Exam 3: Abdominal Flashcards
What is the sequence of exam the abdominal portion of the exam?
Inspection Auscultation Percussion Palpation "I Always Persuade Parents"
How should the patient be positioned for an abdominal exam?
Patient supine with arms at the sides and knees slightly bent to relax the abdominal muscles
Which areas should you examine last during the abdominal exam?
Painful areas
When you visualize the patients abdomen, what types of things should you be looking for?
Contour Distention Hernias Masses Peristalsis Skin markings
What are the four types of abdominal contours?
Flat
Scaphoid
Rounded
Protuberant
What are the three types of protuberant abdomens?
Fat
Gaseous distention
Fluid accumulation (ascites)
What is a herniation of abdominal contents through a defective umbilical ring?
Umbilical ring
What is a herniation of abdominal contents through a pervious incision site?
Incisional hernia
Your patient has a separation of the rectus abdominis muscles, the abdominal contents form midline ridge, and there is an obvious flexion of the neck. What do you suspect?
Diastasis Recti
If you suspect but do not see an umbilical or incisional hernia what should you ask the patient to do?
Ask the patient to raise both head and shoulders off the table
Bulge of hernia will usually appear with this action
You appreciate visible waves of movement seen beneath the skin. What do you suspect and what does it indicate?
Peristalsis
Intestinal obstruction
If you suspect abdominal pulsations where should you look?
Look for increased pulsation of abdominal aortic aneurysm
What can be seen in intraperitoneal or retroperitoneal hemorrhage?
Ecchymosis
What are pink-purple striae of Cushings called?
Striae
What do prominent veins most commonly suggest?
Portal hypertension from cirrhosis
Portal hypertension promotes collateral venous circulation radiating from the umbilicus to the abdominal wall. What is called?
Caput medusa
When you auscultate the abdominal cavity, what are you listening for?
Assess bowel sounds noting frequency and character
Assess for bruits
Why is the auscultation portion of the abdominal exam done before percussion or palpation?
To evaluate the activity of the intestines before altering bowel sounds with abdominal wall pressure
What is borborygmi?
Normal stomach growling
During abdominal auscultation you hear high-pitched, tinkling bowel sounds. What does this indicate?
Intestinal obstruction
During abdominal auscultation you hear hyperactive bowel sounds. What does this indicate?
Diarrhea (gastroenteritis
Peritonitis
During abdominal auscultation you hear absent bowel sounds. What does this indicate?
Ileus
What may cause hyperactive sounds initially, but eventually becomes hypoactive due to progressively severe inflammation and may progress to an ileus?
Peritonitis
What abdominal bruits should be examined?
Aortic
Renal
Iliac
Femoral
When you percuss the abdominal cavity, what are you listening for?
Assess distribution of tympany and dullness
What does norma percussion sound like?
Tympany throughout with scattered areas of dullness representing fluid/feces, dullness of liver and spleen
What sound should predominate during abdominal percussion?
Tympany
What does dullness assess for?
Organ enlargement
What does a distended abdomen that is tympanic throughout upon percussion suggest?
Intestinal obstruction or paralytic ileus
A protuberant abdomen with bulging flanks and dullness should prompt evaluation for what?
Ascites
Where does free fluid in the abdomen accumulate? Where does gas-filled loops of bowel accumulate?
Free fluid sinks
Gas-filled loops of bowel float
Where should you measure the span of the liver and what is a normal size?
Midclavicular line
6-12cm
How does the spleen expand?
Anteriorly, downward, and medially
When you percuss the left lower anterior chest wall from border of cardiac dullness, at the 6th rib, to the anterior axillary down to costal margin and note distribution of tympany to dullness, what are you inspecting?
Spleen enlargement
Is that bladder usually palpable or non-palpable?
Non-palpable
What is the purpose of palpating the abdominal cavity?
Assess for areas of tenderness, muscular resistance, superficial masses and organs (liver, spleen, kidneys), size of aorta
How should you palpate the abdomen?
Lightly then deeply in a minimum of four quadrants, epigastrium, and suprapubic areas. Ask the patient to point to any areas of discomfort.
What is the purpose of light palpation?
Elicits abdominal tenderness
Assess for muscular resistance (guarding and rigidity)
Identifies superficial masses and organs
What is a voluntary contraction of the abdominal wall
muscles with palpation and that may diminish when patient is distracted?
Guarding (tensing)
What is an involuntary reflex contraction of the abdominal wall muscles that may persists over several examinations?
Rigidity (stiffness)
What is the purpose of deep palpation?
Delineates pain
Identifies masses and organs
You should palpate the liver in accordance with what?
Respiratory cycle
Inspiration moves liver and spleen inferiorly
Expiration moves organs back into normal position
During abdominal examination you observe inflammation of the gallbladder, RUQ pain that radiates to right scapular area, and a positive Murphy’s sign. What do you suspect?
Acute choleystitis (gallbladder inflammation)
During abdominal examination you observe acute inflammation of the pancreas and epigastric pain that radiates to the back. What do you suspect?
Acute pancreatitis
During abdominal examination you observe acute inflammation of the appendix, pain initially near the umbilicus that migrates to the RLQ. As well as a + Psoas, obturator, and Rovsing’s sign. What do you suspect?
Acute appendicitis
Peritoneal irritation
During abdominal examination you observe an acute sac like mucosal out-pouching inflammation and LLQ pain. What do you suspect?
Acute diverticulitis
During abdominal examination you observe infectious inflammatory process involving the kidney and costovertebral
angle tenderness. What do you suspect?
Acute Pyelonephritis (kidney inflammation)
During abdominal examination you observe stones that lodge throughout the urinary tract and acute, severe colicky flank pain that radiates down to the groin. What do you suspect?
Nephrolithiasis
Firmness or hardness of liver, bluntness or rounding of its edge, and surface irregularity are suspicious for what?
Abnormal liver
What is the normal size of the abdominal aortic aneurysm?
> 3cm
What does rebound tenderness test for?
Suggestive of appendicitis
What is a positive rovsing’s sign, psoas sign and obturator sing indicative for?
Peritoneal irritation (possible appendicitis)
What does shifting dullness test for?
Ascites
What does fluid wave test for?
Ascites
What does Murphy’s sign test for?
Acute cholecystitis (Gallbladder/ hepatic inflammation)
What does CVA tenderness test for?
kidney pathology (pyelonephritis) or a musculoskeletal cause
