Test 3 Abdomen Flashcards
Previous Health History
- Previous GI problems
- Abdominal/GI injury or surgery
- UTI history
- History of major illness
- Medications such as steroids, aspirin, and Advil can also cause GI problems such as bleeding
Family Health History
- Kidney, urinary problems
- Colon diseases, cancer
- Gallbladder disease
- Malabsorption syndromes
Colo-rectal Cancer (CRC)
- 2nd leading cause of cancer deaths in the US
- 27,150 men and 23,110 women die each year
- more men die for rectal cancer than women
- known as the silent killer as symptoms to not appear until the later stages
CRC Warning Signs
- pain, cramping, and discomfort in lower abdomen
- cramping and pain for long periods of time
- sudden, persistent change in stools consistency (that can’t be contributed to illness
- Visible blood in stool (often can’t be seen)
- Hardness in lower abdomen (persistent and stays in the same place a bad sign)
CRC Warning Signs Cont.
- Prolonged diarrhea
- a sense of incomplete bowel movement (BM but still feel need to go
- Obstruction in bowel movement (stool is extruded through a smaller opening; comes out like a pencil)
- anemia or iron defiency
- Abrupt weight loss
CRC Risk factors
- Older than 50
- African American race
- a personal history of colorectal cancer or polyps
- inflammatory intestinal conditions
- inherited syndromes that increase colon CA risk
- family history of colon CA and polyps
- low fiber, high fat diet and diet high in red meat
- sedentary life style
- diabetes, obesity, smoking, alcohol
Present Health Status
- Nutrition
- Allergies to food/meds
- Alcohol intake (excessive drinking inc. risk)
- Meds (steroids, anti-inflammatory, anticoagulants, can all cause bleeding and ulcers)
- Stool Characteristics (important to know nl to have something to compare to)
- Urinary Characteristics (know color and odor or urine and if they pain and difficulty going)
- expose to infectious diseases
- pregnancy
- recent stress
Reasons for Seeking Care
- Abdominal pain
- Nausea
- Vomiting
- GERD/Indigestion
- Diarrhea
- Constipation
- Dysuria (pain urinating)
- Urinary Incontinence
Equipment
- Stethoscope
- Metric RUler
- Marking pen
- Small pillow
Room/Positioning
- Warm room
- have patient void
- supine
- pillow under head/knees
Note pt. getting onto bed and getting into position
Fetal position - doesn’t stretch out organs and cause pain
Motionless - typically indicates peritonitis
Restless - indicates colic, renal calculi
Examination order for abdomen
Inspection
Auscultation
Percussion
Palpation
Anatomical Mapping
4 quadrants RUQ LUQ RLQ LLW
RUQ
Liver Gallbladder Duodenum Head of pancreas R kidney and adrenal Hepatic fixture of colon Part of ascending and transverse colon
LUQ
Stomach Spleen L lobe of liver Body of pancreas L kidney and adrenal Splenic fixture of colon Part of transverse and descending colon
RLQ
Cecum Appendix R ovary and tube R ureter R spermatic cord
LLQ
Part of descending colon
Sigmoid colon
L ovary and tube
L ureter
9 Regions
Epigastric Umbilical Hypogastric R. Hypochondriac Lt. Hypochondriac R. Lumbar L. Lumbar R. Inguinal (iliac) L. Inguinal (iliac)
Epigastric
Pyloric End of stomach
Duodenum
Head of pancreas
Portion of liver
Umbilical
Omentum (fold of peritoneum connecting the stomach)
Mesentery
Lower duodenum
Jejunum and ileum
Hypogastric (pubic)
ileum
bladder
uterus (in pregnancy)
R. Hypochondriac
Right lobe of the liver Gallbladder Portion of duodenum Hepatic fixture of colon Portion of R. kidney R. adrenal gland
L. Hypochondriac
Stomach Spleen Tail of pancreas Splenic fixture of colon Upper pole of left kidney Portion of duodenum Jejunum
R. Lumbar
Ascending colon
Lower half of right kidney
Portion of duodenum and jejunum
L. Lumbar
Descending colon
Lower half of left kidney
Portion of duodenum and jejunum
R. Inguinal (Iliac)
Cecum Appendix Ileum (lower end) Right ureter and right ovary Right spermatic cord
L. Inguinal (iliac)
Sigmoid colon
Left ureter and L ovary
Left spermatic cord
Grey Turners Sign
Bruising in the flanks; indicates trauma to the kidney, severe pancreatitis, ruptured ectopic pregnancy
Striae
Can be a nl variation
Recent - Pinkish color
Older - white/silver
Abnormal - Blush purple from Cushings Disease
Cullen’s Sign
Blue color around or under umbilicus; indicates abnormal bleeding from trauma, ectopic pregnancy, pancreatitis, or from a leaking or ruptured abnormal aortic aneurysm
Petechia
Tiny and easier to see on abdomen; vascular disease, fat emboli
Keloids
Dense overgrowth (hypertrophy) of fibrous tissue; more common in African Americans
Adhesion
Scar tissue develops in the area where they have their surgery; adhering to other organs or structures
Vena Cava obstruction
Dilated, engorged veins goes from pubis bone upward
Portal hypertension
Veins going in wheel barrow shape around umbilicus
Spider Veins
indicative of liver damage
Direction of Blood flow
Place both index fingers together on a vessel. Press down and move fingers apart
Life one finger up, note flow, repeat with the other side
The way it goes the fastest is the direction of the blood flow
Distention
Unusual stretching and enlargement of abdomen; implies disease; can be symmetrical or asymmetrical distention
6 causes of distention
Fluid (ascites, hemorrhage) Flatulence (gas) Fat (obesity; adipose) Feces (constipation) Fibroid/fatal tumor Fetus
Distended lower third
Could be from extended bladder
scapphid
dip in abdomen in really thin people
distended upper half
stomach or liver area/swelling/ tumor/ masses
Respiratory movement
Men normally breathe through their stomach
If abdominal respiration not present in men, could mean peritonitis and other abdominal problems
Women normally breathe through they chest
Visible peristalsis
Progressive wavelike movement, involuntary
Normally can’t be seen
moves RIGHT TO LEFT
Pyloric stenosis
Reverse peristalsis in infants; malrotation of the bowel
Peristaltic sounds
High pitched gurgling, clicks
Very irregular
Occur q 5-15 seconds or 5-35 sounds per minute
Relative to when pt. last ate
Borborygmi
sounds like breaking glass and water splashing
Caused by diarrhea, early bowel obstruction, laxative overuse, subsiding ileus (paralyzed bowel)
Vascular sounds
Hepatic friction rub - along costal margins; under right breast
Splenic friction rub - under left breast
Aorta - medially above umbilicus
Renal artery - above umbilicus on L and R sides
Iliac artery - on hips
Venous hum - by umbilicus
Femoral - medially by quads
Venous hums
low pitch, soft, continuous; could indicate obstruction of blood flow over liver of umbilicus
Peritoneal Friction Rub
Grating, leather rubbing together, soft
Associated with each breath (make note where we are hearing)
Enlarged liver or spleen rubbing on organs
Could also be from other organs, an abscess or tumor
Tympany
Is most common in abdomen
Dull
Solid masses (organs, distended bladder)
Liver Span
Percuss down on the right MCL until sound changes from resonant to dull (make a mark)
Next percuss up the right MCL until sound changes from tympany to dull (find a mark)
Liver Span: normal findings
span of 6-12 cms at MCL
4-8 cms at sternal line
Palpation
Substantiates other findings
Light Palpation
Gentle exploration by rolling fingers
Use of flat fingers
Do not dig into pt. press in about 1 cm
Note soft or hard first. Could be soft, firm, hard, bouncy like a balloon, or board like (peritonitis)
Moderate/Deep palpation
Same as light but push into patient harder and deeper (we mainly use light palpation on abdomen)
Should feel organs
Deep palpation may produce tenderness over certain areas normally; cecum sigmoid colon, is very uncommonly used
Voluntary guarding
Conscious contraction of the abdominal muscles (rectus muscles). Patients anticipate a painful assessment and tense (bent knees may help this)
Involuntary guarding
Involuntary tensing of the abdominal muscles to protect the inflamed or injured organs from feeling the pressure of pain (peritonitis)
Liver Palpation
Use bimanual trapping or hand over hand
Have them breathe normally then deep so that the diaphragm pushes down on the liver
Hooking Technique (Middleton’s)
Cup hands around ribs; not done often
Hepatomegaly
Enlarged liver; pain, hard, nodular
Gallbladder Palpation
Similar to liver
Located close to RMCL
Murphy’s sign
Pain on inspiration while palpating under rig cage, pt. will suddenly hold breath
Cholecystitis
Inflammation of the gallbladder
Cholelithiasis
A gallstone
Splenomegaly
Enlarged 3X the normal size with trauma, CA, mononucleosis
Pancreas Palpation
Pancreas is too small to palate even if it is diseased
CA not usually found until it is advanced
Kidney Palpation
Non palpable in normal adults
Usually only feel the right kidney
Hydronephrosis
Fluid collecting in the kidneys (tumor)
Ascites
Free fluid in the abdomen
McBurneys Point
Between the umbiliucs and hip bone on the right side, a little closer to the hip bone
Rebound tenderness indicates appendicitis
Roving’s sign
Same as for rebound tenderness with McBurneys Point but on the left side
Indicates peritoneal inflammation or appendicitis
Iliopsoas Muscle Test
Pt supine and ask to hold the right leg
Examiner exerts moderate pressure on the lower thigh
Pt will complain of pain in the RLQ if there is peritoneal inflammation
Obturator Muscle Test
Pt supine and ask them to flex the right hip 90 degrees
Grab the ankle and internally and externally rotate the lower leg, while turning the thigh inward
Will feel hypogastric pain if there is peritoneal irritation
Pediatric Consideration
Potbelly in toddler Abdominal breathers Pulse will be more visible and bounding in the epigastric area Short liver span Very ticklish Distrustful of abdominal exams
Older Adult Consideration
Decreased saliva, gastric enzymes, acids Decreased motility Liver more easily palpable and smaller Prone to constipation and diarrhea more likely to be malnourished Decreased bladder capacity
Mononucleosis
When the spleen ruptures
