Gastrointestinal Systems + Abdomen Flashcards
what position should the patient be in for an Abdomen examination?
- lying flat on the coach
- exposed from the waist up
What should you look for during inspection?
- skin abnormalities
- scars
- masses
- hernias
What does a sunken umbilicus suggest?
obesity
What does a distended and everted umbilicus suggest?
umbilical hernia
What should you do during light palpation?
- nine abdominal regions
- monitor the face for pain
- assess for tenderness
What is in the right hypochondriac region?
gallbladder
What is in the left hypochondriac region?
pancreas
What is in the epigastric region?
- stomach
- duodenum
- pancreas
What is in the right lumbar region?
kidney
What is in the left lumbar region?
kidney
What is in the umbilicus region?
- small bowel
- caecum
- retroperitoneal structures
What is in the right iliac fossa region?
- appendix
- caecum
What is in the left iliac fossa region?
sigmoid colon
What is in the hypogastric region?
- transverse colon
- bladder
- uterus + ovaries
What should you do before starting deep palpation?
warn the pressure that it may be uncomfortable, let them know to say when/if they want to stop
Where do you palpate for the liver?
start at the right iliac fossa, to the costal margin
How do you palpate for the liver?
- using the flat edge of your hand
- ask them to take deep breaths
- palpation on inspiration
What does a palpable liver indicate?
hepatomegaly
What does a palpable spleen indicate?
splenomegaly
Where do you palpate for the spleen?
- start at the right iliac fossa
- move 1-2cm each time from the right iliac fossa to the left costal margin
At what height does the spleen reside?
ribs 9-11
What are the possible causes of splenomegaly?
- portal hypertension secondary to liver cirrhosis
- haemolytic anaemia
- congestive heart failure
- splenic metastases
- glandular fever
Where do you palpate for the kidney?
one hand: below the ribs, and underneath the right flank
other: anterior abdominal wall, below the right costal margin in the right flank
How do you palpate for the kidney?
- push fingers together
- ask the patient to take a deep breath
What are the causes of bilaterally enlarged kidneys?
- polycystic kidney disease
- amyloidosis
What are the causes of unilaterally enlarged kidneys?
renal tumour
What does tenderness on palpation suggest?
- peritonitis
- anxiety
What is guarding on palpation?
voluntary contraction when palpation causes pain
What does rigidity on palpation suggest?
- inflammation of the parietal peritoneum
What is rigidity on palpation?
- reflex contraction and involuntary guarding
- abdominal wall shows no movements of respiration
What does rebound tenderness on palpation suggest?
generalised or localised peritonitis
What is rebound tenderness on palpation?
if the abdominal wall is compressed slowly, and then released there is a sharp stabbing pain
Where do you palpate for the abdominal aortic pulse?
superior to the umbilicus in the midline
What does the abdominal aortic pulse in a healthy individual look like?
- hands move superiorly with each pulse of the aorta
- pulsatile
What does the abdominal aortic pulse in a ill individual look like?
- hands move outwards with each pulse
- expansile mass
What does outward hand movement during palpation of the aortic pulse suggest?
abdominal aortic aneurysm
At what vertebra does the aorta bifurcate?
L4
What does the aorta bifurcate into?
the left and right common iliac artery
At what vertebral level is the transpyloric plane?
L1
At what vertebral level is the subcostal plane?
L3
At what vertebral level is the supracristal plane?
L4
At what vertebral level is the intertubercular plane?
L5
At what vertebral level is the interspinous plane?
S2
What is present at the transpyloric plane?
- pylorus of the stomach
- neck of the pancreas
- fundus of the gallbladder
- renal hilum
- duodenojejunal flexure
- end of the spinal cord
What is present at the subcostal plane?
origin of the inferior mesenteric artery
What is present at the supracristal plane?
bifurcation of the aorta
What is present at the intertubercular plane?
tubercle of crest of ilium
What is present at the interspinous plane?
horizontal axis through the ASIS, marking the boundary between the umbilicus and the hypogastric region
Where do you percuss for the liver?
- from the right iliac fossa to the right costal margin
- from the 4th costal cartilage to the 5th intercostal space
What are the surface markings of the liver?
- right 5th rib at the mid-clavicular line
- lower end of the sternum
- left 5th rib at mid-clavicular line
- costal margin at the right mid-axillary line
Where do you percuss for the spleen?
from the right iliac fossa to the lest costal margin
What do you need to do when percussing for the spleen?
percuss both during expiration and inspiration at the 10th intercostal space
What is shifting dullness?
used to examine ascites
What is ascites?
accumulation of fluid in the peritoneal cavity (due to liver cirrohosis)
What can cause ascites?
- decreased metabolism of the aldosterone and ADH (salt and water retention)
- decreased albumin production (reduces oncotic pressure causing leakage)
How do you assess for shifting dullness?
- percuss from the midline to the flanks, noting change from resonant to dull
- stop at the spot, ask the patient to turn
- wait 30 seconds
- percuss the spot, if now resonant - ascites
What do normal bowel sounds sound like?
gurguling noises due to peristalsis
How do you auscultate to detect bowel sounds?
listen in 2 places on the abdomen, if absent at least 3-4minutes
What do absent bowel sounds indicate?
- paralytic ileus
- peritonitis
What do high pitched and frequent bowel sounds indicate?
intestinal obstruction
What are the 3 regions that urinary tract stones reside in?
- sacro-iliac joint
- pelvic-ureteric junction
- vesicoureteric junction
What is the gold standard imaging for the diagnosis of urinary tract stones?
Ultasound scan (USS)
What is the management plan for urinary tract stones that are <5mm?
pass alone
What is the management plan for urinary tract stones that are >5mm?
- stenting
- lithotripsy
What are the different vascular bruit?
- abdominal aorta
- superior mesenteric
- renal arteries
- liver tumours
- iliac arteries
Where do you auscultate to assess for abdominal aorta bruit?
superior and left of the umbilicus
Where do you auscultate to assess for superior mesenteric bruit?
epigastrium
Where do you auscultate to assess for renal arteries bruit?
2-3cm superior and lateral to the umbilicus
Where do you auscultate to assess for liver tumours bruit?
over the liver
Where do you auscultate to assess for iliac arteries bruit?
in the iliac fossa
What are the surface landmarks of the gallbladder?
intersection between:
- right 9th costal cartilage (transpyloric plane)
- right mid-clavicular line (lateral border of the rectus abdominis muscle)
What is the upper border of the liver?
right dome from the: right 5th rib to the left 5th intercostal pace at the mid-clavicular line
What is the oblique border of the liver?
from:
- right mid-axillary line
- right 9th costal cartilage
- left 8th costal cartilage
- left 5th intercostal space
What are the surface markings of the spleen?
between the:
- mid-axillary line
- lateral border of the erector spinae muscles
at the level of: ribs 9, 10, 11
What are the surface markings for the superior poles of the kidney?
11th/12th ribs
What are the surface markings for the inferior poles of the kidney?
3-4cm above the iliac crests, below the 12th rib
Where is the hila of the kidneys?
4-5cm from the posterior median line
What is the average size of the kidney?
9-12cm long
5-7cm broad
What is the surface markings of the ureter?
- 5cm lateral to the posterior median line at L1
- posterior superior iliac spine
What is the surface landmark of the posterior superior iliac spine?
skin dimple
What are the surface markings of the kidney?
- renal (costophrenic) angle
- 11th/12th rib
- lower pole: 3-4cm above the supracristal plane (L4)
- hilum 4-5 cm from posterior median line
- L1 transpyloric line
