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28 Cards in this Set

  • Front
  • Back
palpation of aorta, what's abnormal
slightly left of midline, abnormal if lateral pulsations felt and >3cm
who should have aorta palpated
>50 yo and anyone c cardiovascular disease
Murphy's sign
place hand firmly @ costal margin in RUQ & ask pt to breath deeply. If pt gasps as gallbladder descends and contact palpating hand, sign is positive for cholecystitis. Maneuver in LUQ should not elicit pain.
assm't for peritoneal irritation
rebound tenderness, psoas sign, obturator sign, cutaneous hypersensitivity
assmt for ascites
fluid wave, shifting dullness
3 most important questions
when did last poop? are you hungry? when was your last period?
Apley's rule
closer to periumbilical area, the better (less likely to be serious than other places)
describe visceral abdominal pain
crampy/paroxsymal, non-localized, may be r/t peristalsis, EX: gastroenteritis
describe pain from peritoneal irritation
constant/steady, localized, pt lies still c knees bent, EX: appendicitis
appendicitis--age range, incidence
most common in 11-20 yo, 1 in 15 people
periumbilical pain that localizes to RLQ wi 4-6 hrs onset, N/V if present start after pain, low fever possible, may urinary or respiratory symptoms
appendicitis--inspection, auscultation, percussion, palpataion
I: guarding, distention, supine c flexed knees
A: auscultate RLL to r/o lobar pneumonia c referred pain
Pe: painful
Pa: McBurney's point tender, rebound tenderness, + peritoneal signs, CAREFUL rectal tender on right
Psoas sign
for appendicitis, supine, life thigh against resistance causes pain
obturator sign
for appendicitis, supine, knee flexed to 90 degrees & rotated laterally & medially, causes pain
ascites--definition, pathology
fluid buildup in abdominal cavity, usually due to portal vein htn from increased resistance to blood flow through inflamed or fibrotic liver
90% ascites due to ________
cirrhosis, cancer, TB, CHF
tests for ascites
fluid wave & shifting dullness
other systems besides abdominal that can cause abdominal pain
1 system up, 1 system down; respiratory, cardiovascular, genitourinary, musculoskeletal, hematologic, psych
besides oldcarts, what addn't info needed for abd pain
alter in ADLs, other family members c same s/s, home or other prescribed tx, previous eval or tx, what client thinks
acute GI infections, hepatitis, PID/STIs, UTIs, diverticulitis, ulcers, gallbladder disease, colitis, cystic fibrosis, food allergies, cancer, cardiac probs, endometriosis, immunizations, trauma, blood transfusions
lab tests-abdomen
LFTs, H Pylori, stool cultures, urinalysis, ova & parasites, abd xray, ct scan or sono
med use- abdomen
abx, laxatives, suppositories/enemas, antacids, ulcer meds, iron/vit, chronic steroid or asa use, birth control, folk remedies
personal hx--abdomen
travel outside country, nutrition/caffeine, LMP, sex hx & protection, substance abuse, stress
skin: scars, striae, dialated veins, rashes, lesions
painless, intermittant reducible bulge in abdomen,
umbilical hernia, inguinal femoral & ventral hernias
umbilical in infants: rarely need intervention, usually correct on own.
All others are usually surgically corrected.
contour of abdomen: scaphoid, protuberant, rounded, distended, symmetrical / asymmetrical
scaphoid: sinking in.
protuberant: sticking out
distended: overblown
8 F's of abdominal distention
fat, feces, fetus, flatus, full bladder, fibroids, fluid, fatal tumor