Abdominal Examination Flashcards by Jenn Cantilli

what in a pts hx indicates a need for an abdominal exam (9)

hemoptysis
n/v
change in bowel movements
- constipation or diarrhea
- blood in stool (melena or hematochezia)
- change in caliber of stool
change in urination
- pain, bloody urine, inc freq, dec stream
fatty food intolerance
drug use
sexual activity
hx of hepatitis
hx of hernia

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what are the 4 components of an abdominal exam

inspection/observation
auscultation
percussion
palpation

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where does stomach refer pain to

middle and lower T spine

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where does small intestine refer pain to

middle T spine

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where does the pancreas refer pain to

upper and lower T spine

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where does gallbladder and liver refer pain to

right, middle, and lower T spine

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where does common bile duct and large intestine refer pain to

middle lumbar spine

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where does sigmoid colon refer paint o

upper sacral region
suprapubic region

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where does kidney refer pain to

lumbar spine (ipsilateral flank)

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where does ureter refer pain to

groin
medial and prox thigh
thoracolumbar region

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where does urinary bladder refer pain to

sacral apex
thoracolumbar region

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what are 2 considerations for abdominal exam

knees bent - keeps psoas relaxed
empty bladder - will be pressing

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how should the borders of the 4 quadrants be drawn

vertical w xyphoid process to pubis
horizontal thru umbilicus

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whats in the RUQ (8)

liver and gallbladder
pylorus
duodenum
head of pancreas
R adrenal gland
R kidney
hepatic flexure of colon
portion of ascending and transverse colon

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what’s in the LUQ (8)

left lobe of liver
spleen
stomach
body of pancreas
L adrenal gland
L kidney
splenic flexure of colon
portions of transverse colon & descending colon

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what’s in the RLQ (8)

R kidney (lower pole)
cecum and appendix
portion of ascending colon
bladder (if distended)
ovary and salpinx
uterus (if enlarged)
R spermatic cord
R ureter

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what’s in the LLQ (8)

L kidney (lower pole)
sigmoid colon
portion of descending colon
bladder (if distended)
ovary and salpinx
uterus (if enlarged)
L spermatic cord
L ureter

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what are the abdominal regions

epigastric
umbilical
hypogastric

borders
- at lower border of costal margin
- upper border of iliac crest

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contents of epigastric region (4)

pyloric end of stomach
duodenum
pancreas
portion of liver

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contents of periumbilical region (4)

omentum
mesentary
lower part of duodenum
jejunum and ileum

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contents of suprapubic region (3)

ileum
bladder
uterus (if pregnant)

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what do you inspect the abdomen for

shape
symmetry
color
scars

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what are stria

white, silvery
- normal - associated w wt gain, wt loss
- ex: pregnancy, obesity, growth spurts

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what are purple stretch marks

cushings syndrome
- can also see rashes

r/i hernia

hold breath and lift head off table (contracting abs) - that pressure will inc presentation of where hernia is

what should be inspected

intestinal peristalsis aortic pulsations umbilicus - displacement - discoloration

if intestinal peristalsis are present what does this make you worry about

intestinal obstruction

if aortic pulsations are present what does this make you worry about

aortic aneurysm inc pulse pressure

what does + presence of umbilicus indicate

underlying mass

what does + bluish discoloration around the umbilicus indicate

intraabdominal bleeding cullen's sign

what does auscultation screen for

bowel and vascular sounds

what will normal bowel sounds be auscultated as

normal peristalsis heard as clicks & gurgles - occur ~5-35x/min

if indicated, would listen to bowel sounds for 5min to appreciate:

inc bowel sounds occur w intestinal obstruction dec bowel sounds occur w peritonitis or paralytic ileus (absent)

what are you listening for when auscultating vascular sounds

bruits (murmurs) indicative of vascular dz - HTN & aneurysm areas of common involvement: - mid epigastric - RLQ and LLQ - femoral regions

what does the presence of auscultated rubs over liver and spleen indicate

inflammation possibly d/t infection, tumor, or infarction

where is aorta auscultated

above, at, and below umbilicus

what are the areas for vascular auscultation

aortic renal (R and L) iliac (R and L)

when is percussion indicated

estimating liver and spleen size - for suspected path - for caution if manual techniques in area are intended presence of fluid, air, or masses in the abdominal cavity

what are the two basic sounds heard from percussion

tympanitic (drum-like) - from percussing over air filled structures dull sounds - over solid structure (ie liver) - over fluid (ie ascites)

liver percussion technique

percuss up from RLQ in R midclavicular line up to 6th rib space - listen for change from resonant to dull sound

where do you percuss a spleen

slight posterior to L mid axillary line b/w 6th and 10th rib spaces

how does percussion of spleen sound

dullness is faint - bc more solid may be tympanic during regular breathing but dull when breath hold or if enlargment is present

what can cause a false positive result on a splenic percussion test

colonic distention or impaction

when is fist percussion of the kidney indicated

used to assess for tenderness in flanks - back pain that doesn't change w mechanics helps screen for possible kidney infection

technique for fist percussion of kidney

place one hand over flank region (around floating rib areas) - strike hand w fist of other hand

what are the results of fist percussion of kidney

normal = pt should feel "thud" and not pain need to correlate other hx and exam findings to inc specificity and r/i pyelonephritis

what are general rules for abdominal palpation

ensure relaxation in abdomen & bladder emptied palpate indicated areas of tenderness or pain last

what are the types of palpation

light deep rebound

when is light palpation indicated

identifying tenderness, muscular resistance, superficial masses and organs

technique of light palpation

4 fingers flat on abdomen, depress ~1cm and move in small circles in 4Qs

what should be noted from light palpation

areas of tenderness, firmness, rigidity, or masses

when is deep palpation indicated

further delineate abdominal masses that may have been suspected on light palpation

what should be noted from deep palpation

presence of masses if so: - size - shape - consistency - tenderness - location

when is rebound tenderness indicated

suspected peritoneal inflammation reports of abdominal pain

what can be an equally useful tool as a rebound tenderness assessment

light percussion

positive sign of rebound tenderness

+ Blumberg sign - sharp stabbing pain - indicates peritoneal irritation

positive sign in RLQ at McBurney's point

McBurney sign - sharp stabbing pain - indicates appendicitis

technique of rebound tenderness

hand at 90deg, fingers extended and press deeply into area prox to identified pain - does it hurt on pressing in? or upon rapid withdrawal?