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Health Assessment > Week 5: Abdominal Exam > Flashcards

Week 5: Abdominal Exam Flashcards

1
Q

Visceral vs. Parietal

A

Visceral is agains the organ vs parietal, internal lining of the skin

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2
Q

GI/Abdomen Symptoms/Questions

A 
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
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3
Q

Urinary Symptoms?

A 
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
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4
Q

Alarm Symptoms (red flag)

A 
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
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5
Q

RUQ pain

A

Gallstones/cholecystitis, liver inflammation, gas, kidney stone, duodenum

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6
Q

Epigastric pain

A

:Reflux, gastritis, gallstones, indigestion/dyspepsia

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7
Q

LUQ:

A

Spleen, indigestion, pancreatitis, constipation

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8
Q

LLQ

A

: colitis, diverticulitis, constipation, left ovarian pain, renal stones

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9
Q

Suprapubic

A

: Bladder infection, pelvic pain/fibroids, STI etc

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10
Q

RLQ

A

: Appendicitis, Right ovarian pain, diverticulitis, gas, renal stones

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11
Q

Visceral Pain:

A

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)

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12
Q

Parietal Pain:

A

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)

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13
Q

Referred Pain:

A

originates at different sites but shares innervation from the same spinal level (gallbladder pain in the shoulder)

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14
Q

SEQUENCE OF EXAM: for abdomen

A

Inspect, Auscultate, Percuss, Palpate

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15
Q

Inspection for abdomen

A 
\: 
Shape/Contour
Symmetry
Umbilicus
Skin/Scars
Pulsations, movement
Hair Pattern
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16
Q

Abnormal Conditions: Diastasis Recti

A

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

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17
Q

Abdominal Exam: Auscultation

A

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.

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18
Q

Normal, hyperactive vs hypoactive? Bowel sounds

A

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

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19
Q

Percussion

A

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

20
Q

Abdominal Exam: Palpation

A

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

21
Q

Palpation: Liver

A

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

22
Q

Costovertebral Angle Tenderness: Indirect Percussion

A

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

23
Q

Palpation of the Spleen

A

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

24
Q

Palpation of the Bladder

A

Palpate over suprapubic area for tenderness

The Bladder is normally not palpable unless distended

25
Q

Inspect & Palpate Aortic Pulsation

Normal Aortic Width:

A

2.5-3 cm; >3cm (pulsatile) = AAA

26
Q

Peritonitis

A

Inflammation of the parietal peritoneum = Acute Abdomen
Guarding – voluntary contraction of the abd wall, often accompanied by grimacing, may be distractible
Rebound tenderness: pain increases when the examiner quickly withdrawals his/her hand from the abdomen
Ask pt if it hurts to go over speed bumps or step down stairs, hop on one foot
Heel drop test: drop heel on table- causes jarring of inflamed peritoneum or Heel Strike test: strike the bottom of the foot (while pt lying on the table)
Hurt in abdomen
Emphasis of strike the heel, jars their peritoneum

27
Q

Guarding –

A

voluntary contraction of the abd wall, often accompanied by grimacing, may be distractible

28
Q

Rebound tenderness:

A

pain increases when the examiner quickly withdrawals his/her hand from the abdomen
Ask pt if it hurts to go over speed bumps or step down stairs, hop on one foot

29
Q

Heel drop test:

A

drop heel on table- causes jarring of inflamed peritoneum or Heel Strike test: strike the bottom of the foot (while pt lying on the table)
Hurt in abdomen
Emphasis of strike the heel, jars their peritoneum

30
Q

Appendicitis

A

Inflammation of appendix of ascending colon
Check for involuntary guarding and rebound tenderness in the right lower quadrant
Palpate for McBurney’s point tenderness
Psoas & Obturator sign

31
Q

McBurney’s point

A

1/3 distance from hip bone (anterior superior iliac spine) and 2/3 way from linea alba (umbilicus)
Tenderness over McBurney’s Point +Appendicitis

32
Q

Obturator Sign

A

Flex right leg, rotate hip internally

+Pain= appendicitis

33
Q

Psoas Sign

A

Extend the right leg back +pain= appendicitis

Lying back and Bend knee against resistance with provider

34
Q

Rovsing’s Sign:

A

Push on left side, causes pain on right side

Test for appendicitis

35
Q

Acute Cholecystitis

A

Inflammation of the gallbladder: caused by stones blocking flow of bile
Liver inflammation
Murphy’s Sign
Deep Palpation of the RUQ along costal margin
Ask pt to take a deep breath
Positive if sharp increase in pain with inspiratory arrest
Quick inspiratory = positive

36
Q

Hernias of the abdominal wall

A

Defect or hole in the abdominal wall
Umbilical
Incisional
Painful: worse with activity, prolonged standing/walking, worse with sit-up or engaging abd muscles
Reducable?
Warm, red
Concerning signs: fever, body aches, chills, diarrhea, n/v, worsening pain - - - incarcerated

37
Q

Ascites

A

Protuberant abdomen with bulging flanks
Fluid is dull on percussion
Dullness will shift to the dependent side and tympany to the top
Check for fluid shift
Fluid movement when pressing one side of abd ?
Causes?
Fluid build-up from CHF, cirrhosis, Kidney dz, CA

38
Q

Diverticulitis

A

Infection of Diverticula (may have colonoscopy w/ diverticulosis seen)
Adults mid-40s or older
Mild to Severe pain
May have n/v
Possible diarrhea during attack
Decreased appetite
Fever/no fever
Typically progressively worsens over time
Any part of colon- usually descending (LLQ), but ascending RLQ

39
Q

Crohns

A 
\: any part of GI tract from mouth to anus
Harvey Bradshaw Index
Cramping abdominal pain
Severe diarrhea w/blood, pus & mucus
Fever, weight loss, fatigue, malaise
↓ hgb/hct, ↑ ESR during exacerbations
Colo: cobblestoning
40
Q

Ulcerative Colitis: colon

A 
Abd pain in LLQ
Diarrhea w/blood and pus
Rectal pain w/bleeding
Weight loss
Fever, tachy, anemia, elevated ESR
Stool cultures have WBCs
Colo: ulcerations of mucosal lining
41
Q

Irritable Bowel syndrome:

A

abdominal pain associated w/bowel pattern changes
Very common
Lifestyle related, but can be related to other conditions
ROME IV criteria
Diarrhea or Constipation Predominant or Mixed
Abdominal pain 1 day/week > 3mos w/altered bowel pattern- usually relieved w/defacation
Diarrhea, constipation or both
Gas, bloating, periods of exacerbation and remission
Exacerbated by stress, and/or eating

42
Q

Dyspepsia:

A

upper abdominal discomfort
Usually brought on by eating
Abdominal discomfort, sensation of bloating
Can be periods of intense pain “gnawing” “twisting” “stabbing”
May radiate to back or up into chest
May be relieved by antacids, pepto, alkaline foods such as yogurt, milk
Exacerbated by known triggers suc

43
Q

Gastroesophageal Reflux Disease “Heartburn”

A

Pain in chest or epigastric area
Burning, gnawing or pressure sensation
Difficulty swallowing or globus sensation
Worse after meals or w/certain foods (citrus, alcohol, spicy, fatty/fried foods, large meals)
Relieved w/antacids or other alkaline foods
Cough, hoarseness- even may mimic bronchitis
Regurgitation
Worse at night w/lying flat

44
Q

Pediatric Exam

A 
Exam Techniques
Protuberent belly until 4-5 years old
Spleen easily palpable 
1-2cm below costal margin
Soft with sharp edge
45
Q

Clinical Considerations for abdominal

A

Celiac disease: Antibody tests, endoscopy of shortened or flattened intestinal villi (gold standard)
Inflammatory bowel disease: CBC with differential that has a high WBC count, endoscopy with biopsy that shows crypt abscesses (gold standard)
Hepatitis: Acute viral hepatitis panel, comprehensive metabolic panel
Pancreatitis: High amylase and lipase levels
Cholecystitis: Ultrasonography, hepatobiliary scan
Gastroesophageal reflux disease (GERD): Upper endoscopy and biopsy, esophageal pH monitoring
Appendicitis: Graded compression ultrasound
Hepatomegaly and splenomegaly: Ultrasound, CT, and MRI

Health Assessment (9 decks)

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