Gastro exam Abdomen

Question 1

Things to do - Gastro exam of the abdomen

Answer 1

Inspect, palpate, percuss, auscultate
INSPECT
-is anything distended
-scars
-Striae
-Caput medusae
-Visible pulsations or peristalsis
-Visible masses
PALPATE
-ask the patient if they have any pain if so start furthest away
-use the flat of fingers
-light palpation of nine regions, say the name of each one as you touch
-assess for tenderness, rigidity and guarding (stopping or pulling away you bc of pain)
-say “no signs of tenderness or guarding”
-deep palpation feeling for masses
-palpate for liver
-palpate spleen
-palpate kidneys
PERCUSS
-percuss liver to determine the liver span
-percuss the spleen
-maybe test for dull shifting
-percuss bladder
AUSCULTATE
-Auscultate for bowel sounds
-Ausuclate for renal Brewis

Question 2

Gastro exam of the abdomen, distention

Answer 2

-look from the side of the bed eye level same as the patient
-is anything sticking out too much
-if not “no abdominal distension”

Question 3

Gastro exam of the abdomen, scars

Answer 3

-look for scars
-“no obvious scaring”

Question 4

Gastro exam of the abdomen, Striae

Answer 4

-stretch marks

Question 5

Gastro exam of the abdomen, Caput medusae

Answer 5

engorged network of veins around belly buttons

Question 6

Gastro exam of the abdomen, peristalsis

Answer 6

involuntary contraction of muscles in the gastrointestinal system

Question 7

Gastro exam of the abdomen, palpating liver

Answer 7

-ask the patient to take breathes in and out
-feel during inspiration, move during expiration
-start at the bottom of their right side and move up the abdomen
-report “no enlargement of the liver” or “unable to palpate the liver suggesting there is no enlargement”

Question 8

Gastro exam of the abdomen, palpating spleen

Answer 8

-ask the patient to take breathes in and out
-feel during inspiration, move during expiration
start at the bottom right and move diagonally towards their top left
shouldn’t be able to feel the spleen

Question 9

Gastro exam of the abdomen, palpating the kidneys

Answer 9

one hand under the side one hand on top
push up with the bottom hand and see if you can feel with the top hand
should only be able to feel I really low bmi or enlarged kidneys
do for both sides

Question 10

Gastro exam of the abdomen, percussing liver

Answer 10

start at the top left side near the clavicle
percuss down until dull
ask the patient to put the finger where it goes dull
then do the same from the bottom
if the liver span is less than 13cm report “Although I don’t have a ruler liver span appears normal”

Question 11

Gastro exam of the abdomen, percussing spleen

Answer 11

-go from their bottom right to the top left where the spleen is
should stay resonate, if the dull spleen is enlarged
-if stays resonate say “as percussion remained resonate the whole way, I wouldn’t test dull shifting, unless you would like me too”
-if they say yes or dull sound is made test for shifting dullness
-percuss from umbilicus towards their left until becomes dull, and place finger where it becomes dull
-ask patient to roll towards you on their right side, hold for 30s and then repeat percussion
-If note turns resonate this indicates dullness has shifted , suggesting acities

Question 12

Gastro exam of the abdomen, percussing the bladder

Answer 12

-go from the umbilical cord down towards the pubic area, if the bladder is distended percussion will change to a dull note
-if not dull “percussion indicates that the bladder is not distended”

Question 13

Gastro exam of the abdomen, Auscultating for bowel sounds

Answer 13

-make a medium-sized rectangle around the umbilicus
-normal sounds have a gurgling character
-tinkling sound suggests bowel obstruction
-if no sounds are heard then you must wait 3 mins before being sure
-take note of friction rubs “No friction rubs of the peritoneum

Question 14

Gastro exam of the abdomen, Auscultating for renal Brewis

Answer 14

-small rectangle 1-2cm around the umbilicus
report findings