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