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Advanced Health Assessment > Quiz 2- Abdomen > Flashcards

Quiz 2- Abdomen Flashcards

1
Q

musculature of abdomen

A

4 layers of large flat muscle form ventral wall

can lead to low back pain when weak

helps with stabilization and movement

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2
Q

viscera of abdomen

A

SOLID ORGANS- maintain shape- liver, pancreas, spleen, adrenal, kidneys, ovaries, uterus (technically hollow but doesn’t change shape unless pregnant); some are PALPABLE

HOLLOW ORGANS- shape depends on content: stomach, gallbladder, small intestine, colon, bladder, usually NON-PALPABLE (unless colon with stool burden, distended bladder, etc.)

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3
Q

quadrants of abdomen

A

RUQ- liver, gallbladder, head of pancreas, right kidney/adrenal gland, hepatic flexure of colon, part of ascending and transverse colon

LUQ- stomach, spleen, left lobe of liver (not always), body of pancreas, left kidney/adrenal, splenic flexure of colon, part of transverse/descending colon

RLQ- cecum, appendix, right ovary/fallopian tube, right ureter, right spermatic cord

LLQ- part of descending colon, sigmoid colon, left ovary/tube/ureter/spermatic cord

MIDLINE- aorta, uterus, bladder

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4
Q

female abdominal pain AEIOU (not all inclusive)

A

appendix

ectopic pregnancy

inflammatory (PID)

ovarian-cyst/cancer

urinary

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5
Q

epigastric pain

A

MI, peptic ulcer, acute cholecystitis, perforated esophagus

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6
Q

RUQ pain

A

acute cholecystitis, duodenal ulcer, congestive hepatomegaly, hepatitis, pyelonephritis, RLL pneumonia, early appendicitis

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7
Q

LUQ pain

A

ruptured spleen, gastric ulcer, aortic aneurism, perforated colon, LLL pneumonia, pyelonephritis

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8
Q

RLQ pain

A

appendicitis, salpingitis, R ovarian abscess, ruptured ectopic, renal/uretic stone, diverticulitis, crohn’s, incarcerated hernia

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9
Q

LLQ pain

A

intestinal obstruction, pancreatitis, sigmoid diverticulitis, early appendicitis, salpingitis, L ovarian abscess, ruptured ectopic, renal/uretic stone, diverticulitis, crohn’s incarcerated hernia

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10
Q

examples of referred pain

A

cholecystitis- RUQ pain, referred straight back to below R scapula

pancreatitis- RUQ pain, referred to L shoulder/scapula area

renal colic- LUQ pain, referred to flank and mid back

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11
Q

surgeries and their associations

A

esophageal resection- associated with fat malabsorption, abnormal swallowing, obstruction

stomach resection- associated with dumping syndrome, anemia, delayed emptying, malabsorption

small bowel resection- associated with steatorrhea, fat malabsorption, anemia, short gut syndrome

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12
Q

cullen’s sign

A

intra abdominal bleed, bluish periumbilical color

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13
Q

infant abdomen

A

rounded and protuberant

blood vessels and peristalsis more visible

DIASTASIS RECTI may be noted in normal infants, but check for any herniation

ABNORMAL- exaggerated “potbelly” appearance;may indicate malabsoprtion d/t celiac, CF, constipation, or aerophagia (ingestion of air; seen in infants with difficulty feeding)

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14
Q

abnormal striae

A

prolonged stretching (pregnancy, cushing’s, obesity, ascites, tumors)

purple/dark red- cushing’s

white/red- pregnancy

shiny white-obesity

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15
Q

abdominal pulsations

A

normal=aorta pulsation, possibly peristalsis with thin pts

abnormal- marked pulsation in aortic area (AAA, HTN)

visible peristalsis+distended abdomen=obstruction

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16
Q

abdominal hair distribution

A

normal=diamond in males, triangle in females

abnormal=changes seen with endocrine disorder or hormone imbalance

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17
Q

sister mary joseph nodule

A

firm mass at umbilicus

if patients had this nodule-poor outcome from gastric CA

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18
Q

bowel sounds

A

normal= high pitched gurgling cascading sound; occurs irregularly 5-30 seconds

BORBORYGMUS- stomach growling, normal hyperactive

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19
Q

hyperactive bowel sounds

A

loud, high pitched, rushing, tinkling

indicates increased peristalsis

seen with EARLY OBSTRUCTION- hyperactivity in LUQ then absent in LLQ (below obstruction)

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20
Q

hypoactive bowel sounds

A

less frequent (longer than 30 seconds), quiet

seen after abdominal surgery, or with inflammation of peritoneum/paralytic ileus

SILENT ABDOMEN- must listen for 5 MINUTES (very uncommon)

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21
Q

vascular sounds in abdomen

A

important in patients with HTN- idenfity AAA, bruit, friction rub

NORMAL- no vascular sounds present

ABNORMAL- listen with bell or bruit: aorta, renal/iliac/femoral arteries

SYSTOLIC BRUIT- pulsating blowing sound heard with occlusion of an artery

FRICTION RUB- rare, indicates inflammation of peritoneum

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22
Q

liver border: scratch test

A

place stethoscope over liver (lower costal margin, R MCL)

start in RLQ and scratch moving up toward liver

when scratching sound in stethoscope becomes magnified you have entered onto liver border (solid transmits sounds louder)

gross assessment of size, confirm with percussion/palpation

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23
Q

bladder distention: scratch test

A

place stethoscope just above symphysis pubis, midline

scratch downward from umbilicus 1 cm, when sound intensified locates upper edge of bladder- full bladder produces sound of solid organ

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24
Q

purpose of abdominal percussion

A

assess density of abdominal contents, locate organs, look for abnormal fluid/masses

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25
method of abdominal percussion
percuss lightly in all 4 quadrants, determine tympany vs. dullness normal=tympany (high pitched d/t air) abnormal= dullness over distended bladder, fat, stool, fluid or mass; hyperresonance with gaseous distention
26
liver span
start at MCL over lungs to percuss resonance, move down until dullness-mark this spot start in RLQ at MCL to percuss tympany, move up until dullness- mark this spot measure the distance- normal=6-12 cm; larger in taller perons M=5-10 cm, F=7cm >liver span=HEPATOMEGALY <6cm=ATROPHY
27
spleen
percuss posterior MAL L side have pt take a deep breath, percuss at last IC space in L MAL- should sound resonant normal= should NOT be able to percuss spleen abnormal= resonance of lungs changes to dullness (splenomegaly with mono, trauma, infection; poor technique; pt just ate)
28
costovertebral angle tenderness
indirect first percussion causes tissues to vibrate place hand over 12th rib at CVA, thump hand with ulnar edge of fist, assess both kidneys normal=no pain abnormal= pain (inflammation of kidney or paranephric area, renal stone)
29
fluid wave
done to assess ascites seen with CHF, portal HTN, cirrhosis, hepatitis, pancreatitis, CA place PTS HAND ulnar edge on midline abdomen, place YOUR HAND on R flank, tap L side ABNORMAL= blow will generate fluid wave that is felt by hand on flank if distended from gas or fat, you will feel no change
30
shifting dullness
done to assess ascites, supine fluid settles by gravity into flanks percuss top of abdomen to hear tympany (air), then percuss downside and it changes to dullness (fluid)- mark this spot turn pt to side-percuss upper side of abdomen downwards until your hear dullness ABNORMAL- fluid shifted with movement-ascites (spot where dullness is heard moves) **it will not detect <500 mL of fluid**
31
purpose of abdominal palpation
judge size/location/consistency of organs; screen for abnormal masses/tenderness have pt lay on exam table with KNEES BENT (relaxes abdomen) and hands at the side if **area of tenderness-palpate last** LIGHT palpation- depress skin 1 cm with gentle rotary motion in all 4 quadrants assessing for muscle guarding, rigidty, large masses, and tenderness DEEP palpation- press down 5-8 cm (2-3 inches), then small circle motion
32
deep palpation of abdomen
move clockwise from RLQ to LLQ, imagining normal structures underneath if pt is obese- BIMANUAL TECHNIQUE NORMAL- xyphoid process, liver edge, muscle borders, cecum/ascending colon, sigmoid, full bladder (hollow organs will only feel if something inside- stool/urine) ABNORMAL: tenderness occurs with local inflammation, inflammation of peritoneum/organ
33
palpation of liver border
RUQ place hand under back at 11-12th rib place right hand on RUQ, push deeply down and up under costal margin have patient take a **deep breath** and **push down and up under rib cage** normal= feel edge of liver bump your hand, firm/smooth, often non palpable too abnormal= hard, nodular, tender, enlarged (extending down farther into RUQ)
34
palpation of spleen
normally NOT PALPABLE- must be enlarged x3 to be felt place one hand over LUQ under costal margin with fingers pointing towards L axilla, other hand underneath at 11-12th rib, turn pt slightly towards you push down deeply while pt takes a deep breath ABNORMAL= if enlarged, will feel firmness sliding under fingers
35
child/infant spleen palpation
easily palpated/movable, soft with sharp edge projects downward like a tongue under left costal margin, 1-2 cm SPLENOMEGALY- would feel a larger amount; d/t infection, hemolytic anemia, infiltrative disorders, portal HTN, inflammatory/autoimmune diseases
36
palpation of kidneys
RIGHT KIDNEY- one hand pressing upwards on right flank, other pressing deeply in RUQ, have pt take a deep breath may feel round, smooth mass slide between fingers; may feel nothing LEFT KIDNEY- not palpable
37
palpation of aorta
palpate pulsation, SHOULD BE 2.5-4CM WIDE in adult ABNORMAL= widened with aneurysm (>4cm)
38
palpation of bladder
palpate a full bladder only starting at umbilicus moving downward towards pubis if maneuver elicits an URGE TO VOID- fundus is distended at that level
39
abdominal wall tenderness
pain on palpation may arise from abdominal wall, parietal peritoneum, underlying viscera AFTER FINDING AREA OF TENDERNESS, while abdomen is relaxed, keep hand over site, have patient sit up (arms crossed over chest) and apply pressure (CARNETT'S SIGN) if tenderness on palpation is increased by tension of abdominal muscles (upon sitting up), pain originates from the abdominal wall= +ABDOMINAL WALL TENDERNESS +AWT usually indicates ABSENCE OF INTRAABDOMINAL PATHOLOGY (not so in children/elderly/rigidity)
40
+abdominal wall tenderness can be indicative of what?
muscular strain, viral myositis, fibrositis, nerve entrapment, trauma
41
abdominal reflex
contraction of abdominal muscles and DEVIATION OF UMBILICUS TOWARDS STIMULUS with pen/reflex hammer/nail- start at umbilicus and lightly scratch outwards (4 directions) can be helpful in determining SPINAL LESION (if absent); obesity may interfere with response
42
rebound tenderness (mcburney's point)
pain that increases upon release of deep palpation associated with peritoneal inflammation apply several seconds of pressure at point (RLQ) and quickly release PAIN= +MCBURNEY'S associated with appendicitis
43
rovsing's sign
associated with peritoneal inflammation same maneuver but apply pressure to LLQ, pain felt upon release in RLQ PAIN IN RLQ= +ROVSINGS associated with appendicitis
44
murphy's sign
seen with cholecystitis (sonographic murphy's) palpate during inspiration at liver margin; assess for RESPIRATORY ARREST (pt stops breathing/grasps when gallbladder presses against fingers) PAIN WITH INSPIRATION = +MURPHY'S
45
iliopsoas muscle test
associated with peritoneal irriation/appendicitis irritation of the underlying lateral iliopsoas muscles (located close to appendix) place hand on right thigh and push down as patient raises leg- creates resistance/flexion PAIN IN RLQ= +ILIOPSOAS associated with inflamed appendix
46
obturator test
associated with ruptured appendix or pelvic abscess irritation of the obturator internus muscle (located close to appendix) flex right leg at hip and knee, rotate leg internally and externally PAIN IN HYPOGRASTRIC AREA (RLQ or R lower back)= + OBTURATOR SIGN
47
signs of peritoneal irritation
tenderness to palpation, rebound tenderness, cough tenderness, guarding, involuntary guarding, rigidity
48
risk factors for colorectal CA
older age, men>women, AA, jews of eastern european descendent (ashkenazi) highest risk LIFESTYLE- obesity, inactivity, smoking, ETOH, diet high in red/processed meats, lower fiber diet, frying/grilling/cooking at high heat PERSONAL HX- ovarian/endometrial/breast cancer, IBD (UC, crohn's), IBS, T2DM STRONG FAMILY HISTORY- colon CA or polyps in one first-degree relative dx at 55 or younger, or two first- degree relatives dx at any age, genetic disease (FAP, HNPCC)
49
colon CA
3rd leading cause of cancer related death in the US incidence increasing but mortality decreasing SURVIVAL RATE R/T STAGE OF DISEASE AT DIAGNOSIS- overall 5 year survival- 65%, with bowel wall only- 91% with regional involvement- 72% with metastasis- 15% WARNING SIGNS- anemia, rectal bleeding (black/dark stools), change in bowel habits, narrowing of stools, persistent abdominal discomfort (cramping, gas, pain, bloating), unexplained weight loss, weakness/fatigue, N/V
50
american cancer society recommendations for colon CA
AVERAGE RISK: screening every year from age 45-75 yo can be STOOL-BASED TEST (cologuard) or through COLONOSCOPY
51
CDC recommendation for colon CA
AVERAGE RISK: screening from age 45-75 yo TESTED EARLIER IF: close relative has had colorectal polyps or colorectal cancer IBD such as crohn's disease or ulcerative colitis genetic syndromes such as familial adenomatous polypsosis (FAP) or hereditary non-polyposis colorectal cancer (lynch synrome, HNPCC) VAST MAJORITY OF NEW CASES OF COLORECTAL CANCER (ABOUT 90%) OCCUR IN PEOPLE WHO ARE 50 AND OLDER
52
positive family hx for colon cancer, screening options
# CHOOSE ONE OF THE FOLLOWING: colonoscopy every 5 years double contrast barium enema every 3-5 years at age 40 or 10 years before cancer was diagnosed in the youngest affects family member, whichever is earlier
53
familial adenomatous polyposis
flexible sigmoidoscopy or colonoscopy YEARLY STARTING AT AGE 10-12 genetic counseling- if + consider removal of colon
54
lynch syndrome (3-5% of cancers)
hereditary non-polyposis colon cancer (HNPCC) AGE 20-25 or 10 years before youngest case in family colonoscopy every 1-2 YEARS consider genetic counseling
55
IBD (ulcerative colitis and crohn's) screening for colon cancer
colonoscopy with biopsies for dysplasia every 1-2 YEARS 7-8 YEARS after DIAGNOSIS OF PANCOLITIS 12-15 YEARS after DIAGNOSIS OF LEFT SIDED COLITIS
56
as you approach lou with a c/o abdominal pain, you recall that the proper order of assessing the abdomen is:
inspection, auscultation, percussion, palpation
57
as you are assessing the abdomen, you notice purple/blue striae. you suspect...
cushing's
58
during a routine history and physical, you note thin, spoon shaped nails. you would want to order a...
CBC indication of anemia
59
mary's physical examination is unremarkable except for RUQ tenderness and positive murphy's sign. which of the following would you most likely suspect?
cholecystitis
60
upon palpation of the abdomen, you elicit pain on RLQ by palpation of LLQ. this would be what?
roving's
61
the american cancer society recommends a sigmoidoscopy for colon cancer screening in persons at average risk how often?
age 45 for 2 years then every 3-5 years dependent on risk person with a +family history is not at average risk
62
in which patient would a slight pulsation in the epigastric area be expected?
a very thin patient
63
while examining the abdomen, you stroke each quadrant of the abdomen lightly with a cotton tipped swab or the end of a reflex hammer, moving outward from the umbilicus. what does this cause?
contraction of the abdominal muscles and pulling of the umbilicus toward the stroked side reflex toward the stimulus
64
you note that the span of the patient's liver is 18 cm. on palpation, the liver is enlarged, soft, and tender, suggesting...
hepatitis
65
you observe a proliferation of superficial veins over the abdomen and upper chest of a patient, suggesting:
portal hypertension

Advanced Health Assessment (7 decks)

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