Abdominal screening lab Flashcards
what are some history questions to ask the patient?
pain in abdomen?
change in appetite?
chewing and swallowing problems?
heartburn?
nausea, vomiting, regurgitation?
voiding difficulty?
previous surgery?
weight gain or loss?
what is in the right upper quadrant?
gallbladder
liver
duodenum
head of pancreas
right kidney
hepatic flexure of colon
part of ascending and transverse colon
what is in the right lower quadrant?
cecum
appendix
right ovary and fallopian tube
right ureter
what is in the left upper quadrant?
stomach
spleen
left lobe of liver
body of pancreas
left kidney and adrenal gland
splenic flexure of colon
parts of transverse and descending colon
what is in the left lower quadrant?
part of the descending colon
sigmoid colon
left ovary and fallopian tube
left ureter
what should the clinician do in preparation of an abdominal exam?
short fingernails
wash hands thoroughly with soap and water
informed consent
what should the patient do in preparation of an abdominal exam?
use the bathroom
position supine with pillow under head knees slightly flexed
drape inferior border of breasts/pecs to pubic symphysis
what is the sequence of assessment?
inspection
auscultation
percussion
palpation
what are we looking for when inspecting the skin pigmentation?
jaundice (liver disease)
for patients with darker skin pigmentation, examine sclera of eye
what are we looking for when inspecting for skin lesions?
skin cancer
striae (stretch marks)
normal flesh colored
cushing syndrome- pink and purple
scars (should match surgical/medical record)
what are we looking for when inspecting bruising?
if unexplained or possible internal organ- immediate referral to ER
Cullen’s sign- bluish hue of umbilicus (may be seen in patients with ruptured ectopic pregnancy, leaked aortic aneurism, and intraabdomial malignancies)
about how many cases of melanoma are diagnosed each year in the US?
62,000
where are the most common metastases sites?
skin, lung, brain, liver, bone, and intestine
about how many people die a year from melanomas according to the American Cancer Society?
8,4000
what are risk factors for a melanoma?
age greater than 15, fair complexion, persistently changed or changing mole, presence of many moles, presense of atypical moles, personal or family history of melanoma, sun sensitivity, excessive sun exposure, medical conditions, white race, residence near equator
what are risk factors for a nonmelanoma skin cancer?
older age, fair complexion, male sex, inability to tan, prolonged redness after exposure to the sun, white race, and residence near equator
what is the ABCD checklist for skin cancer screening?
Asymmetry
Border
Color
Diameter
when do the ABCDs for skin cancer raise suspicion?
asymmetry: when bisected, one half of the lesion is not identical to the other half
border: the border is uneven or ragged as opposed to smooth and straight
color: the lesion is more than one shade of pigment
diameter: is greater than 6mm
presence of one or more of these elements raises suspicion that lesion is cancerous
what else are we inspecting?
umbilicus in midline
shape (should be flat, distention)
movement (should move with respiration, pulsations are abnormal)
what can be the problem if the abdomen is distended?
small bowel obstruction, enlarged spleen or liver, AAA
when should auscultation be done?
prior to percussion and palpation because bowel sounds may chance with manipulation
what are normal bowel sounds?
5-30/min
what is a hypoactive bowel?
4/min or less communicate with the physician
what is a hyperactive bowel?
30 or more/min rush of symptoms with abdominal cramping communicate with physician
what is the procedure for auscultation of bowel sounds?
place diaphragm of stethoscope lightly on abdomen in RUQ
listen for bowel sounds (low pitched gurgling sounds)
repeat with other quadrants (most prevalent in RLQ)
what is bruits?
unusual sound that blood makes when it rushes past obstruction
abnormal
indicative or arterial disorder (stenosis, aneurysm)
what is the procedures for auscultation of bruits?
place bell of stethoscope over artery (abdominal artery, renal artery, iliac artery, can be assessed in carotid artery as well) if present document and call physician
why is percussion used?
to identify potential abnormal anatomy (abdominal mass) or as a provocative test (kidneys)
if the sound heard from percussion is tympanic what does this mean?
air filled structure
normally present over most of the abdomen in supine
if the sound heard from percussion is dull what does this mean?
if in that area should be tympanic-> possible underlying abdominal mass
what is the procedure for percussion?
hyperextend your middle finger of non-dominant hand and place the distal interphalangeal joint firmly against the patient’s abdomen (Avoid contact with other part of your hand)
with the end of the opposite middle finger, use a quick flick of the wrist to strike the middle finger
what is the procedure for percussion of the liver?
start percussion in the right mid clavicular line just above the umbilicus (you should hear tympany of the bowel)
continue upward until you hear your first dull sound (this is the inferior border of the liver, you can note this location with a skin marker or have the patient mark with a finger)
continue along this same path until you hear a new sound. this should be the resonant sound of the lungs (this is the superior border of the liver, you can note this location with a skin marker or patient finger)
the distance between the two point should be between 6-12cm (if >12 cm possible enlarged liver or lung mass)
what is the procedure for skin percussion?
start percussion at the lowest intercostal space along the left anterior axillary line (this area is normally tympanic)
ask the patient to take a deep breath and percuss this area again (dullness in this area is a sign of splenic enlargement)
why do we do kidney (Murphy’s) percussion?
patients with kidney disease may complain of pain over the costovertebral angle with referral to the iliac crest
pain is often unchanging with assumption of a different position and movement
what is the procedure for kidney percussion?
patient sitting on exam table
use heel of closed fist to strike patient over costovertebral angles
perform bilaterally and compare
what is the procedure for palpation?
broad hand contact (reduces ticklishness)
circular fashion
start superficial (if no complaint of tenderness or palpable mass, use deeper pressure)
areas of tenderness should be noted, especially if: associated with other symptoms, local mass, muscle guarding, or referral of pain/reproduction of symptoms)
what does local abdominal pain with tenderness on palpation and muscle guarding indicate?
peritoneal inflammation
what is rebound tenderness useful for?
appendicitis
what is the procedure for rebound tenderness?
locate McBurney’s point (2/3 distance from umbilicus to ASIS)
press deeply on abdomen with hand
after a moment, quickly release the pressure
if it hurts more when you release the patient had rebound tenderness
what is an AAA (abdominal aorta aneurysm)?
abnormal widening of blood vessel (>3cm in diameter)
weakening of medial-middle “layer” of blood vessel
approximately 75% of aneurysms occur in abdominal aorta
what is the procedure for palpating for an AAA?
patient supine with hips and knees flexed
locate abdominal aorta pulse (0=absent, 2+= normal, 4+ bounding)
press down deeply in the midline above the umbilicus
the aortic pulsation is easily felt on most individuals
a well defined pulsatile mass, greater than 3cm across, suggests an aortic aneurysm
what is the procedure for measuring AAA?
locate the abdominal aorta pulse which is just left of midline superior to umbilicus
once a pulse has been detected with midabdominal palpation, place both index fingers with deep but gentle pressure, along the sides of the pulse noting the presence of a laterally expansive pulsation >3cm across
such a finding would warrant abdominal auscultation for the presence of a bruit
