155 Week 6

Front 1

Name the organs that are normally palpable in the abdomen (p575 figure 21-25)

Back 1

-xiphoid process
-normal liver edge
-right kidney, lower pole
-pulsatile aorta
-rectus muscles, lateral borders
-sacral promontory
-cecum ascending colon
-sigmoid colon
-uterus (gravid)
-full bladder

Front 2

describe the proper positioning and preparation of the patient for the examination (p564)

Back 2

-strong overhead light and a secondary stand light.
-expose the abdomen so that it is fully visible. Drape the genitalia and female breast
-empty the bladder
-keep the room warm
-supine, head on pillow, knees bent or on pillow, arm crossed on chest or at the sides
-stethoscope and piece must be warm, hands must be warm, fingernails must be very short
-examine painful area at last
-use distraction: breathing exercise, emotive imagery, low soothing voice, the person relating abdominal history while palpate

Front 3

state the rationale for performing auscultation of the abdomen before palpation or percussion

Back 3

-Percussion and palpation can increase peristalsis
-would give a false interpretation of bowel sounds

Front 4

discuss inspection of the abdomen, including findings that should be noted (contour, symmetry, umbilicus)

Back 4

-contour:describe nutritional state, normal should range from flat to rounded. Scaphoid, protuberant (except in kids less than 4) are abnormal
-symmetry: should be symmetrical bilaterally. Note bulges and masses
-umbilicus: should be midline and inverted. Everted with acites, or underlying mass, deeply sunken with obesity. Enlarged and everted with umbilical hernia. Bluish periumbilical color with intra-abdominal bleeding

Front 5

discuss inspection of the abdomen, including findings that should be noted (skin,pulsation or movement, hair distribution and demeanour)

Back 5

-skin: smooth and even, With homogeneous color. striae--slivery white linear, of 1-6cm long are common. Recent striae are pink or blue
-skin glistening and taut with ascites, striae also occur with ascites
-purple-blue striae with Cushing's syndrome
-moles are common on abdomen
-draw location and indicate length of scar
-veins are usually not seen(maybe visible in thin persons)
-good skin turgor reflects healthy nutrition

Front 6

discuss inspection of the abdomen, including findings that should be noted (pulsation or movement, hair distribution, demeanour

Back 6

-plusation or movement:
-may see pulsations from arota beneath skin, especially in thin persons.
-Respiratory movement shows in abdomen, especially in males.
-waves of peristalsis sometimes visible in very thin persons (ripple slowly)
-Hair distribution:pubic hair--diamond shape in males, inverted triangle in females
-Demeanour: benign facial expression and slow, even respiration

Front 7

describe the procedure for auscultation of bowel sounds

Back 7

-use the diaphragm end piece because bowel sounds are high pitched
-hold the stethoscope lightly against skin because pushing too hard may stimulate more bowel sounds
-begin in the RLQ because bowel sounds are normally always present there
-must listen for 5min before deciding bowel sounds are completely absent

Front 8

Differentiate the following abdominal sounds: normal, hyperactive, and hypoactive bowel sounds, succession splash, bruit

Back 8

-normal: high-pitched, gurgling, cascading sound
-hyperactive: loud, high-pitched, rushing, tinking sound
-hypoactive: dimished or absent sounds
-succession splash: very loud splash auscultated over the upper abdomen when the infant is rocked side to side, indicate increased air and fluid
-bruit:a pulsatile blowing sound

Front 9

identify and give the rationale for each of the percussion notes heard over the abdomen

Back 9

-percuss lightly in all four quadrants. Move clockwise, tympany should predominate because air in intestines rises to the surface when supine.
-dullness occurs over a distended bladder, adipose tissue, fluid or a mass
-hyperresonance is present with gaseous distension

Front 10

list four conditions that may alter normal percussion notes

Back 10

-liver or spleen enlargement
-dullness occurs with lung disease (eg.pleural effusion of consolidation)
-dullness pushed up with ascites or pregnancy
-dullness with gas distension in colon, which obscures lower border

Front 11

descirbe the procedure for percussing the liver span

Back 11

-liver span:
-begin in the area of lung resonance, and percuss down the interspaces until the sound changes to a dull quality. mark the spot
-then find abdominal tympany and percuss up in the midclavicular line. Mark where the sound changes from tympany to a dull sound, normally at the right costal margin
-Measure the distance between the two marks

Front 12

describe the procedure for percussing the spleen

Back 12

-locate the spleen by percussing for a dull note from the ninth to eleventh intercostal space just behind the left midaxillary line.(normally not wider than 7cm in adults)
-percuss in the lowest interspace in the left anterior axillary line, should hear tympany. Ask the person to take a deep breath, normally tympany remains.

Front 13

describe these manoeuvres and discuss their significance: fluid wave test

Back 13

-fluid wave test:
-place the ulnar edge of another exminer's hand or the patient's own hand firmly on the abdomen in the midline.
-place your left hand on the person's right flank, right hand reach across the abdomen and give the left flank a frim strike
-if ascites is present, will generate a fluid wave through the abdomen, you will feel a distinct tap on your left hand.
-positive fluid wave test occurs with large amount of ascitic fluid

Front 14

describe these manoeuvres and discuss their significance: shifting dullness

Back 14

-will hear a tympanitic note as percuss over the top of the abdomen as gas-filled intestines float over the fluid.
-then percuss down the side of the abdomen. If fluid is present, the note will change from tympany to dull as you reach its level. Mark the spot
-turn the person onto the right side. The fluid should gravitate to the dependent (right) side. Begin percussing the upper side of the abdomen and move downward. The sound changes from tympany to a dull sound as you reach the fluid level. Level of dullness is higher this time.
-shifting dullness is positive with large volume of ascitic fluid, not detect less than 500ml of fluid

Front 15

differentiate between light and deep palpation and explain the purpose of each (light palpation)

Back 15

light palpation: first four fingers close together, depress the skin about 1cm. Make a gentle rotary movement, sliding the fingers and skin together. Then lift the fingers and move clockwise to the next location around the abdomen.
-purpose is to form an overall impression of the skin surface and superficial musculature. discriminate between voluntary muscle guarding and involuntary rigidity

Front 16

differentiate between light and deep palpation and explain the purpose of each （deep palpation)

Back 16

-same technique as light palpation, but push down about 5-8 cm.
-note the location, size, consistency and mobility of any palpable organs and the presence of any abnormal enlargement, tenderness and masses.

Front 17

list two abnormalities that may be detected by light palpation and two detected by deep palpation

Back 17

light palpation:muscle guarding, rigidity, large masses and tenderness
deep palpation:enlarged liver, enlarged spleen, tenderness