A

Left hypochondriac

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33
Q

Name abdominal region 4

A

Right Lumbar

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34
Q

Name abdominal region 5

A

Umbilical region

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35
Q

Name abdominal region 6

A

Left Lumbar

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36
Q

Name abdominal region 7

A

Right Iliac

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37
Q

Name abdominal region 8

A

Hypogastric region

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38
Q

Name abdominal region 9

A

Left Iliac

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39
Q

What organs are situated in the right hypochondriac?

A

Larger lobe of liver
Gallbladder
Right kidney
Small intestine

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40
Q

What organs are situated in the epigastric region?

A

Stomach
Smaller lobe of liver
Pancreas
Spleen
Duodenum (first part of small intestine)
Adrenal glands

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41
Q

What organs are situated in the left hypochondriac?

A

Spleen
Colon (large intestine)
Left kidney
Pancreas

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42
Q

What organs are situated in the right lumbar?

A

Base of liver
Right colon

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43
Q

What organs are situated in the umbilical region?

A

Umbilicus (navel)
Parts of the small intestine

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44
Q

What organs are situated in the left lumbar?

A

Descending colon (large intestine)

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45
Q

What organs are situated in the right iliac?

A

Appendix
Cecum

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46
Q

What organs are situated in the hypogastric region?

A

Urinary bladder
Sigmoid colon (large intestine)
Female reproductive organs

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47
Q

What organs are situated in the left iliac?

A

Descending colon (large intestine)
Sigmoid colon (large intestine)

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48
Q

Before palpating the abdomen, what should you first do?

A

Auscultate for bowel sounds

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49
Q

Why should you auscultate before palpating the abdomen?

A

Palpation of the abdomen can alter bowel sounds

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50
Q

Which side of your stethoscope should you use when auscultating the abdomen?

A

The diaphragm - picks up higher pitched bowel sounds

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51
Q

What is classed as ‘normal’ bowel sounds?

A

Irregular gurgling sounds

Frequency of 5-30 in a minute

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52
Q

If you hear over 30 bowel sounds in a minute what is this a sign of?

A

Hyperactive bowel - such as in diarrhoea

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53
Q

If you hear less than 5 bowel sounds in a minute what is this a sign of?

A

Underactive bowel - such as in constipation

54
Q

What do absent bowel sounds indicate?

A

A possible bowel obstruction

55
Q

When auscultating the abdomen you hear tinkling sounds, what can this indicate?

A

Early bowel obstruction.

56
Q

How long should you ideally listen to bowel sounds in each quadrant?

A

1 minute

57
Q

Where should you first auscultate the abdomen?

A

Right of the umbilicus

Move around the quadrants starting in the LRQ

58
Q

Name quadrant A

A

Right upper quadrant (RUQ)

59
Q

Name quadrant B

A

Left upper quadrant (LUQ)

60
Q

Name quadrant C

A

Lower right quadrant (LRQ)

61
Q

Name quadrant D

A

Lower left quadrant (LLQ)

62
Q

Aside from auscultating for bowel sounds, what should you also auscultate for?

A

Bruits of the aorta, renal and iliac arteries

63
Q

What is bruits, what causes it and what does it sound like?

A

abnormal sounds described as whooshing noises due to turbulent blood flow caused by atherosclerosis

64
Q

How should you auscultates the aorta, renal and iliac arteries for bruits?

A

with the bell of your stethoscope - best at picking up low pitched sounds

65
Q

How do you auscultate the aorta, renal and iliac arteries for bruits?

A

Firstly listen to the aorta
Then the renal arteries
Lastly the iliac arteries

66
Q

Where would you best auscultate the aorta?

A

Just above the umbilicus

67
Q

Where would you best auscultate the renal arteries?

A

2cm above the umbilicus and 2cm horizontally either side

68
Q

Where would you best auscultate the iliac arteries?

A

2cm down from the umbilicus and 2cm horizontally either side

69
Q

What would you expect to hear when auscultating for bruits in a healthy individual?

A

Nothing

70
Q

Before palpating the patients abdomen, what must you first check?

A

If they have any pain

71
Q

If a patient is complaining of pain in their right upper quadrant, what organs could this indicate an issue with ?

A

Underlying organs such as the liver; right kidney or gall bladder

72
Q

If a patient is complaining of pain in their left upper quadrant, what organs could this indicate an issue with ?

A

Pancreas, spleen, left kidney

73
Q

If a patient is complaining of pain in their lower left quadrant, what organs could this indicate an issue with ?

A

Descending colon

74
Q

If a patient is complaining of pain in their lower right quadrant, what organs could this indicate an issue with ?

A

Ascending colon
Appendix

75
Q

After palpating lightly in all 4 quadrants what should you do?

A

Palpate deeply
Test for guarding

76
Q

What organs would you palpate in the right upper quadrant?

A

Liver
Gallbladder

77
Q

What organs would you palpate in the left upper quadrant?

A

Transverse colon
Spleen
Pancreas

78
Q

What organs would you palpate in the lower left quadrant?

A

sigmoid colon
descending colon

79
Q

What organs would you palpate in the lower right quadrant?

A

appendix

80
Q

What organs would you palpate in the hypogastric region?

A

Urinary bladder

81
Q

What is guarding?

A

Guarding is the voluntary contraction of the abdominal muscles over inflamed organs or tissues below - to protect from pain

82
Q

When would you most likely observe guarding?

A

Localised inflammation of an organ - for example in peritonitis or appendicitis

83
Q

Why does guarding make abdominal assessments harder to conduct?

A

Often unable to feel organs below
Unable to palpate deeply due to patient discomfort

84
Q

What is rigidity?

A

Involuntary muscle spasm due to generalised hardness and inflammation of the abdomen

Often global

85
Q

When would you most expect to observe rigidity?

A

Peritonitis

86
Q

When would you most likely expect to observe rebound tenderness?

A

Appendicitis
Peritonitis

87
Q

What is McBurney’s point?

A

McBurney’s point refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis

88
Q

Where is McBurney’s point?

A

The line between the umbilicus and the iliac crest, moving 1/3 of the way up from iliac crest

89
Q

If rebound tenderness is observed on palpation of McBurney’s point, what is this indicative of?

A

Appendicitis

90
Q

Explain Rosvings sign.

A

Palpate the lower left quadrant of the abdomen - If referred pain is experienced on the lower right quadrant this is indicative of appendicitis

91
Q

What condition is rebound tenderness also common in aside from appendicitis?

A

Peritonitis

92
Q

How do you test for rebound tenderness?

A

Palpate an area of the abdomen deeply and release quickly - if pain is experienced when the hand is removed, this is known as rebound tenderness

93
Q

What is ascites?

A

Excess fluid in the abdomen

94
Q

What condition is often the cause of ascites?

A

Liver failure

95
Q

How would you percuss for the presence of ascites?

A

Percuss in a straight line from the umbilicus to the flank
You should hear tympany/hyper-resonance - if you hear any dullness, mark with tape for later reference

96
Q

What does hyper-resonance/tympany on percussion indicate?

A

hollow, high, drumlike sounds that indicate the presence of air/gas

97
Q

If dullness has been observed on percussion of the abdomen, which further 2 tests can you perform to confirm the presence of fluid in the abdomen?

A

The shifting dullness test - After determining an area of dullness in the abdomen, the patient is asked to roll onto the side of dullness, facing away from the examiner
Wait 30 seconds
Percussion from umbilicus to flank is repeated
A positive test: the area of dullness will shift to the dependent site and the area of tympany will shift towards the top

Fluid wave test - Ask the patient to place the ulnar aspect of their hand vertically above the umbilicus and push down
The examiner then taps one flank, while feeling on the other flank for the tap.
The result is considered positive if tap can be felt on the other side.

98
Q

Why must a hand be placed in the centre of the abdomen during the fluid wave test?

A

The pressure on the midline prevents vibrations through the abdominal wall and prevents a false positive from the movement of tissue

99
Q

Can the spleen often be palpated?

A

No
In a healthy individual the spleen will not be palpable

100
Q

If the spleen is palpable, what is this called?

A

splenomegaly (enlarged spleen)

101
Q

If the spleen is palpable, what is the common cause?

A

Glandular fever
Trauma

102
Q

How do you palpate the spleen?

A

Stand on the right side of the patient, place your left hand under the LS ribcage to support the abdomen
Start at the umbilicus, move up towards the left upper quadrant palpating for the splenic edge by pushing down and up

103
Q

Where do the kidneys sit?

A

Mostly under the ribs on both sides

104
Q

How do you palpate the kidneys?

A

Normally unable to palpate
Bi-manual technique (2 handed).
Left hand behind pt just below 12th rib and in the costovertebral angle, lift left kidney upwards and place right hand in right upper quadrant to try to capture the kidney between both hands.
Ask pt to breathe in as palpating.
Repeat for right kidney, left hand underneath with right hand on top.

105
Q

When palpating the kidneys what are you observing for?

A

Any tenderness or inflammation

106
Q

What could tenderness or inflammation during palpation of the kidneys indicate?

A

pyelonephritis

107
Q

What is pyelonephritis?

A

Pyelonephritis is the infection of one or both of the kidneys

108
Q

What are the most common causes of pyelonephritis?

A

Untreated UTIs / infections of the bladder leading to the infection of the kidney(s)
Kidney stones

109
Q

When palpating the liver, what should you feel?

A

Often not palpable, but if it is it should be smooth and anglular

110
Q

What is the costal margin?

A

lower margin of the thoracic wall (bottom of the ribcage)

111
Q

How do you palpate the liver?

A

Start by placing fingers in right iliac
Ask patient to breathe in and out, during the expiratory phase, move your fingers into position & during inspiration push inwards, trying to feel the liver edge.
With every breath gradually work your way up to the patient’s right costal margin.
Feel for the edge of the liver hitting your fingers

112
Q

What might you feel on palpation of the liver that could indicate cirrhosis?

A

Wobbly surface - usually the liver should feel smooth and angular

113
Q

If the liver is felt to be protruding below the ribs what could this indicate?

A

hepatomegaly
(hep-uh-toe-MEG-uh-le)

114
Q

What is hepatomegaly?

A

The enlargement of the liver

115
Q

In what condition is enlargement of the liver often seen?

A

Hepatitis

116
Q

How would you test for Murphy’s sign?

A

Place left hand flat under patients right costal margin (rib cage) 2-3cm from midline
Ask the patient to take a deep breath in, as they breathe out push your hand up under their ribcage
If the patient experiences immediate pain when their gallbladder hits your fingers - this is a positive test

117
Q

What does a positive Murphy’s test indicate?

A

Cholecystitis

118
Q

When is cholecystitis most prevalent?

A

Heavy drinkers
5 F’s - female, forties, fair, fat, fertile

119
Q

Why would you percuss the liver?

A

To assess the size

120
Q

How would you percuss the liver?

A

Percuss downwards along the right mid-clavicular line from the top of the chest
Mark where the sound changes from norm-resonant to dull
Then starting at the bottom of the abdomen, percuss upwards until the sound changes from tympany to dull and again mark with tape
Measure the distance between the tape marks
Normal is between 6-12cm

121
Q

After percussing the liver you measure more than 12cm, what could this indicate?

A

hepatomegaly - an enlarged liver
exampled in liver disease

122
Q

When percussing all 4 quadrants of the abdomen what would you expect to hear?

A

Tympany / hyper-resonance

Unless directly over an organ/structure, where you would expect to hear hypo-resonance

123
Q

When percussing the abdomen, you note hypo-resonance, what could this indicate?

A

Indicate an underlying organ, solid or fluid

124
Q

What does DRE stand for?

A

Digital Rectal Exam

125
Q

What exam SHOULD be included in a full abdominal assessment but should NOT be performed in an OSCE?

A

Digital Rectal Exam

126
Q

Why should a DRE not be performed in the OSCE?

A

It is not appropriate or necessary in the situation

127
Q

What omission should you ensure you note on any paperwork after stating a full abdominal exam has been performed, why?

A

A digital rectal exam (DRE) has not been performed - so it is not assumed it has been completed and therefore no adverse findings

128
Q

How would you perform a DRE?

A

Ask the patient if they want a chaperone present
Get the patient to lay in the left lateral position with their knees tucked up to their chest
Using a gloved and lubricated index finger, insert it into the rectum feeling all 4 quadrants

129
Q

What are you observing for in a DRE?

A

Pain
Bleeding
Faeces
Prostrate (men)
Cervix (female)

130
Q

What is the costal margin?

A

lower margin of the thoracic wall (bottom of the ribcage)

131
Q

What can be observed in this photo?

A

Caput Medusae

Year 3 - Paramedic Care of Minor Illnesses (6 decks)

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