Assessment of the Abdomen - Unit 3 Flashcards
Kidney’s are located near the…
Costovertebral angle! (It’s tested…if there is pain, instead of a thud….that could be bad!)
What is some subjective data for the abdominal assessment?
Appetite (Anorexia?), Dysphagia (difficult swallowing), food intolerance, pyrosis (heartburn), eructation (belching), pain, nausea or vomitting, bowel habits, past abdominal history, medication and smoking history, nutritional assessment, etc.
What are two types of abdominal pain?
Pain from organs (hollow viscera) and Pain from the lining (peritoneum.)
Organ (Hollow viscera) pain - info
Crampy, paroxismal (stops + starts), often poorly localized, related to peristalsis, patient writhing on exam table.
Pain from the lining (Peritoneum) - info
Steady/constant, often localized, patient lies still with knees up.
Some abdominal pain can radiate to the back. T/F?
True!
What happens with acute appendicitis pain?
Appendicitis is inflammation and the filling of puss - of the Appendix!
Diffuse periumbilical pain and anorexia early, pain localized to RLQ as peritonitis develops, low grade fever, nausea and vomiting, X-Rays and other tests are often NEGATIVE.
Describe Acute Cholecystitis -
Mostly caused by stones in the bileducts. Localized or diffuse RUQ pain. Radiation to right scapula. Vomiting and constipation. Low grade fever. CLAY STOOL (no bile.)
Acute Renal Colic - info
Severe flank pain, radiation to groin, vomiting and urinary symptoms, blood in the urine.
What is some of the equipment needed?
Warm hands and short fingernails, good light, a quiet room and a stethoscope.
Should a patient go to the bathroom before an abdominal exam?
YES!!!!
Preparation for an abdominal exam - the bed should be ___, the patient should be ____ with small pillow under head, and a drape should be present so only the __ is exposed.
elevated.
supine.
abdome.
What organs are located in the RUQ?
Liver, gallbladder, hepatic flexure of the colon, duodenum, head of the pancreas, right kidney/adrenal gland.
What organs are located in the RLQ?
Appendix, Cecum, Right Ovary/Fallopian tube, Right Spermatic Cord, Right ureter, lower pole of kidney.
What organs are located in the LUQ?
Stomach, spleen, left body of pancreas, kidney + adrenal gland, splenic flexure of colon.
What organs are located in the LLQ?
Left ovary + left fallopian tube, Left ureter/spermatic cord, sigmoid colon, left lower kidney pole.
The urethra + urinary bladder are ____.
Midline!
What is the order for assessment of the abdomen?
- Inspection (Look).
- Auscultation (Listen.)
- Percussion (Touch.)
- Palpation (Feel.)
Where do we start for an abdominal assessment and what order do we go in?
RLQ, then go in a clockwise motion!
We have to listen for __ to ___ minutes in each section before we can say “no sounds present.”
3-5 minutes!
Abdominal Inspection - what do we do?
Observe Countour (rounded, flat, distended, scaphoid, etc.) Symmetry, Surface motion, and then are there any scars, striae, hernias, vascular changes, etc.
Should we inspect “attachments?”
Yes, things like NG tubes, dressings, drains, and intestinal and urinary diversions should be checked!
What can cause abdominal distention? (All F’s!)
Fat, fetus, fluid, flatulence, feces, fibroid tumor and fatal tumor.
Impaction - watch for it in __ folks.
Older folks!
Tumor - this would present with…(symmetry or asymmetry?)
Asymmetry - think Large Liver or spleen or other pelvic organs.
Stretch marks indicate previous __ of abdomen.
Distention.
Distended collateral veins - When seen, may appear above and below umbilicus. T/F?
True!
Hernia - info on it.
Congenital, raiased intraabdominal pressure.
Umbilicus - Eversion - what is it?
Raised intraabdominal pressure (Ascites, tumor.)
Pulsations - Epigastric
Aortic Aneurysm.
Gurgling should typically occur every __ to ___ seconds.
5-20 seconds.
Increased bowel sounds sound like —-
loud, gurgling, rushed sounds - may be high pitched.
Borborygmi - what is it?
Growling stomach. An occasional one is fine. Could be the start of a bowel obstruction!
Decreased bowel sounds - what time?
One or two in two minutes. (Peritonitis, Ileus) - bowel obstruction.
Absent bowl sounds - what?
None! In any quadrant in 3-5 minutes (like with anesthesia!)
Listen for a bruit in the abdomen to make sure there isn’t an aneurysm. T/F?
True!
Percussion - start where?
Start in right lower quadrant.
Ascites - def (in regards to percussion)
Flanks full, dull to percussion, shifting dullness, fluid thrill.
Flatus - def (in regards to percussion.)
resonant to percussion. Intestinal obstruction, illeus
Palpation - what do we do?
Light - check for tenderness, masses, abdominal or bladder distention.
Deep - check for impaction, constipation.
We describe firmness (hard, soft, rigid, etc.)
Palpation - never start with the tender area first. T/F?
True!
When pressing the abdomen, if when you let up and it bounces back and it hurts for the patient, you have….
Rebound Tenderness (a sign of Peritoneal irritation!)
What is the Psoas Sign?
Place your hand above the patient’s right knee and ask the patient to flex the right hip against resistance. if they have increased abdominal pain, this is a positive Psoas sign, which means they could have appendicitis!
What are some changes in an older person’s GI system?
Salivation decreases, along with sense of taste.
Esophageal emptying delayed (could aspirate!)
Gastric acid secretion is decreased.
Gallstones increase.
Live size goes down (so drug metabolism may be impaired!)
Increased constipation!
