OMED 1401 - Advanced Patient Assessment (ABDOMINAL ASSESSMENT) Flashcards
How to Approach an Abdominal Assessment?
End of Bed Assessment (Verbal Primary Survey)
Red Flags
History Taking using Frameworks
Observations
Is it Time Critical?
ENHANCED PT ASSESSMENT:
Hands —> Arms —> Head/Face —> Neck/Glands/JVP
Assess Abdomen - IAPP
Special Tests
What are Red Flags when Referring to an Abdominal Assessment?
AAA - Sudden Severe Abdo/Back Pain, Hypotension, Pulsating Mass
Appendicitis - Pain Starts in Umbilical Area, Settles in Lower Right, Rebound Tenderness
Intestinal Obstruction - Cramping Pain
Acute Pancreatitis - Constant Pain in Upper Left Quadrant
Ectopic Pregnancy - Atypical Presentation, Pelvic
Intussusception - Paediatrics Mainly, Positioning, Jelly Stool.
Abnormal Observations.
What is Meant by Referred Pain?
Pain Percieved at a Location other than the site of the Painful Stimulus/Origin
It’s the Result of a Network of Interconnecting Sensory Nerves. Network Supplies Different Tissues.
Where there is an Injury at one Place in the Network, this Pain can be Interrupted in the Brain to Radiate Nerves and can give Pain elsewhere in the Related Areas of the Network.
What is the Cullen’s Sign when Inspecting in an Abdominal Assessment?
Blue Discolouration around the Umbilicus.
Potential Diagnosis:
Intraperitoneal Haemorrhage
Trauma
Pancreatitis
Pancreatic Carcinoma
What is the Grey Turners Sign when Inspecting in an Abdominal Assessment?
Blue Discolouration around the Flanks of the Abdomen.
Potential Diagnosis:
Pancreatitis
Trauma to Underlying Organs
Retropetitoneal Haemorrhage
Non-Specific Abdominal Bleed
What is the Spider Naevi Sign when Inspecting in an Abdominal Assessment?
A Cluster of Veins which Appear Web Like.
Causes: Liver Damage, Sun Damage, Hormones or Injury.
What is the Caput Medusa Sign when Inspecting in an Abdominal Assessment?
Superficial Epigastric Engorged and Distended Veins around the Umbilicus. Sign of Portal Hypertension.
How to Percuss the Liver for Hepatomegaly in an Abdominal Assessment?
Locate the Liver and Measure the Span.
Begin at the Lower Margin, per cussing Superiorly along the Right Mid Clavicular Line.
The Pitch will change to Hypo-Resonant when the Liver is Percussed. Measure the Span of Hypo-Resonance.
How to Percuss the Spleen for Splenomegaly in an Abdominal Assessment?
Locate the Spleen and Measure its Span.
The Spleen is located slightly Posterior of the Left Midaxillary LIne and Produces an Oval Area of Dullness between the 9th and 11 Ribs.
Only a Small Surface of a Normal Spleen is Superficial enough to be Detected and the Splenic Dullness is often Obscured by Gastric or Colonic Tympany. An Englarged Spleen is Expanded towards the midline, Anteriorly and Downward and might be Detected by percussion.
How to Palpate (SUPERFICIAL AND DEEP PALPATION) in an Abdominal Assessment?
Ask Location of Pain and Examine these Last to Gain Trust. Observe the Patients Face throughout for Signs of Discomfort.
Light Palpation - Palpate each of the 9 Abdominal Regions, Assessing for any of the Below.
Tenderness - Note the Areas involved and the Severity of the Pain.
Rebound tenderness - Pain is Worsened on Releasing the Pressure - Peritonitis.
Guarding - Involuntary Tension in the Abdominal Muscles - Localised or Generalised?
Masses - Large/Superficial Masses may be noted on Light Palpation.
Deep Palpation - Assess each of the 9 Regions again, but with Greater Pressure applied during Palpation.
If Any Masses are Identified than Assess:
Location - Which Region?
Size
Shape
Consistency - Smooth / Soft / Hard / Irregular
Mobility - Attached to Superficial/Underlying Tissues.
What are the Signs and Symptoms of Appendicitis?
Abdominal Pain: Most common Symptom
Nausea: 61-92% of Patients
Anorexia: 74-78% of Patients
Vomiting: Nearly always follows the Onset of Pain, Vomiting that preceded pain suggest intestinal Obstruction.
Diarrhoea or Constipation - As many as 18% of Patients.
Patient usually lie down, flex their hips and draw their knees up to reduce movement and to avoid worsening their Pain.
Rebound Tenderness, Pain on Percussion, Rigidity and Guarding: Most Specific Finding.
Male Infants and Children occasionally present with an Inflamed Hemiscrotum.
What are the Special Tests for the Appendix?
Rovsing Sign (RLQ pain with Palpation of the LLQ): Suggests peritoneal Irritation, Specifically Appendicitis.
Obturator Sign (RLQ pain with Internal and External Rotation of the Flexed Right Hip): Suggest the Inflamed Appendix is Located deep in the Right Hemipelvis.
Psoas Sign (RLQ Pain with Extension of the Right Hip or with Flexion of the Right Hip against Resistance) Suggests that an Inflamed Appendix is Located along the Course of the Right Psoas Muscle.
What is Mc Burnley’s Point and Rebound Tenderness?
When Checking for Appendicitis, Locate McBurney’s Point:
- Draw Imaginary Line from Right Iliac Crest to Umbilicus.
- McBurney’s Point is one third from the Illiac Crest.
- Pain Upon deep Palpation at this Location is a Sign of Acute Appendicitis.
Rebound Tenderness (NOT SPECIFICALLY APPENDICITIS TEST)
- Ask the PT to point to the Area of Pain
- When Palpating the Area, Press down with your Fingertips and Watch the PT.
- Release your Hand quickly and note any Grimace/Pain.
- Pain upon Release of Pressure is noted as Rebound Tenderness. This Can Indicate Peritonitis.
What are the Special Tests for Acute Cholecystitis in an Abdominal Assessment?
- Ask the PT to Exhale
- Examiner Places hand below Costal Margin on the Right Side at the Mid Clavicular Line
- The PT is Instructed to Inspire.
POSITIVE MURPHY’S SIGN:
The PT stops breathing in and winces with a Catch in Breath. (DUE TO THE INFLAMED GALLBLADDER BEING PALPATED AS IT DESCENDS ON INSPIRATION)
What are the 5 F’s of Gallstone Risk Factors?
Female
Fair Complexion
Forty or Over
Fertile
Fat
