Week 5: Abdominal Exam Flashcards
(45 cards)
Visceral vs. Parietal
Visceral is agains the organ vs parietal, internal lining of the skin
GI/Abdomen Symptoms/Questions
Appetite? Heartburn? Reflux? Dysphagia? Food Intolerance? - lactose intolerance? N/V? How much? Describe Blood/Coffee Ground? Frequency? BM Pattern? Change? Diarrhea/Melena/Constipation, Weight loss/gain? liquid stool? does it break apart in the water? PAIN: OLDCART Acute or Chronic? Aggravating/Alleviating factors Travel History? Occupational Hazards? Dietary Habits (24 hr diet recall) Suspicious Foods or new foods? Ill Contacts? Drinking water? Adventurous food? Meds? PMH? FH? Social Hx: ETOH, Tobacco
Urinary Symptoms?
Suprapubic pain Dysuria: painful urination Urgency Frequency Hesitancy: difficulty to start or stop Incomplete emptying: unable to empty urination Nocturia: get up to pee at night Hematuria: blood in pee Polyuria: pee a lot Urinary incontinence Stress vs. urge Do you pee when you cough, sneeze or laugh Flank pain: is it traveling down? Ureteral colic: pain that comes and goes in the area of your uterers
Alarm Symptoms (red flag)
Dysphagia (difficulty swallowing/choking) Odynophagia (pain with swallowing) Recurrent vomiting Severe abdominal pain GI Bleeding Unintentional Wt Loss Unexplained anemia: source for loss of blood Risk Factors for GI CA Palpable Mass Jaundice
RUQ pain
Gallstones/cholecystitis, liver inflammation, gas, kidney stone, duodenum
Epigastric pain
:Reflux, gastritis, gallstones, indigestion/dyspepsia
LUQ:
Spleen, indigestion, pancreatitis, constipation
LLQ
: colitis, diverticulitis, constipation, left ovarian pain, renal stones
Suprapubic
: Bladder infection, pelvic pain/fibroids, STI etc
RLQ
: Appendicitis, Right ovarian pain, diverticulitis, gas, renal stones
Visceral Pain:
when hollow organs (stomach, colon) forcefully contract or become distended. Solid organs (liver, spleen) can also generate this type of pain when they swell against their capsules. Visceral pain is usually gnawing, cramping, or aching and is often difficult to localize (hepatitis)
Parietal Pain:
when there is inflammation from the hollow or solid organs that affect the parietal peritoneum. Parietal pain is more severe and is usually easily localized (appendicitis)
Referred Pain:
originates at different sites but shares innervation from the same spinal level (gallbladder pain in the shoulder)
SEQUENCE OF EXAM: for abdomen
Inspect, Auscultate, Percuss, Palpate
Inspection for abdomen
\: Shape/Contour Symmetry Umbilicus Skin/Scars Pulsations, movement Hair Pattern
Abnormal Conditions: Diastasis Recti
Splitting of abdominal muscle wall
Mid line bulge- most obvious when doing a “sit up”
Caused by abdominal obesity or pregnancy, more common with rapid weight gain
Abdominal Exam: Auscultation
Always auscultate before palpating or percussing the abdomen: otherwise induces hyperactive bowel sounds
Place the diaphragm of the stethoscope over the abdomen
Listen to bowel sounds in All 4 Quadrants: start with RLQ
Normal, hypoactive or Hyperactive? (normal 5-30/minute) Hypo: less than 5/min
Absent, count for a full minute or two
Gurgling, high pitched, clicking
Place diaphragm over the aorta: where is it located?
Bruit?
Peristalsis: the movement of smooth muscle tissue in GI tract which propels food and fluid along the tract. This is what causes bowel sounds, may feel it.
Normal, hyperactive vs hypoactive? Bowel sounds
hypoactive:Less than 5 per min in a quad
6 or more a min in a quad
Hyperactive: 30 or more a min in a quad
5 min a quadrant to diagnosis absence
Percussion
Assists to assess the amt and distribution of gas, fluid, presence of masses, and size of the liver and spleen
Percuss over all four quadrants
Percuss over the liver in both the midclavicular line
and at the midsternal line
Midclavicular percussion should demonstrate a vertical span of 6–12 cm; longer indicates an enlarged liver
Midsternal line percussion should be 4–8 cm; shorter than this can indicate a small, hard cirrhotic liver
Liver: right upper, dont percuss - dull sound (otherwise not organ sounds flat)
3 cm or more percussed below the margin
Spleen:
Epigastric
Umbilicus
Superpuic area
Abdominal Exam: Palpation
Start with NONTENDER area, work your way to tender area
Slide your hands to each area, don’t pick them up (you will miss something)
Dominant hand first, most sensitive, use that hand
Light Palpation: 1-2 cm
Light palpation in 4 quadrants
Be deliberate; identify any superficial organs or masses
Assess for voluntary guarding vs. involuntary guarding
Use relaxation techniques to assess voluntary guarding (distraction)
Watch the patient’s face for grimacing
Deep Palpation: 5-8cm
Delineate abdominal masses and organ size, may use bimanual technique
Hollow visceral: more tympanic
Liver or organ: more dull
Hyperresonance = more gas
Palpation: Light vs. Deep
Palpation: Liver
Using the left hand to support the back at the level of the 11th and 12th rib, the right hand presses on the abdomen inferior to the border of the liver and continues to palpate superiorly until the liver border is palpated
Ask the patient to take a deep breath
This can illicit pain in liver or gallbladder disease and also makes it easier to find the inferior border of the liver
Hooking Technique
Useful with obese patients
Costovertebral Angle Tenderness: Indirect Percussion
Fist Percussion
+ in Pyelonephritis
Documented as : No CVAT or +CVAT
Costovertebral angle - kidney infection and stone
A little below the rib and trap. Below the back and abdomen and percuss
If you are right handed be on right side of patient, if you are left handed be on left side of patient
Palpation of the Spleen
Left upper quadrant, just below midaxellary line, push in and up, palpate the edge
Should not feel spleen unless you are a child
Turn on their right side to get to their left upper quadrant easier
Palpation of the Bladder
Palpate over suprapubic area for tenderness
The Bladder is normally not palpable unless distended
