Exam 4 - Abdomen Flashcards
Subjective data to ask about abdomen
Appetite Dysphagia Food intolerance Abdominal pain Nausea/vomiting Bowel habits Past abdominal history Medications Nutritional assessment
What should you ask a patient about food intolerance?
What food?
What happens when you eat that food?
What should you ask pt about abdominal pain?
Find out where
Document which quadrant
What should you ask patient about vomiting?
How many times?
What color?
What should you ask pt about bowel habits?
How often?
Color?
Consistency?
What should you ask pt about past about past abdominal history?
Surgeries? (Appendectomy, gallbladder, hernia?)
Hepatitis?
Jaundice?
What should you ask patients about medications?
Do they take over the counter meds like NSAIDS?
Alcohol?
Smoking?
What should you ask pt about nutritional assessment?
24 hour diet recall (to assess risk of nutritional deficit)
How should you prepare to do physical exam for patient?
Empty bladder
Lighting and draping
Use proper draping (only undrape what you are assessing)
Order of abdominal examination
Inspection
Auscultation
Percussion
Palpation
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
Types of abdominal contour
Flat
Rounded
Scaphoid
Protuberant
Abdominal shape that is inverted?
Scaphoid
Abdominal shape that is more round than typical rounded abdomen?
Protuberant
What should you document while inspecting abdomen?
Contour Symmetry Umbilicus Skin Pulsations Hair distribution Demeanor
What should you document about pt’s umbilicus?
Is it in the midline?
What should you document about skin?
Scars (size, location, and if vertical, diagonal, or transverse)
Striae (if visible and where)
What should you document about pulsations?
Look for pulsations in aorta
Can be normal in thin patients
What should hair distribution be like?
Diamond shape in males and inverted triangle in females
What causes hair patterns on abdomen to be altered?
Endocrine or hormone abnormalities
Chronic liver disease
How should you measure abdominal girth?
While pt is lying down, around belly button
How should you auscultate bowel sounds?
Use diaphragm with light pressure
Begin in RLQ (then RUQ, LUQ, LLQ)
Must listen to all 4 quadrants
What do bowel sounds sound like?
Gurgling
Irregular
Should be 5-30 sounds per minute
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
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
