Abdominal Exam Flashcards
Alimentary tract organs
Runs from the mouth to the anus and includes the esophagus, stomach, small intestine, large intestine. Ingests and digests food, absorbs nutrients, electrolytes, and water, and excretes waste products
Hepatobiliary tract organs
Liver, pancreas, gallbladder, spleen, bile ducts
Function: digestion
4 quadrants of abdomen and organs contained
RUQ, RLQ, LLQ LUQ
Umbilicus is marker for horizontal and vertical lines
9 regions of abdomen
Divided by 2 midclavicular lines vertically, 1 costal margin line and iliac crest line horizontally.
Regions: R/L hypochondric, R/L lumbar, R/L iliac/inguinal, epigastric (middle top), umbilical, and hypogastric/pubic (middle bottom)
Equipment for abdominal exam
Stethoscope, ruler, measuring tape, marking pen
Components/ order of abdominal exam
Auscultate first~ remember you can mess stuff up with palpation first in the abdomen. Inspection, auscultation, percussion, palpation. Put pt in supine position, If patient has pain, have pt point to painful area, and examine that part last! Cover upper and lower body with gown and drape. Expose area from xyphoid process to pubic hairline. Knees bent, arms at side.
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Inspection (Abd. Exam)
Skin color, symmetry, shape, contour, deformities (herniations, bulges, masses), movement (aortic pulsation - seen in skinny patients, increased peristalsis - indicates obstruction), scars, striae (silver - not new , purple - indicates Cushings), lesions, venous pattern, jaundice, umbilicus (inverted/everted, bluish - Cullen sign)
Abdomen: Flat, schaphoid (sucken anterior wall, really skinny person), rounded (slightly distended - kids), Protuberant (distended - fluid, feces, fetus, ascites)
Venous patterns: usually not apparent, direction of blood flow (should be away from umbilicus; if towards suggests inferior vena cava obstruction)
Percussion (Abd. Exam)
Typanic: air filled stomach and intestines
Dullness: areas of stool, organs, fluid filled areas, masses
Sounds heard when auscultating abd.
Clicks and Gurgles (irregular, 5 - 35/ min.)
Borborygmi (long prolonged gurgle, can sometimes be heard indicating anything from hunger, gastroenteritis, or early bowel obstruction)
High pitched tinkles (suggest fluid and air under pressure)
Purpose of rectal exam, pelvic exam, and GU exam
Lies adjacent to the FI system. In the case of sever symptoms, the source of the problem cannot be fully detected without exam of those systems
RUQ pain
Pleuritic pain
RLQ pain
Appendicitis
Periumbilical pain
Small intestine, appendix, proximal colon
LUQ pain
Splenic infarct
LLQ pain
Diverticulitis
Cullen sign
superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. Sign of intraperitoneal hemorrhage
Ballottement
Indicates increased fluid in the supra patellar much over the patella at the knee joint. To test ballottement the examiner would apply downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the opposite hand.
Grey Turner sign
Ecchymosis of flanks indicates hemoperitoneum or pancreatitis. The bruising appears as a blue discoloration, and is a sign of retroperitoneal hemorrhage. Can be associated with Cullen sign.
Shifting dullness
When dullness by percussion changes going from supine to laying on the side due to gravity, sign of ascites.
Murphy sign
Abrupt cessation in inspiration while palpating gallbladder indicates cholecystitis
Fluid wave
Patient uses own hand as barrier in mid-abdomen. Tap on one side while palpating the other. Wave transmitted across is positive for ascites.
Rovsing sign
is a sign of appendicits If palpation of the LLQ of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis.
