finisher Flashcards
Describe Bristol Stool Chart
1 to 7, 1 indicating constipation, 7 indicating diahreeah
3 and 4 smooth and firm or lumpy and firm are healthy and normal
Organs contained w/i RUQ
liver, gallbladder, duodenum, head of pancreas, right kidney, hepatic flexure of colon, parts of ascending and transverse colon.
Organs contained in LUQ
stomach, spleen, left lobe of liver, body of pancreas, left kidney, splenic flexure of colon, parts of transverse and descending colo
Organs contained within RLQ
– cecum, appendix, right ovary and fallopian tube, right ureter, right spermatic cord.
Organs contained within LLQ`
part of descending colon, sigmoid colon, left ovary and fallopian tube, left ureter, left spermatic cord.
Where in the abdomenal wall can aorotic pulsations be felt?
the left upper anterior abdominal wall.
Where would liver referred pain appear
may produce dull pain in RUQ or epigastrium.
Esophagus referred pain
Gastroesophageal reflex disease (GERD) (“heartburn”).
Gallbladder refererd pain
cholecystitis is sudden pain in RUQ that may radiate to the right or left scapula.
Stomach referred pain
– gastric ulcer pain is dull, aching, or burning in epigastric region, often radiates to the back.
Appendix referred pain
starts as dull, diffuse pain in periumbilical region that later shifts to be localized in the RLQ.
Kidney referred pain
kidney stones produce a sudden onset of severe flank or lower abdominal pain
Older person factors in regards to GI system
Decreaed salivation, more prone to dehydration
Decreased renal function
Constipation
Food access, recall, emotionall characteristics
Some consideration before stomach examination
-Have patient empty bladder before exam
-Warm room
-Fully exposed abdomen - lift the gown and pull down the covers (genitalia and breasts remain covered)
-Ask about tender areas – palpate last
-Patients arms/hands at side and pt can bend knees slightly (or pillow beneath knees)
How long should bowel sounds b lsitended for if no soudns?
up to 5 minutes
Normal bowel sounds
5-30 times per minute
Percussion sounds
dullness is heard over solid organs, or over a distended bladder, tympany over air (air in peritoneal cavity rises to surface when pt is supine).
What is the percussion sound heard in a patient with gaseous distention
Hyper-resonance
During a physical exam of abdomen, what is the last step
Palpate last
- Can cause tenderness, shift fluids, cause abnormal souneds
Correct order of avdomen assesssment
Inspection, asucultation, percussion, palpation
How is light abdomelan palpation done
Put four fingers together and gently press down into abdomen. Approx 1 cm. make gentle rotary motion and then pick up fingers and move to another location. Don’t drag.
Save the examination of any tender area of the abdomen for last.
Blumberg’s sign
Rebound tenderness during abdomen palpation
pain on release of pressure. Means peritoneal inflammation. And often appendicitis.
Murphy’s sign
Inspiratory arrest
liver or gallbladder pain. Hold fingers under the liver border and have patient take a deep breath. If pain at liver margins, then positive for liver or gallbladder inflammation
Iliopsoas muscle test
done when acute abdominal pain is suspect for appendicitis. With patient supine, lift the right leg straight up, flexing at the hip, and push down over the lower part of the right thigh as the patient tries to hold the leg up. With appendicitis – there is RLQ pain with this manouver. If no pain, it is negative.
