Gastrointestinal/Genitourinary Flashcards
positioning for the abdominal examination
lie flat on the couch in supine position
you can relax the abdominal musculature by?
head of the patient may be raised slightly by adjusting the headrest of the couch or by adding a pillow under the head
exposure of the patient for the abdominal exam
entire abdomen is exposed from the xiphisternal joint to the pubic symphysis
why might some physicians tend to do the auscultation before any palpation or percussion?
in order to prevent the bowel sounds being disturbed by deep palpation
you should visually inspect the abdomen for?
shape of the abdomen, skin abnormalities, surgical scars, masses, hernias, movements of the abdominal wall with respiration, and for any asymmetry
During inspiration, what happens in the abdomen?
abdominal wall moves out and the liver, spleen and the kidneys move downwards
Distended and everted umbilicus may indicate?
umbilical hernia`
Abnormally enlarged veins on the anterior abdominal wall indicate?
portal hypertension or an obstructed inferior vena cava
define ascites
fluid collection in peritoneal cavity
how to do light palpation of the abdomen
patient is asked to flex the hip & knee joints to relax the anterior abdominal wall muscles > palm of the hand should be moulding over the abdominal surface while the fingers flex at the metacarpophalangeal joints > look for tender areas and any lumps in the abdominal wall structure in each region > ask the patient to show you where any pain is present, and to report any tenderness during palpation > you will observe the patient’s face for any discomfort.
how to do deep palpation of the abdomen
use both hands where the upper hand is used to exert pressure, while the lower hand is used to feel the organs or masses much deeper in the abdominal cavity
For palpation of edges of organs (liver, spleen) or masses, what is the most sensitive?
lateral (radial) surface of the forefinger (index finger)
what signs should you watch out for in palpation?
tenderness
guarding of the abdomen
rigidity of the abdomen
rebound tenderness
Tenderness with minimal pressure over a wider area of the abdomen may be due to?
peritonitis
anxiety of the patient
voluntary guarding
abdominal wall tends to contract voluntarily when palpation causes pain
involuntary guarding
When there is inflammation of the parietal peritoneum, the abdominal wall muscles undergo a reflex contraction
what is rebound tenderness?
In patients with generalised or localised peritonitis, if the abdominal wall is compressed slowly, and then released suddenly they will experience a sharp stabbing pain.
can you palpate the liver edge in a healthy adult person?
no
if you feel the liver edge, you should describe it in terms of?
smooth or irregular
soft or hard
tenderness?
pulsations?
how to palpate the liver
start at right iliac fossa w/ index finger parallel to right costal margin > apply pressure > patient taking deep breaths > still during inspiration > during expiration move 1cm closer to the costal margin > keep going
is normal healthy spleen palpable?
no
if spleen becomes palpable that indicates?
splenomegaly
what helps you distinguish enlarged spleen and lower pole of enlarged left kidney?
sharp upper border a characteristic notch will be the leading edge of the organ
how to palpate the spleen?
right hand right iliac fossa, left hand under left posterior abdomen pull forward where kidney is > patient slow deep breaths > still during inspiration > between breaths move 1cm towards the left costal margin across the umbilicus
positioning for kidney palpation
lie flat on a couch in supine position
exposure for the kidney palpation
entire abdomen
lower poles of the kidneys are palpable through?
the anterior abdominal wall just below the costal margins
are the upper poles of the kidneys palpable?
no
they are inaccessible
bimanual palpation of the kidney
left hand underneath the subject’s flank with palm facing upwards (anteriorly) and the fingers in the renal angle > right hand to palpate the kidney through the anterior abdominal wall of the upper quadrant. You should press down deeply below the costal margin > patient takes deep breath
what is the renal (costophrenic) angle
angle between the posterior median line and the lower border of the 12th rib
what is balloting
pushing the kidney back and forwards between the two hands
how to do balloting
swiftly flex the index and middle fingers at the metacarpophalangeal joints in order to push the lower pole of the kidney anteriorly to “strike” the right (palpating) hand
where is the abdominal aorta usually palpated
above the umbilicus just left of the midline
palpation of the abdominal aorta
both hands with the palm facing downwards with pads of the fingers pressing deeply into the abdominal wall.
The fingers of both hands will be pointing towards the epigastrium whilst the ulnar borders (little finger side) lie parallel to the right and left costal margins
what would feel when palpating a normal abdominal aorta
pulsation
if the abdominal aorta is pulsatile and expansile, you would suspect?
abdominal aortic aneurysm
percussion of the liver (measure the liver span)
ask the patient to hold the breath in full expiration > percuss downwards from right 4th rib along the MCL > listen for a change in the percussion note from resonant to dull > indicates the position of the upper border of the liver > continue inferiorly until you reach the end of liver dullness, usually at the right costal margin
liver span is usually what is a healthy adult?
measure the distance between the upper and lower limits of the liver 13cm
percussion of the spleen
percuss over the lowest intercostal space (10th intercostal space between 10th & 11th ribs) in the left anterior axillary line whilst the patient lies in supine position > if dull on full inspiration, suspect splenomegaly
what is shifting dullness?
technique for examining ascites
ascites is classically due to?
liver cirrhosis
how does liver cirrhosis lead to ascites?
subsequent liver failure > decreased aldosterone and ADH metabolism > salt and water retention > decreased production of albumin > decreased oncotic pressure > leak of fluid into peritoneal space
apart from liver cirrhosis, ascites can also be caused by?
liver cancers
heart failure
how to examine shifting dullness?
percuss from the midline out to the flanks, noting where the change from resonant to dull occurs > ask the patient to turn onto opposite side > wait 10 seconds for fluid to shift > palpate that spot if dullness is now resonant > ascites is present
main aim of auscultation of the abdomen is for?
detect bowel sounds
normal bowel sounds are heard as?
gurgling noises due to the peristalsis of the gastrointestinal tract.
are bowel sounds poorly or well localised?
poorly
how long should you listen for to determine bowel sounds are absent?
3-4 minutes
bowel sounds may be absent in?
paralytic ileus
peritonitis
what can happen to bowel sounds when there is intestinal obstruction?
become high pitched and frequent
