week 3 Highlights of ABD-LF Flashcards
what is the most important part of any patient assessment
how do we do chief complaint
patient history. try to stay relevant to current problems.
chief complaints are exactly what patient says
PQRST
precise location quality/quantity radiant/referred severity time frame
what are the A’s of what else you can tell me about your problem
what else can you tell me
associated symptoms
absent symtpoms
alarm symptoms
most common GI diagnosis
gerd
review of abdomen exam
inspection
auscultation
percussion
palpate (light and deep)
Right Upper Quadrant structures
Liver Gallbladder Duodenum Head of the pancreas Right kidney and adrenal Part of the ascending and transverse colon (Umbilical)
Left Upper Quadrant
Stomach (Epigastric) Spleen Left lobe of the liver Body of the pancreas (Epigastric) Left kidney and adrenal Part of the transverse and descending colon (Umbilical)
Right Lower Quadrant
Cecum Appendix Right ovary and tube Right ureter Right spermatic cord
Left Lower Quadrant
Part of the descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord
Suprapubic
Bladder
Uterus
visceral pain
parietal pain
referred pain
v- pain associated with hollow/solid organs
P-occurs with inflammation of hollow or solid organs that effect the parietal peritoneum
referred-felt at distant sites that share innervation from the spinal level,
Developmental Considerations
Infants and Children
Breast feeding vs bottle feeding – formula used
Eating habits of the child
Constipation
Childhood obesity
Developmental Considerations
Elderly
ADLS are important to consider – how do they receive and prepare food
Blunting of abd pain is common
Bowel habits
Dentition
why is order important for abdomen exam
because if you percuss or palpate before auscultation- it will elicit bowel sounds and does not give an accurate indication of patients condition
inspection of abdomen includes what odd thing that hammon discussed in class
tangential lighting for peristalsis and pulsations
name all the places to auscultate on the abdomen
bowel sounds each quadrant.
diaphragm over aorta, iliac, femoral - checking for bruits/hums
place diaphragm over liver and spleen to listen for friction rub
where do you percuss
for tympani
dullness
tympani- over intestines
dullness -liver, spleen, large stool, or mass.
when should percussion of the spleen be tympanic
percussing the lowest interspace in the left anterior axillary lines. then have the patient take a deep breath and repeat.
called splenic percussion sign
deep palpation detects
masses
light palpation detects
tenderness and guarding
if patient is obese what technique can help locate the liver
hooking technique
patient has ascites- what is the presentation?
what will percussing the middle and sides produce
testing fluid wave
protuberant abdomen with bulging flanks
tympany in the center. dullness lateral sides
tap the side for fluid wave with hand in the center of abdomen
what are reasons for enlarged spleen
should it be palpable
mono
hematological disorders- cause enlargements of spleen
should not be palapble
murphy signs
with cholecystitis there is pain when you hold your fingers under the liver border and have the client take a deep breath. The test is positive when the client cannot complete the breath but rather stops the breath abruptly.
pancreas presents with abdominal pain radiating where.
what symptoms are common
to the back
n&v
alcoholism accounts for 80% of admissions
school age children who present with stomach pain- suspect what
bully at school
anxiety can cause belly pain
what is concerning about the spleen and significant trauma
it can easily rupture
stomach
Positive hemoccult
Tenderness
Bruits
can indicate upper GI bleed or malignancy- should occur with any epigastric pain
PUD and pancreatitis
abdominal aortic aneurysm
Blumberg’s sign
appendicitis
Pushing perpendicular on the abdomen in a site away from the pain. Release of the pressure will cause pain
McBurney’s point
appendicitis- Mild palpation to RLQ will increase pain significantly
Rovsing’s sign
appendicitis- (referred rebound tenderness in the right lower quadrant when the left lower quadrant is palpated and released)- can also hit on bottom of foot
Psoas sign
appendicitis-the patient flexes his thigh against the examiner’s hand; pain indicates a positive sign)
Obturator sign
flex the patient’s thigh and rotate the leg internally at the hip; pain indicates positive signs hypogastric pain with the hip and knee flexed and hip internally rotated.
h pylori testing
breath ID- breath into a bag
carbon 13 urea- helps identify the present of h pylori
if h pylori is present carbon 13 gets metabolized in the stomach and you breath it out. otherwise it is naturally eliminated
what are polyps considered
precancerous
colonoscopy at age
50 or before with a family history of colon cancer
what should you not use on hernias
nitrous
who do we see umbilical hernias on
seen at birth or may be seen in clients with chronic ascites or increased pressure in the adbomen
are ovaries palpable in post menopausal women
no
what is the concern with very large ovaries being removed
they can have their own blood supply and bleed alot
7 F’S OF ABDOMINAL DISTENTION
Fat- remember, fat is symmetrical Flatus- after eating? No bowel sounds? Fluid- ascites, ileus Fetus- “I can’t believe I am pregnant” Feces- hmmm Fetal growth- refer to above Fibroid- Tumor? asymmetrical
what bad habit is highly associated with bladder ca
Smoking is highly associated with bladder CA
medications- NSAIDS can present with what in the urine
protein!
male urinary history
ask about stream, start and stop and strength infant hernia repair vasectomy family history sexual history
PID
Often presents with pain, bleeding, and discharge
Metrorrhagia
Bleeding at irregular intervals
Menorrhagia
Excessive bleeding during the menstrual cycle
always check pregnancy status
last cycle
all women are presumed pregnant unless proven
red glass for GI
Hematuria Abrupt onset of testicular pain Decreased or absent urine Acute urinary retention Kidney mass Toxic appearing patient with any of the above
Red flags for female GYN
Pain is unilateral when doing a bimanual exam or lower abd Uterine bleeding Ascites Post menopausal bleeding or discharge Ovaries fixed, hard or nodular
Red flags for male reproductive
Sudden onset testicular pain Cellular or necrotic changes in skin of penis or scrotum Erection greater than 30 minutes Decreased urination Increased pain or new mass
perimenopausal changes
FSH and LH may be normal, subjective data for DX, decrease of length and flow and other S/S
Amenorrhea
primary
secondary
Amenorrhea – primary at age 16, secondary is after 3 months in a woman who had menses
uterine bleeding and discharge in peri or post menopausal
In young often benign BUT in post or peri-menopausal may be a red flag
BV odor
fishy
chalamydia
yellow
no order
origin in cervix
GC
yellowish no odor
what is yeast
an overgroth - NOT INFECTION- associated with post antibiotic tx
PCOS
increased LH
decreased FSH
in AA and hispanics PCOS can have what skin condition
acanthosis-dark discoloration in body folds
Ectopic pregnancy
Severe RLQ pain
Amenorrhea
Positive pregnancy test
Rebound tenderness
Ovarian Cyst
Younger women
Fluid filled
Tenderness increases in cycle
Bartholin’s Cysts
between vagina and rectum
Swollen and painful
Usually I&D, antibiotic and C&S
clap
GH
Chlamydia - Yellow discharge no odor
Gonorrhea – purulent discharge
Trich
Trich -Grayish foul discharge, travels with other STD’s, strawberry spots, macroscopic exam for flagellated protozoa
which std’s are bff
C and GH
BV
BV – non infection results from increased pH and change in flora, fishy odor, whiff test
Prolapse 1,2,3 degree designation
Increased with older women
Increased number of pregnancies
Obesity
Cysto or retro (bimanual and bear down)
Presents with frequency and infection
DX by examination
Torsion
6-8 hour window Most often in early puberty Abdominal pain Nausea and or vomiting Scrotal swelling Unilateral
Prostatitis
Acute bacterial
Chronic bacterial
Inflammatory/ non inflammatory
Asymptomatic inflammatory
