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NURB 3060 > Assessing the Abdomen > Flashcards

Assessing the Abdomen Flashcards

1
Q

inspection of the abdomen

A
  • coloration
  • vascularity
  • striae
  • scars
  • lesions and rashes
  • umbilicus
  • location of umbilicus
  • contour of umbilicus
  • contour
  • symmetry
  • respiratory movements
  • aortic pulsations
  • peristaltic waves
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2
Q

normal findings of coloration of skin

A

skin may be paler than the general skin tone because this skin is so seldom exposed to the natural elements.

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3
Q

abnormal findings of coloration

A
  • Purple discoloration at the flanks (Grey–Turner sign) indicates bleeding within the abdominal wall, possibly from trauma to the kidneys, pancreas, or duodenum or from pancreatitis.
  • The yellow hue of jaundice may be more apparent on the abdomen.
  • Pale, taut skin may be seen with ascites (significant abdominal swelling indicating fluid accumulation in the abdominal cavity).
  • Redness may indicate inflammation.
  • Bruises or areas of local discoloration
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4
Q

normals findings of vascularity of abdominal skin

A

-scattered veins may be visible

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5
Q

abnormal findings of vascularity of abdominal skin

A
  • dilated veins, can indicate cirrhosis of liver, obstruction of inferior vena cava, portal hypertension, or ascites
  • dilated surface arterioles and capillaries with a spider angioma, may indicate liver disease or portal hypertension
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6
Q

normal findings of striae

A
  • pink or bluish (new)

- silvery, white, linear, uneven (old, past pregnancies or weight gain)

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7
Q

abnormal findings of striae

A
  • dark bluish-pink, Cushing syndrome

- result of ascites, resulting from liver failure or disease

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8
Q

normal findings of scars

A

pale, smooth, minimally raised

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9
Q

abnormal findings of scars

A
  • non-healing wounds
  • redness
  • inflammation
  • deep, irregular scars from burns
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10
Q

normal findings of umbilicus

A

tone is similar to surrounding skin or even pinkish

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11
Q

abnormal findings of umbilicus

A
  • Cullen sign: bluish or purple discoloration around umbilicus, indicates intra-abdominal bleeding
  • grey-turner sign: bluish or purplish discoloration on the abdominal flanks
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12
Q

normal findings of umbilical location

A

midline at lateral line

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13
Q

abnormal findings of umbilical location

A

-deviated, can be caused from pressure from a mass, enlarged organs, fluid, hernia, or scar tissue

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14
Q

normal findings of umbilical contour

A
  • recessed (inverted), protruding no more than 0.5 cm

- round or conical

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15
Q

abnormal findings of umbilical contour

A
  • everted, seen with abdominal distention

- enlarged and everted suggests umbilical hernia

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16
Q

normal findings of abdominal contour

A

-flat, evenly rounded, or scaphoid (normal in thin adults)

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17
Q

abnormal findings of abdominal contour

A
  • protuberant or distended abdomen, due to obesity, air (gas), or fluid accumulation
  • distention below the bladder, due to full bladder, uterine enlargement, or ovarian tumor or cyst
  • distention of upper abdomen seen with masses of the pancreas or gastric dilation
  • scaphoid, seen with severe weight loss or cachexia (wasting of the body) related to starvation or terminal illness
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18
Q

major causes of abdominal distention

A
  • fat
  • feces
  • fetus
  • fibroids
  • flatulence
  • fluid
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19
Q

how to inspect abdominal contour

A

sit at the patient’s side and look slightly higher than the patient’s abdomen inspecting the area between the lower ribs and pubic bone

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20
Q

normal findings of abdominal symmetry

A

-symmetrical

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21
Q

abnormal findings of abdominal symmetry

A

-asymmetrical, seen with organ enlargement, large masses, hernia, diastasis recti, or bowel obstruction

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22
Q

abnormal findings of respiratory movement

A

diminished or change to thoracic breathing in males, may reflect peritoneal irritation

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23
Q

normal findings of aortic pulsations

A
  • slight pulsation visible in the epigastrium

- extends full length in thin people

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24
Q

abnormal findings of aortic pulsation

A

-vigorous, wide, exaggerated, may be seen with abdominal aortic aneurysm

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25
Q

normal findings of peristaltic waves

A
  • normally not seen

- may be visible in very thin people as slight ripples

26
Q

abnormal findings of peristaltic waves

A

increased and progress like ripples fro LUQ to RUQ with intestinal obstruction

27
Q

what to auscultate for when assessing abdomen

A
  • bowel sounds
  • vascular sounds
  • venous hum
  • friction rub over liver and spleen
28
Q

normal findings of bowel sounds

A
  • soft clicks and gurgles at rate of 5-30 per minute

- hyperactive bowel sounds (borborygmus), loud prolonged gurgles (stomach growling

29
Q

abnormal findings of bowel sounds

A
  • hyperactive bowel sounds that are rushing, tinkling, and high pitched, indicates rapid mobility heard in early bowel obstruction, gastroenteritis, diarrhea, or laxative use
  • decreased or absence, indicate no bowel motility, emergency, immediate referral needed
30
Q

how to auscultate for vascular sounds

A

Use the bell of the stethoscope to listen for bruits (low-pitched, murmur-like sound) over the abdominal aorta and renal, iliac, and femoral arteries
-important if client has hypertension or if arterial insufficiency is suspected in legs

31
Q

normal findings of vascular sounds

A

-bruits not normally heard over abdominal aorta or renal, iliac, or femoral arteries

32
Q

abnormal findings of vascular hum

A

-bruit with both systole and diastolic components, occurs when blood flow in artery is turbulent or obstructed, may indicate an aneurysm or renal arterial stenosis (RAS)

33
Q

how to listen for venous hum

A

-use bell of stethoscope and listen in the epigastric and umbilical areas

34
Q

normal findings of venous hum

A

not heard

35
Q

abnormal findings of venous hum

A

-accentuated venous hum heard suggests increased collateral circulation between the portal and systemic venous systems, as in cirrhosis of the liver

36
Q

how to auscultate for friction rub over the liver and spleen

A

use diaphragm and listen over the right and left lower rib cage

37
Q

normal findings of friction rub over liver and spleen

A

no friction rub present

38
Q

abnormal findings of friction rub over liver and spleen

A
  • heard over the lower right costal area, can be hepatic abscess or metastases.
  • heard at the anterior axillary line in the lower left costal area, can be splenic infarction, abscess, infection, or tumor.
39
Q

palpation of the abdomen

A
  • tone
  • span or height of the liver
  • spleen
  • liver and kidneys
  • light palpitation
  • deep palpitation
  • massess
  • umbilicus
  • aorta
  • liver
  • urinary bladder
40
Q

normal findings of tone of the abdomen

A
  • tympany heard over the abdomen due to air in the stomach and intestines
  • dullness heard over the liver and spleen
41
Q

abnormal findings of tone of abdomen

A
  • accentuated tympany or hyperresonance is heard over a gaseous distended abdomen
  • enlarged area of dullness, heard over enlarged liver and spleen
42
Q

how to percuss the lower border of the liver

A
  • begin in the RLQ at the midclavicular line and percuss upward
  • note the change from tympany to dullness, that is the lower border of liver dullness
43
Q

how to percuss the upward border of the liver

A
  • percuss over the upper right chest at the MCL and percuss downward
  • note the change from lung resonance to liver dullness, that is the upper border of liver dullness
44
Q

how to measure the span of the liver

A

mark the distance between the upper border and the lower border of the liver

45
Q

normal findings of percussion of the lower border of the liver

A

dullness located at the costal margin to 1-2 cm below

46
Q

normal findings of percussing the lower border of the liver

A

on deep inspiration, dullness may descend from 1-4 cm below the costal margin

47
Q

normal findings of percussing the upper border

A

located between the left fifth and seventh intercostal spaces

48
Q

abnormal findings of percussing the upper border

A

difficult to estimate due to obscured pleural fluid of lung consolidation

49
Q

normal findings of percussing the span of the liver

A
  • 6-12 cm

- greater in men and taller patients, less in shorter patients

50
Q

abnormal findings of percussing the span of the liver

A
  • hepatomegaly, liver span is enlarged, found in liver tumors, cirrhosis, abscess, and vascular engorgement
  • span is decreased, due to atrophy of liver
  • lower in position, may be caused by emphysema
  • higher in position, may be caused by abdominal mass, ascites, or a paralyzed diaphragm
51
Q

how to percuss the spleen

A

starting posterior to the left midaxillary line percuss downward noting the change from lung resonance to splenic dullness

52
Q

normal findings of percussing the spleen

A

-oval area of dullness approx. 7cm wide near the left tenth rib and slightly posterior to the MAL

53
Q

abnormal findings of percussing the spleen

A

splenomegaly, area of dullness greater than 7 cm wide, may result from traumatic injury, portal hypertension, and mononucleosis

54
Q

how to perform blunt percussion on the liver and kidney

A
  • percuss the liver by placing your left hand flat against the lower right anterior rib cage, use the ulnar side of your right fist to strike your left hand
  • perform on kidneys at the costovertebral angles on the 12th rib
55
Q

normal findings when percussing the liver and kidneys

A

no tenderness elicited

56
Q

abnormal findings when percussing the liver and kidneys

A

tenderness elicited over the liver may be associated with inflammation or infection

57
Q

abnormal findings when blunt percussing the kidney

A

tenderness or sharp pain suggests kidney infection (pyelonephritis), renal calculi, or hydronephrosis

58
Q

how to do light palpitation

A
  • use fingertips and compress to a depth of 1 cm in a dipping motion
  • used to identify area of tenderness and muscular resistance
59
Q

normal findings of light palpitation of abdomen

A

nontender and soft, no guarding

60
Q

abnormal findings of light palpitation of abdomen

A
  • involuntary reflex guarding, reflects peritoneal guarding

- right sided guarding due to cholecystitis

61
Q

normal findings when palpating for masses

A

no palpable massess

62
Q

abnormal findings when palpating for masses

A

mass detected, may be due to a tumor, cyst, abscess, enlarged organ, aneurysm, or adhesions

NURB 3060 (3 decks)

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