W12: Abdominal Assessment & Conditions Flashcards
What is the order of function in the GI system?
- ingestion
- propulsion
- digestion
- absorption
- elimination
Define ingestion
Taking food into mouth
Define propulsion
- deglutition
- peristalsis
Define digestion
- mechanical
- chemical
Define absorption
- substances pass into blood/lymph
Define elimination
Undigested substances leave body
What are some acute abdominal conditions?
- appendicitis
- intestinal obstruction
- gastroenteritis
- AAA
- gynaecological conditions
What are some chronic abdominal conditions?
- IBS
- ulcerative colitis, Chron’s disease
- gastric and duodenal ulcers
- gynaecological conditions
What are gallstones?
Stones that form in the gallbladder or bile duct, formed when chemicals harden into mass
What can gallstones lead to?
Obstructive jaundice, caused by gallstones moving into common bile duct
How do you recognise gallstone pain?
Colicky pain in the upper right quadrant of the abdomen
What is pancreatitis?
Inflammation of the pancreas, caused by pancreatic enzymes become active before they reach duodenum and attack the pancreas (severe can cause widespread damage)
What are known factors that can cause pancreatitis?
- gallstones
- alcoholism
What are signs of pancreatitis?
Epigastric pain radiating into the back
What can pancreatitis lead to?
Peritonitis
What are some symptoms of appendicitis?
- sudden pain on the right side of the abdomen
- nausea and vomiting
- loss of appetite
- fever
- constipation or diarrhoea
- abdominal bloating
What can cause an upper GI bleed?
- peptic ulcers
- gastritis
- oesophageal varices
- neoplasms
- inflammation of the GI lining from ingested materials
What causes a lower GI bleeds?
- diverticular disease
- neoplasms
- inflammatory bowel disease
- infection diarrhoea
- polyps
- hemorrhoids
- anal fissures
What does Malena tell us?
(black/tarry stool)
Signs of bleeding from the upper digestive tract- stomach, small intestine (stomach ulcers, malignancy, medication)
What is haematemsis?
Coffee ground vomit
What is diverticulitis?
Pressure within the large intestine causes bulging pockets of tissue to push out from walls
What can diverticulitis progress onto?
Diverticulum can rupture and cause infection
What are the most common signs of diverticulitis?
-lower left quadrant tenderness
- fevers
- nausea
What is an abdominal aortic aneurysm?
(AAA)
A localised weakness of aortic weakness of aortic wall with dilation
What can an AAA rupture lead too?
- shock
- severe pain
What are the main symptoms of an AAA?
- pulsating mass in abdomen
- side and lower back pain
- pain radiates into groin
- rupture=shock
What should you do in presence of an AAA?
Rapid transport to vasular A+E
What are some risk factors of an AAA?
- male
- smoking
- hypertension
- advanced age
Define bowel obstruction characteristics
- partial or complete
- patients unable to pass wind
What are the main symptoms of a bowel obstruction?
- vomiting large amounts of indigested food or bowel fluid
- constipation
- bloated or full feeling
- nausea
- prev surgery (adhesions)
What is a UTI?
An infection in the bladder, kidneys or tubes connected to them
What are symptoms of a UTI?
- pain/burning sensation when urinating
- needing to urinate more often (especially the night)
- needing to urinate suddenly
- cloudy/bloody urine
- pain in the lower abdomen/back
- fever
What is urinary retention?
Inability to empty the bladder, can be acute or chronic
What is a symptom of urinaru retention?
- unable to empty bladder
- great discomfort or pain
What can urinary retention lead too?
UTI
What is renal colic?
Waste removed from the blood usually dissolved into the urine, which can cause crystals which gather to form hard lumps
What is the main symptom for renal colic?
Severe pain caused as they travel towards the bladder from the kidneys
Define acute renal failure?
- sudden decrease in function
- reversible with prompt diagnosis and treatment
What causes acute renal failure?
- haemorrhage
- dehydration
- trauma
- shock
- sepsis
- heart failure
- medications
- drug abuse
- kidney stones
Define chronic renal failure
- irreversible
- progressive and develops over months and years
- kidney tissue shrinks and function diminishes
- needs dialysis or transplant
What is chronic renal failure caused by?
Diabetes or hypotension, but is progressive and develops over months and years
What must you remember to do for an abdominal exam?
- establish a rapport with the patient
- maintain hygiene
- gain informed consent
- explain what you are doing
- maintain dignity and privacy throughout
What is the sequence of abdominal examination?
- inspection
- palpitation
- percussion
- auscultation
What is performed during abdominal inspection?
Look for scars and pulsating masses
What is performed in the palpation of abdomen?
(9 regions)
- light palpation, looking at the patients face
What are you looking for in a general inspection of the abdomen?
- pain
- colour- pale, sweaty, flushes
- abnormal discolouration
- rashes/broken skin
- nausea/ vomiting
- patient position
- odour- patient/breath
- weight- loss/gain
- oedema
What are some red flags of the liver?
- skin rashes
- loss of appetite
- curved white nails
- nausea
- abdominal pain/tenderness from gas
- dry mouth
- occasional headaches, dizziness
mental confusion/mood swings - fatigue
What should patient position be for an abdominal assessment?
- position patient comfortably supine with the head but not shoulders resting on the pillows, helps the abdominal muscles relax
- expose patient from xiphisternum to pubis to allow full inspection
What is light palpation/why is it helpful?
Helpful in identifying tenderness, superficial organs and masses (approx 1.5cm)
What is deep palpation/why is it helpful?
Usually required to detect abdominal masses, check for tenderness or rebound tenderness, approx 5-7.5cm
What are you looking for when palpating?
Assessing the size, shape, position and tenderness of major organs and to detect masses and fluid, the abdomen should be soft and non-tender as you palpate all four quadrants
How do you perform light palpation?
- ensure patient is relaxed and comfortable and has arms placed by side
- encourage the patient to report discomfort
- examine each region in turn, starting from the area of tenderness
- void using fingertips- induces muscular resistance
- place examining hand on abdomen and maintain continuous contact with patients abdominal wall
How do you perform deep palpation?
Palpate abdomen more deeply with flat of the hand, look for
- rigidity
- pain when hand is removed
- masses/lumps/hernia
- pulsatile areas- aorta
What is ascites?
Free fluid in the abdominal cavity
What is ascites associated with?
- liver failure
- cancer
- CHF
- CKF
What female considerations must be taken into account into an abdominal assessment?
The female reproductive system:
- uterus
- fallopian tube
- ovary
- cervix
- vagina
