Module 7 Flashcards
what are the four quadrants of the abdominal surface
Right upper, right lower, left upper, left lower
what are the 3 midline finding abdominal surface terms
epigastric, periumbilical, suprapubic
what organs are peritoneal
liver(RUQ), stomach (LUQ), gallbaladder, bladder
this is behind peritoneal
signs are often different from true abdomen organs
retroperitoneal
what organs are retroperitoneal
kidneys, pancreas vena cava, aorta
what should you ask during personal history for abdomen
weight changes, change in appetite, food allergy/intolerance, food supplements, diet
what do you ask about in weight changes
time frame
current weight, usual weight, highest and lowest weight has ever been
what types of changes in appetite are you looking for
anorexia (decreased appetite) and polyphagia (increased appetite- may indicate diabetes)
what do you look for during problems with digestion
eructation, pyrosis, nauseas with or without emesis
what do you look for in characteristics of vomit
partially digested food
fecal material
frank blood
coffee grounds
what are coffee grounds indicative of
coming from digestive(duodenum)
what do you look for during timing of emesis
meals and activities
what do you ask for relevant history
change in appetite, problems with digestion, characteristics of vomit, timing of emesis, changes in bowels, abdominal pain
what do you look for in changes of bowel habits
diarrhea, constipation, frank blood, tarry stool
what do you ask for during abdominal pain
timing, course, location, quality, and radiation
what is hollow viscera referred to as
colic (common)
what are characteristics of colic
crampy, poor localization, related to peristalsis, person writhes in pain
what type of pain is more ominous (sign of profound problem)
peritoneal irritation
infection or irritation of the peritoneum
peritonitis
what are characteristics of peritoneal irritation
stead/constant, localized well, lies with knees up, not related to peristalsis
is pain always confined to the abdomen
no organs move around
pain pathways cross
referred pain
this is referred pain
common in children
position is variable
pain varies with anatomy but moves to RLQ
appendicitis
inflammation of gallbladder
due to obstruction of bile ducts by bile stones
can include infection and necrosis
cholecystitis
pain generally felt on back
kidneys can harbor stones for years(become large)
occurs when stone is lodged in ureter
acute renal colic
tips for inspecting patient
patient should have empty bladder
lay supine with examiner on their right side
quiet exam room
watch for signs of discomfort
what do you examine for during inspection
scars, striae, hernias, vascular changes, lesions, rashes
how do you inspect the abdomen
look at configuration (at eye level)
movement (peristalsis or pulsations)
abdominal contour
what is common after surgery
scars
obstruction and adhesion
this should be done PRIOR to percussion and palpation
auscultation
why do you auscultate first
sounds change with manipulation
what are transmitted widely
bowel sounds so only one quadrant is necessary to check
are bowel sounds good or bad
good/normal
to conclude no bowel sounds what must be done
listen in all four quadrants for 5 min
what part of the stethoscope do you use to check for bowel sounds and why
diaphragm-high pitched
what sequence do you check the quadrants in
RLQ, RUQ, LUQ, LLQ
click and gurgles
irregular
occur about every 5-35 seconds
normal bowel sounds
hyperactive
heard every 5 seconds or less
borborygmi
increased bowel sounds
hypoactive
heard every 35 seconds or more
decreased bowel sounds
vascular sounds
abnormal
heard over arteries
bruits
how do you listen to bruits
with the bell in five locations
what are the five locations you listen to bruits over
aorta, R and L renal arteries, L and R iliac arteries
to do this use blunt object
stroke lightly on abdomen
superficial
abdominal reflex
what does abdominal reflex check for
the contraction of abdominal muscles and deviation of umbilicus towards stimulus
do this BEFORE palpation, why
percussion as it causes less discomfort
how do you percuss
check all four quadrants
indirect percussion
what sounds will you hear during percussion
tympany (normal) OR
dull (abdominal mass)
during this you are looking for areas of tenderness
light palpation
what may be present during light palpation
voluntary or involuntary guarding
what is the most sensitive indicator of tenderness
facial expression
discomfort caused or increased by examination
tenderness
sign
tenderness
symptom
pain
something the person tells you about as part of history
pain
this helps identify deep tenderness
3-4 cm into abdomen
deep palpation
press deeply left of midline (above umbilicus)
easily felt on most individuals
palpation of aorta
pulsatile mass
greater than 3 cm across
aortic aneurysm
test for peritoneal irritation
rebound tenderness
how do you check for rebound tenderness
warn person
press deeply on abdomen then release pressure
if hurts more when you release then rebound tenderness
associated with renal disease and kidney stones
costovertebral angle tenderness
how do you check for costovertebral angle tenderness
warn person, have them sit on table
use heel of fist to strike costovertebral angle
compare L and R
NOT NORMAL
what occurs in infants with breathing
synchronous chest and abdominal movement
what are seen in premature infants
superficial veins
what are common in the epigastric region of infants
pulsation
what is the contour of infants
abdomen is round and protrudes
where is the liver palpable in infants
1-3 cm below costal margin
what is common in adolescents
tanning lines, fine venous networks, flat contour
what is common in pregnancy
nausea/vomiting, diminished abdominal reflex, decreased peristalsis, abdominal striae, linea nigra
separation of two halves of rectus abdominus
diastasis recti
how do you check for diastasis recti
supine postion
place fingers below umbilicus
have person put chin on chest
feel for separation
what is common in elderly
decreased intestinal motility, abdominal wall is thin(less firm), fat pad is common, loss of muscle tone, midclavicular liver span decreases
what occurs as a result of decreased midclavicular liver span
hepatic blood flow and liver cells decrease which effects drug metabolism
