Exam 4 - Abdomen Flashcards by Katy Peterson

Subjective data to ask about abdomen

Appetite
Dysphagia
Food intolerance
Abdominal pain
Nausea/vomiting
Bowel habits
Past abdominal history
Medications
Nutritional assessment

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What should you ask a patient about food intolerance?

What food?

What happens when you eat that food?

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What should you ask pt about abdominal pain?

Find out where

Document which quadrant

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What should you ask patient about vomiting?

How many times?

What color?

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What should you ask pt about bowel habits?

How often?
Color?
Consistency?

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What should you ask pt about past about past abdominal history?

Surgeries? (Appendectomy, gallbladder, hernia?)
Hepatitis?
Jaundice?

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What should you ask patients about medications?

Do they take over the counter meds like NSAIDS?
Alcohol?
Smoking?

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What should you ask pt about nutritional assessment?

24 hour diet recall (to assess risk of nutritional deficit)

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How should you prepare to do physical exam for patient?

Empty bladder
Lighting and draping
Use proper draping (only undrape what you are assessing)

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Order of abdominal examination

Inspection
Auscultation
Percussion
Palpation

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Why do you do the order of examination with auscultation second instead of last?

Don’t want to stimulate sounds that weren’t already there

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Types of abdominal contour

Flat
Rounded
Scaphoid
Protuberant

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Abdominal shape that is inverted?

Scaphoid

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Abdominal shape that is more round than typical rounded abdomen?

Protuberant

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What should you document while inspecting abdomen?

Contour
Symmetry
Umbilicus
Skin
Pulsations
Hair distribution
Demeanor

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What should you document about pt’s umbilicus?

Is it in the midline?

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What should you document about skin?

Scars (size, location, and if vertical, diagonal, or transverse)
Striae (if visible and where)

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What should you document about pulsations?

Look for pulsations in aorta

Can be normal in thin patients

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What should hair distribution be like?

Diamond shape in males and inverted triangle in females

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What causes hair patterns on abdomen to be altered?

Endocrine or hormone abnormalities

Chronic liver disease

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How should you measure abdominal girth?

While pt is lying down, around belly button

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How should you auscultate bowel sounds?

Use diaphragm with light pressure
Begin in RLQ (then RUQ, LUQ, LLQ)
Must listen to all 4 quadrants

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What do bowel sounds sound like?

Gurgling
Irregular
Should be 5-30 sounds per minute

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What happens if you don’t hear any bowl sounds?

Must listen for 5 minutes in that quadrant before saying bowel sounds are absent
Go get physician

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What do hyperactive bowel sounds sound like?

Loud, rushing, tingling sounds

What do hyperactive bowel sounds indicate?

Increased motility

Term for stomach growling

Borborygmus

Abnormal abdomen sounds

Hypoactive or absent (silent abdomen)

When would a patient have a silent bowel?

After abdominal surgery especially | Or after any anesthesia

What should you do when you document vascular sounds in abdomen?

Note location, pitch, and timing

How should you listen to vascular sounds in abdomen?

``` Use diaphragm with firm pressure Listen to 7 areas: - Aorta - Left and right renal artery - Left and right iliac artery - Left and right femoral artery ```

How should you percuss the abdomen?

All 4 quadrants | Use defined zigzag pattern starting at RLQ, moving up and around, and ending in LLQ

Normal sound heard over abdomen while percussing? (Spelling)

Tympany

What would the abdomen of an obese person sound?

Tympany with scattered dullness

What would the abdomen of someone with air or gas in their abdomen sound like?

Tympany

Would would someone’s abdomen sound like if they has ascites?

Tympany over intestines with dullness over ascitic fluid

If a patient has a palpable aortic aneurysm, what symptoms would you find?

- A palpable, focal bulging >5 cm - Feels like a pulsating mass in upper abdomen just left of midline - You will hear a bruit - Femoral pulses are present but decreased

Where is the liver located?

R MCL | Upper right quadrant

How should you percuss the liver?

Percuss from lung resonance down to where sound changes to dull (from upper) Percuss from Tympany of abdomen to where sound changes to dull (from lower)

How should you palpate the liver?

Have pt bend knees and put feet flat on bed Use tips of fingers Have them take deep breath in and feel under their rib cage

Where should you percuss when looking for the spleen?

Percuss 9-11th ICS | Percuss lowest interspace in left anterior axillary line

What should you have patient do when percussing the spleen?

Take a deep breath

What should percussion sound like when percussing the spleen?

Tympany in full inspiration

What does an abnormal sound while percussing the spleen sound like? And what does this mean?

If Tympany changes to dullness with full inspiration = splenomegaly

How should you check a patient for CVA tenderness?

Use indirect fist percussion

How do you perform indirect fist percussion for CVA tenderness?

Place hand at 12th rib at costovertebral angle (CVA) | Thump hand with ulnar edge of other fist

What is a normal result when checking for CVA tenderness?

Pt will feel thud but no pain

What would an abnormal result of CVA tenderness feel like and what would it mean?

Sharp pain | Means inflammation of kidney

How would you perform light palpation of the abdomen?

Use first four fingers close together Depress skin about 1 cm Use gentle rotary motion Overall impression of skin surface and superficial musculature

How should you perform deep palpation of the abdomen?

For use on very large or obese abdomens | Use bimanual technique

What is a normal result of palpating the abdomen?

No pain

What should you document if you notice a mass while palpating a patient’s abdomen?

``` Location Size Shape Consistency: soft, firm, hard Surface: smooth or nodular Mobility: including movement with respirations Pulsatility Tenderness ```

Which structures in the abdomen are palpable?

``` Normal liver edge Right kidney lower pole Pulsatile aorta Rectus muscles, lateral borders Sacral promontory Ascending colon Sigmoid colon Cecum Uterus Full bladder ```

Where is the liver located?

Right upper quadrant

How should you palpate the liver?

Place left hand under back (11-12th rib) Right hand on RUQ Push deeply Ask pt to take deep breath

What would a normal liver feel like

Normal = not palpable Or Feel firm edge of liver hit your fingers as diaphragm pushes it down during inhalation

Explain the alternate “hooking technique” to palpate the liver

Hook both hands around rib cage and ask pt to take deep breath

How should you palpate a patient’s spleen?

Left hand behind left side (11-12th rib) Place right hand just inferior to rib margin Push deeply down and under left costal margin Ask pt to take deep breath

What does a normal person’s spleen feel like?

Not palpable

How large would a person’s spleen be if it was palpable?

3x normal size

How should you palpate a patient’s kidneys?

Place hands together and press together | Ask pt to take deep breath

What would the right kidney feel like while palpating?

Normal = not palpable Or May feel lower pole of kidney

Which kidney is higher? By how much?

Left kidney is 1 cm higher

What would the left kidney feel like while palpating?

Not palpable

How should you palpate the aorta?

Palpate upper abdomen slightly left of midline and above belly button

What does a normal aorta feel like while palpating?

2.5 to 4 cm wide | Pulsates in anterior direction

What is the procedure to test for rebound tenderness called?

Blumberg’s sign

What is Blumberg’s sigh used for?

To test rebound tenderness Abdominal pain Or elicit tenderness during palpation

How do you test for Blumberg’s sign?

Push hand down slowly and deeply in LRQ and LLQ Then, lift up quickly Pain on release of pressure = rebound tenderness

Why does rebound tenderness occur?

Peritoneal irritation

What is a positive / negative result of the Blumberg’s test?

Pain = positive | No pain = negative

Which test is used to detect pain in the appendix?

McBurney’s point

Which test is done to detect pain in the gallbladder?

Murphy’s sign