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90 Cards in this Set
- Front
- Back
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Describe the abdomen.
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A large, oval cavity
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What are the boundaries of the abdomen?
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Extends from the diaphragm to the brim of the pelvis.
Back: spine and paravertebral muscles Front: lower rib cage and abs |
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What are the internal organs inside the abdominal cavity called?
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viscera
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What are the 4 layers of large, flat muscles that from the ventral abdominal wall?
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1. external oblique
2. internal oblique 3. transversus muscles 4. rectus abdominus |
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What are all of the abdominal muscles joined by at midline?
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A tendon sheath: the linea alba
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What are the 4 common descriptive landmarks we use for the abdomen?
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RLQ, RUQ, LLQ, LUQ
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What are the 9 regions we use to describe abdominal pathology?
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Epigastric, umbilical, suprapubic
R/L hypochondrium R/L lumbar R/L inguinal |
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Where is the appendix located?
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RLQ: at the ileocecal junction
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What does pain around the bellybutton refer to?
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pain in the small intestine
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Where is most of the liver located?
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RUQ
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How do you check for gallbladder pain?
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Palpate the liver since you can't directly palpate the gallbladder
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Which kidney is higher and why?
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Left kidney is higher
(right kidney gets pushed down by the liver) |
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Which artery bifurcates at the umbilicus?
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aorta
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What should you do anytime you have a bifurcation?
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check for bruits
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What are the most common primary care problems?
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GI issues
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What does anorexia mean?
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when someone does not feel like eating
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What are 10 pieces of subjective data to acquire during the history?
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1. appetite
2. dysphagia 3. food intolerance 4. ab pain 5. N/V 6. bowel habits 7. past ab hx (ie surgery) 8. meds 9. nutritional assessment (24 hour recall) 10. Weight changes? were they planned? |
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What should you ask someone who complains of dysphagia?
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do they have difficulty swallowing with liquids? solids? both?
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Where does pain in the appendix start?
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epigastric peritoneum
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Where does GI pain most frequently occur in elderly?
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LLQ
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What does GERD and a heart attack have in common?
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they both have pain in the same place
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Where does the gallbladder refer pain to?
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the back of the scapula
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Where does liver pain occur?
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in the back
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What is ureter colic? Where is the pain referred?
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pain the in GROIN when kidney stones get lodged in the ureter
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Where does visceral pain come from?
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an internal organ
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Describe visceral pain
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dull, POORLY localized
people writhe in bed |
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What causes parietal pain?
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inflammation of the OVERLYING PERITONEUM
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Describe parietal pain.
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sharp, PRECISELY localized, aggravated by movement
don't want to move |
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What is referred pain?
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when a person gives a hx of ab pain, the pain's location might not necessarily be directly over the involved organ
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How should you prepare for an abdominal exam?
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1. warm room
2. good lighting 3. empty bladder (to prevent dull percussion) 4. supine position with knees bend, arms at side 5. warm steth, short nails |
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After a patient points out an area of pain, when should you examine that area?
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last
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What is the order of techniques for the abdominal exam?
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Inspection, ascultation, percussion, palpation
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Why shouldnt you percuss and palpate before you ascultate?
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percussion and palpation increases peristalsis, masking CV signs like bruits
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What should you inspect for on the ab?
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1. demeanor
2. contour (protuberant? scaphoid?) 3. skin 4. hair dist 5. pulsation, movement 6. umbilicus **look straight down and tangentially |
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What should the umbilicus look like on a man/woman?
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M: diamond
W: triangle |
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What types of problems might distend veins in the abdomen?
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liver problems
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What side of your steth should you use for ascultating bowel sounds?
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diaphragm
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Where should you begin ascultation? why?
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ileocecal valve in RLQ
if sounds occur here, you should have bowel sounds everywhere |
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How frequent should normal bowel sounds occur?
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5-30/min
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What do hyperactive bowels sound like? what causes these?
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loud, high-pitched, tinkling
diarrhea, early obstruction |
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What conditions are characterized by hypoactive bowels?
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-surgery
-peritonitis -paralytic ileus |
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What is borborygomy
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low, loud gurgles of peristalsis
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Where might you see aortic pulsations from an aortic aneurism?
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epigastric area
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What might evidence of peristalsis from inspection indicate?
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diarrhea
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Where do hernias show up?
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-sites of old scar
-ventral region on umbilicus |
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Which vascular sounds should you ascultate?
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-aorta
-L/R renal arteries -L/R iliac arteries -L/R femoral arteries |
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What do arterial bruits with both systolic and diastolic components suggest?
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partial occlusion or aorta or large arteries
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What type of bruit might be normal?
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epigastric systolic bruit
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What are aneurisms characterised by?
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decreases pulses
increased bruits |
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What percussion sound should predominate in the abdomen?
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tymphany
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What are 5 areas of dullness that are in the abdomen?
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1. mass or enlarged organ
2. fluid in sides/ full bladder 3. feces 4. fetus 5. fibroid |
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What is ascites?
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excess fluid in the space between the tissues lining the abdomen and abdominal organs
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How do you percuss the span of the liver?
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check for enlargement by percussing the intercostal spaces down (to dullness) and then abdomen up (tymphany to dullness)
-do this on the right side, MCL -should be 6-12 cm |
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How should you modify your percussion of the liver span in a large breasted woman?
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do test along the sternal border
-4-8 cm |
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What does cirrhosis do to the liver?
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shrinks its size
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What does cirrhosis do to the spleen?
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increases its size
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What does hepatitis do to the liver?
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increases its size
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What is the effect of mono on the liver and spleen?
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increased size
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What does COPD do to the liver?
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pushes the liver into the lower ab (does NOT change its size)
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What does the liver scratch test do?
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helps define the liver borders when the abdomen is DISTENDED or the muscles are TENSE
(ie pregnancy, ascites, can't relax abs) |
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How do you do the liver scratch test?
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place the steth over the liver:
1. start in RLQ and scratch with finger tip upward 2. when sound becomes MAGNIFIED, you've crossed from hollow organ to solid (liver edge) |
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Where do you attempt to percuss the spleen? what should you hear?
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in the lowest interspace in the L anterior axillary line
tymphany |
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What should you ask the person do do during the spleen percussion test?
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take a deep breath so that the diaphragm can push the spleen down---> you should still get tymphany through a full inspiration
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If you get a change from tympany to a dull sound in deep inspiration, what does this indicate?
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(+) splenic percussion sign--> splenomegaly
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What 4 conditions cause splenomegaly?
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1. mono
2. people who stop exercising 3. cirrhosis 4. malaria |
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What do you check for when assessing the kidney?
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CVT: costovertebral tenderness
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How do you assess the kidney for CVT?
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pressure from fingertips or a thrust of fist may produce tenderness due to a kidney infection (but it also may be musculoskeletal)
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How should you palpate the ab?
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light and deep
-circular movements in 4 quadrants around the ab use 2 hands (feel w dom hand/ push w nondominant hand) |
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What is the purpose of abdominal palpation?
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to know the size, location and consistency of ab organs
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Which organs are solid?
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liver, spleen, adrenal glands, pancreas
**keep their shape with enlargement |
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Which organs are fluid filled?
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aorta, bladder, gallbladder
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Which organs are hollow?
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stomach, intestines, colon
*palpable with distension |
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What are 4 reasons why the abs might feel tender?
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1. voluntary muscle guarding (ask to blow out air to relax muscles)
2. involuntary rigidity (from peritonitis) 3. peritoneal irritation (cough hurts this area) 4. rebound tenderness |
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How do you do hook's method to palpate the liver?
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below the ribs, your left hand lifts up while your right hand hooks the ribs. during the breath, you want to feel a smooth edge of the liver
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4 abnormalities in ab palpation?
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1. enlarged liver
2. enlarged nodular liver 3. enlarged gallbladder 4. enlarged spleen |
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How do you palpate the spleen?
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reach over the patient and hold up the ribs
-press down to palpate the spleen (don't poke) |
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How large must the spleen be for you to be able to palpate it?
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3x its normal size
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When might you be able to feel a kidney?
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if someone has an adrenal tumor, the kidney gets pushed down
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Which kidney is more likely to be palpated (even though it's rare)
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right kidney
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What technique should you use for kidney palpation?
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duckbill, deep breath, try to grab it
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If the aortic pulsation is greater than 5cm, what should you order?
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an ultrasound
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Where are 95% of aortic aneurisms found?
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between the renal and iliac arteries
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What percentage of aortic aneurisms are palpable?
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80%
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What do you notice with aortic aneurisms?
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-feel bruit
-femoral pulses do not decrease |
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What is rebound tenderness?
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It refers to pain upon removal of pressure rather than application of pressure to the abdomen
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What is Rovsing's sing?
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If palpation of the left lower quadrant of a person's abdomen results in more pain in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis
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What is the Psoas sign?
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passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip.[1] If abdominal pain results, it is a "positive psoas sign". The pain results because the psoas borders the peritoneal cavity, so stretching (by hyperextension at the hip) or contraction (by flexion of the hip) of the muscles causes friction against nearby inflamed tissues. In particular, the right iliopsoas muscle lies under the appendix when the patient is supine, so a positive psoas sign on the right may suggest appendicitis.
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What is the obturator test?
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If an inflamed appendix is in contact with the obturator internus, spasm of the muscle can be demonstrated by flexing and internal rotation of the hip
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What does murphy's sign assess for?
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acute cholecystitis (sudden inflammation of the gallbladder)
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What is murphy's sign?
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it is performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers) and winces with a 'catch' in breath, the test is considered positive.
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