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Patient Assessment Methods II > Patient Assessment Methods II Abdomen > Flashcards

Patient Assessment Methods II Abdomen Flashcards

1
Q

What is the order/flow of the abdominal exam?

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation

(least invasive to most invasive)

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2
Q

What is the typical patient position during an abdominal exam?

A

Supine with KNEES BENT, HEAD OF TABLE SLIGHTLY ELEVATED, and arms relaxed at the sides

(waistband should be lowered to the level of the ASIS and gown raised to the lower ribs to expose the abdomen)

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3
Q

What is the typical doctor position during an abdominal exam?

A

On the RIGHT side of the table facing the patient (with the exception of palpating the left kidney at the end of the exam)

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4
Q

What is assessed during the inspection portion of the abdominal exam?

A
  1. Skin (colour, rashes, striae)
  2. Scars (piercings, surgical history, trauma)
  3. Contour (flat, scaphoid, rounded, protuberant, symmetry)
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5
Q

Which abdominal contour is considered to be normal?

A

Flat

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6
Q

Which abdominal contour is normal in a thin person?

A

Scaphoid (concave)

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7
Q

What are some causes of a rounded/protuberant abdomen?

A

The four F’s:
1. Fat (most common cause)
2. Fetus (pregnancy)
3. Fluid (ascites)
4. Flatus (gas)

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8
Q

What are some causes of an asymmetric abdominal contour?

A

Hernia, lipoma, other tumours

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9
Q

What is it called when there are visible wave-like contractions of the muscles of the digestive tract?

A

Overt peristalsis

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10
Q

What does reverse peristalsis indicate?

A

Severe blockage in the digestive tract

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11
Q

What causes ascites?

A

Ascites (fluid in the peritoneal cavity) is due to decreased serum albumin levels

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12
Q

True or False: Ascites is always abnormal

A

True

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13
Q

What patient populations have decreased serum albumin levels?

A

Individuals with liver diseases (hepatitis or cirrhosis), malnutrition, malabsorption disorders, or kidney diseases

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14
Q

What are the four special tests for ascites?

A
  1. Auscultatory percussion (most sensitive)
  2. Puddle Sign
  3. Shifting Dullness
  4. Fluid Wave (least sensitive)
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15
Q

What is the most sensitive test for ascites?

A

Auscultatory percussion

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16
Q

What is the least sensitive test for ascites?

A

Fluid wave

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17
Q

What is the positive when performing auscultatory percussion for ascites?

A

Identification of a fluid line (line of dullness along the lower quadrants)

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18
Q

What is the positive when performing puddle sign for ascites?

A

Periumbilical dullness

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19
Q

What is the positive when performing shifting dullness for ascites?

A

Line of dullness rises/shifts when the patient moves from supine to side-lying

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20
Q

What is the positive when performing fluid wave for ascites?

A

The sensation of a fluid wave against the flat hand on the abdomen

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21
Q

What is assessed during the auscultation portion of the abdominal exam?

A
  1. Bowel sounds
  2. Organs (liver and spleen)
  3. Bruits (abdominal aorta, renal arteries, iliac arteries, femoral arteries)
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22
Q

What is the normal range of bowel sounds per minute?

A

5-34 sounds per minute

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23
Q

Which side of the stethoscope is used to listen for bowel sounds during the auscultation portion of the abdominal exam?

A

Diaphragm

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24
Q

What is indicated by increased bowel sounds per minute (above the normal range)?

A

Hyper-peristalsis and diarrhea

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25
What is indicated by decreased bowel sounds per minute (below the normal range)?
Hypo-peristalsis
26
What is indicated by absent bowel sounds?
Intestinal obstruction and/or peritonitis if in the presence of a rigid abdomen (call 911 if this is the case)
27
How long should you listen for bowel sounds in the right lower quadrant (RLQ)?
1 minute
28
How long should you listen for bowel sounds in the right upper quadrant (RUQ)?
Until hearing one bowel sound
29
How long should you listen for bowel sounds in the left upper quadrant (LUQ)?
Until hearing one bowel sound
30
How long should you listen for bowel sounds in the left lower quadrant (LLQ)?
Until hearing one bowel sound
31
Which side of the stethoscope is used to listen for the liver during the auscultation portion of the abdominal exam?
Diaphragm
32
Where is the diaphragm placed when auscultating the liver?
Right midclavicular line at the costal margin
33
How should the doctor instruct the patient while auscultating the liver?
Tell the patient to take a deep breath to move the organ
34
What would be an abnormal finding when auscultating the liver?
The presence of a friction rub, indicating inflammation of the peritoneal surface of liver (for example, hepatitis)
35
Which side of the stethoscope is used to listen for the spleen during the auscultation portion of the abdominal exam?
Diaphragm
36
Where is the diaphragm placed when auscultating the spleen?
Left midaxillary line at the 7th intercostal space
37
What anatomic structure can be used to find the spleen?
The xiphoid process (at the level of the 6th intercostal space)
38
How should the doctor instruct the patient while auscultating the spleen?
Tell the patient to take a deep breath to move the organ
39
What would be an abnormal finding when auscultating the spleen?
The presence of a friction rub, indicating inflammation of the peritoneal surface of the spleen (for example, infectious mononucleosis)
40
What side of the stethoscope is used when auscultating for bruits?
Bell
41
What is the definition of a bruit?
Turbulent blood flow through an artery
42
Which arteries are auscultated for bruits during an abdominal exam?
1. Abdominal aorta 2. Renal arteries 3. Iliac arteries 4. Femoral arteries
43
Where is the bell placed when auscultating the abdominal aorta?
Directly above the umbilicus
44
Where is the bell placed when auscultating the renal arteries?
Midclavicular line between the umbilicus and costal margins (upper quadrants)
45
Where is the bell placed when auscultating the iliac arteries?
Midclavicular line between the umbilicus and ASIS (lower quadrants)
46
Where is the bell placed when auscultating the femoral arteries?
Midclavicular line between the pubic symphysis and ASIS, below the inguinal ligament (patient does a figure-four pose)
47
What are two common causes of a bruit?
1. Atherosclerosis 2. Aneurysm
48
What is assessed during the percussion portion of the abdominal exam?
1. General percussion (all four quadrants) 2. Measurement of the liver 3. Spleen enlargement
49
What is the normal percussive note of the abdomen?
Tympany (with scattered areas of dullness over stool)
50
What is considered an abnormal percussive note of the abdomen?
Dullness that spans over a large area
51
What are common benign causes of suprapubic dullness?
Full bladder, pregnancy, tumours, organomegaly
52
Where is the liver percussed and measured during an abdominal exam?
In a vertical plane along the midclavicular line and midsternal line, starting below where you would expect to find the liver and then above the liver (mark where tympanic sound of bowels changes to the dull sound of the liver and measure the distance between the marks)
53
What is the normal measurement of the liver at the midclavicular line?
6-12 cm
54
What is the normal measurement of the liver at the midsternal line?
4-8 cm
55
In what direction does the spleen become enlarged?
The spleen enlarges downward
56
Where is the spleen percussed during an abdominal exam?
Where it should not be, in the 9th intercostal space of the anterior axillary line
57
What is the normal percussive note in the 9th intercostal space of the anterior axillary line?
Tympany
58
How should the doctor instruct the patient while percussing the spleen for enlargement?
Ask the patient to inspire while the doctor continues to percuss
59
What is a positive finding when percussing the spleen for enlargement?
Tympany changes to dullness as the patient inspires (if positive, DO NOT PALPATE)
60
What are some causes of spleen enlargement?
Infections like mononucleosis and hepatitis, or lymphoma, leukemia, and hemolytic anemias
61
Why should you perform percussion of the spleen before palpation?
Avoid rupturing the spleen
62
What is peritonitis?
Inflammation of the peritoneum
63
What are the four special tests for peritonitis?
1. Rebound tenderness 2. Obturator muscle 3. Anvil 4. Jar
64
What is the positive when performing rebound tenderness for peritonitis?
Sharp stabbing pain at the original site of pain
65
True or False: When performing rebound tenderness for peritonitis, the doctor presses into the abdominal region in the same quadrant as the area of discomfort
False (correction: the doctor presses into a DIFFERENT quadrant from the area of discomfort)
66
What is the positive when performing the obturator muscle test for peritonitis?
Reproduction of abdominal pain
67
Is the obturator muscle test performed ipsilateral or contralateral to the side of pain?
Ipsilateral
68
What is the positive when performing the anvil test for peritonitis?
Reproduction of abdominal pain
69
Is the anvil test performed ipsilateral or contralateral to the side of pain?
Ipsilateral
70
What is the positive when performing the jar test for peritonitis?
Reproduction of abdominal pain
71
How should the doctor instruct the patient while performing the jar test?
Tell them to support their neck
72
What is appendicitis?
Inflammation of the appendix and surrounding peritoneum
73
What is the name of the site of pain characteristic to appendicitis?
McBurney's point (RLQ)
74
What are the special tests for appendicitis?
1. Rebound Tenderness 2. Psoas Sign
75
In which quadrant is rebound tenderness performed for appendicitis?
Any quadrant except the RLQ
76
What is it called when there is pain at McBurney's point while pushing in during rebound tenderness?
Rovsing's sign
77
What is it called when there is pain at McBurney's point while withdrawing during rebound tenderness?
Blumberg's sign
78
What is the positive when performing the psoas sign for appendicitis?
Increased abdominal pain in the RLQ
79
True or False: Psoas sign is performed on the side of complaint
True
80
What is acute cholecystitis?
Inflammation of the gallbladder and surrounding peritoneum
81
What is the name of the site of pain characteristic to acute cholecystitis?
Murphy's point
82
What is acute pyelonephritis?
Inflammation of the kidney
83
What is the name of the special test for acute pyelonephritis?
Murphy's punch
84
What is the positive when performing Murphy's punch?
Pain
85
When performing Murphy's punch, which side is tapped first?
Asymptomatic side
86
What is assessed during the palpation portion of the abdominal exam?
1. Abdominal aorta 2. Superficial abdomen 3. Deep abdomen 4. Liver 5. Spleen 6. Kidneys
87
What special test should be performed if an abdominal mass is palpated?
The patient should perform an abdominal crunch; if still feel mass = superficial abdominal wall, if not = deep intraabdominal mass

Patient Assessment Methods II (1 decks)

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