• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

Card Range To Study



Play button


Play button




Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

89 Cards in this Set

  • Front
  • Back
What type of movement might you see in the abdomen

peristaltic movement

a/synchronous with chest

Abdominal distention can be benign when it's related to these (3) things

after feeds

air swallowing from feeding/crying

overflow from bagging/vent/CPAP/high flow NC

Abdominal distention that is pathologica may be caused by these (68 things


Organomegal (liver/spleen/pancreas)

Renal anomalies - MC cause of abdominal masses

Distended bladder/uterus

Gastric perforation/pneumoperitoneum



Intestinal obstruction

Causes of intestinal obstruction (5)

Atresias / stenosis

Ileus (slowed peristalsis / sepsis)

Mec ileus / plug

Hirschsprung's dx (ganglion not at end of intestinal track

Imperforate anus


FREE AIR in the abdominal cavity

-bowel perf NOT always a/c free air

-free air does NOT always mean bowel perf (could be air from lungs)

Normal size of girth

Less than HC until 30-32 weeks

32-36 weeks should be =

after 36 weeks should be greater than HC

When do babies normally have 1st stool (by weight)

98% > 2500 gm stool 1st 24 hrs

80% infants < 1500 gm stool 1st 48 hrs

90% ELBW - by 12 days

**Most pass stool before being fed

1st passage r/t GA & BW

An increase in abdominal girth by _____ may be abnormal

at least 2 cm (think feeding intolerance/gastric residuals/follow carefully)

check girth just above umbilicus

IS bilious residual OK in preemie? (what might be a cause)

a little is OK, may be tube too deep into small intestine (also sphincter sometimes loose)

Epigastric distention with visible peristalsis may be a sign of

duodenal/jejunal obstruction

pyloric stenosis

When does hypertrophic pyloric stenosis present? What are the main signs (4)?

~ 3 weeks of age, but can begin at birth

more prevalent in males

-failure to advance transpyloric tubes

-feeding intolerance

-projectile vomiting

-olive shape in pyloric area (felt 1-2 cm just above umbilicus, midline or sl. to R - check after emesis)

Linea nigra

line down midline under umbilicus; seen often, normal, dt maternal hormones

Omphalocole: incidence / size / what it is

-3/10,000 live births

-> 4 cm in diameter

-herniation of umbilicus through which abdominal contents and other organs protrude through umbilicus (6th week guts out, 10th week SHOULD come back in)

-covered by a translucent membrane

-high incidence of other congenital abnormalities (get echo, RUS, be sure nothing else is going on)

Syndromes associated with an omphalocele

beckwith-wiedemann syndrome, trisomy 13/18/21

May have to stage repair


Overgrowth syndrome

-large abdominal viscera

-large tongue


-ear pits


-kidney abnormalities

-at risk for cancerous and noncancerous tumors

Gastroschisis: incidence / what is it

-to SIDE of umbilical cord


-herniation of abdominal contents and other organs through opening

-distinguished from omphalocele by location (to R of midline, does NOT include umbilicus)

-no membranous sac

-fewer congenital anomalies associated

-protruding bowel appears dark or necrotic (exposure to amniotic fluid)

Risk to baby if they have an abdominal defect (5)



-Fluid loss

-Electrolyte imbalance

-Requires immediate surgical attention

--> plastic bag to minimize hypothermia/fluid loss

--> put baby on side and watch bowel color, could get kinked, etc

exstrophy of the bladder - what is it; commonly seen with what other sign

Fissure between anterior abdominal wall & Urinary bladder

visible over bladder area

epispadia - common finding in males with this condition

Eagle-Barrett syndrome

"prune belly"

-No abdominal muscles

-cryptorchidism (tests in abdomen)

-renal anomalies (increased risk of UTIs)

Diastasis recti

Gap between rectus muscles

-common in healthy nbn

-palpable and visible when infant cries

-benign in basence of hernia

umbilical hernia:MC seen in ____ / cause / how do you confirm diagnosis / what do you do to fix?

MC seen in LBW & AA infants in 1st year of life

-Non AA? Think hypothyroid. = between males and females

-Cause: separation of rectus muscle with herniation of omentum & sometimes bowel

-palpation confirms diagnosis

-note size & protrusion

-large hernia or strangulation of abdominal contents into herniated area = SURGERY

-most close spontaneously by 5 yo (diameter less than size of nickel will probably close)

What does 1 artery mean in umbilical cord? What % of infants have it?

1 artery in 1% of newborns

-associated with othe ranomalies particularly genitourinary

-if no other congenital malformation or chromosomal abnormality further screening is controversial

Normal length of umbilical cord / what determines length

30-90 cm, average is 55 cm (2 ft)

intrauterine space and fetal movement determines length (inactive babies have shorter cords... down's, neuromuscular d/o)

Normal umbilical cord color

bluish white & gelatinous at birth

yellow/green - exposure to mec at least 6-12 hrs prior to delivery

umbilical cord thickness

1-2 cm in diameter

what does wharton jelly's reflect?

What is it's job?

Reflects nutrition

-Protects umbilical vessels from compressions

Abnormalities of umbilical cord (4)

-Unusual color

-Uneven diameter (strictures / hematomas)

-Redness, foul smelling


When do cords usually fall off? What may cause longer cord separation?

7-14 days

Longer cord separation:

-preterm infants and c/s infants

-when cleansed with alcohol rather than sterile water (up to 3 weeks)

*A small amount of blood may be noted at time of separation

If your umbilical cord is attached longer than 3 weeks, what diagnosis might you consider? Tell me more about it :)

LAD (leukocyte Adhesion Deficiency)

-rare, 1:1 million, x-linked recessive

-late cord separation

-presents with h/o recurrent bacterial and fungal infections due to neutrophil dysfunction

What are you thinking if your umbilical cord continues to bleed and bleed?

Think hemophilia or blood d/o

Why do some nbns develop a small rim of erythema around the drying cord?

Thought to related to the normal WBC infiltration that occurs with cord separation

Cord hematoma

rupture of umbilical vein - could be lethal

-if large, could lead to high output cardiac failure (can act similar to AV fistula if large enough)

Cord hemangioma

-if large, could lead to high output cardiac failure (can act similar to AV fistula if large enough)

-deaths have been reported

umbilical granuloma

granulation tissue, can be normal, is excessive

use vaseline around area 1st, then silver nitrate

patent urachus

persistence of embryonic connection between bladder and umbilicus

vitelline (omphalomesenteric) duct abnormalities (3)

--> abnormal connections between intestine and skin @ umbilicus, see pg. 15 for image

-Vitelline band - should go away completely. Can become a volvulus or ischemic/atresia area like an amniotic band

-Vitelline duct cyst

-Vitteline sinus - stool drips out of umbilicus;(persistent vitelline duct from ileum to umbilicus)

what is the omphalomesenteric duct

-embryonic tract connecting ileum to the umbilicus

-ileal liquid seeps out of the duct

-fecal drainage from cord - fistula between omphalomesenteric duct & colon

Meckel's Diverticulum

-MOST COMMON vitelline duct abnormality

-Can be a problem - start of intussusception

-Blind pouch

-The most common presenting symptom is painless rectal bleeding such as melaena-like black offensive stools, followed by intestinal obstruction, volvulus, and intussusception


-EMERGENCY, ischemia = death

-Currant jelly stool

-the inversion of one portion of the intestine within another

What reflex do you check in the perianal area? Also look for meconium where?

Wink reflex (scratch side of anus)

- look for meconium in urethral or vaginal orifice or along perineum in females; in urethral orifice or along median raphe in males --> thinking some type of fistula, ex. rectovaginal fistula (not fixed right away)

Anal atresia vs anal stenosis

How long does it take most terms to pass stool?

Atresia - no passage of stool

Stenosis - small, thin stool

Mechanical or functional obstruction --> abdominal distention, vomiting (quickly if no stool).

94% of terms pass stool in 1st 24 hrs, most 1st 12 hrs

How long do you have to listen to the abdomen to claim no bowel sounds?

5 minutes

When are bowel sounds present after birth? Preemie? Sedated baby?

audible in 1st 15 minutes

preterm? Less active BS

sedated? Less active or absent BS

What do bowel sounds sound like? How often are they heard?

What might the baby have if BS are absent? If they're hyperactive?

Metallic, tinkling quality - heard about every 15-20 seconds

Absent? ileus

Hyperactive? just fed or obstruction

Frictional rubs? present with peritoneal irriation

If you hear a bruit over the abdomen you might be thinking....

abnormal umbilical, hepatic vascularization, renal stenosis, hepatic hemangioma

What might you be feeling if you feel a sausage shape in lower L quadrant?

Same shape in upper R or L quadrant?

meconium in descending colon

may be intussusception

Mass between umbilicus and R lower costal margin likely ____ ?

Solid or cystic masses likely _____?

pyloric stenosis

renal in origin

Tense rigid tone think -->

Flaccid tone think -->

Tense - peritoneal irritation

Flaccid - neuromuscular disease, perinatal compromise or maternal meds causing depression

How do you check turgor?

gently pink a small piece of skin and release it

When do you use percussion? What two sounds do you hear and what do they mean?

Use to distinguish between tympanic and dull sounds

-Tympanic - sounds over organs that contain air (stomach)

-Dull - over liver, spleen, and bladder suggests organ enlargement / masses

How do you assess liver? Where should you feel it?

Index finger just above the groin, gently compressing motions gradually move finger upward toward liver edge

Normal - edge is up to 1-2 cm below RCM at midclavicular line (may be lower with hyperexpanded lungs)

Normal vs abnormal vs congested liver (how do they each feel)?

Normal - smooth, firm with sharp well defined edge

Abnormal - hard, nodular liver

Congestion - rounded liver edge

Downward displacement of liver... this is called ____ potentially caused by ____ (4)


-Perinatal infection

-Blood group incompatibilities


-Hyper-expanded chest wall may cause downward displacement but liver can be a normal size

What do you see with a ruptured liver? What may cause it?

Rupture may be d/t difficult delivery or aggressive resuscitation


-May appear well 1st 24-48 hrs

-mass in liver region

-ab. distention as free blood fills peritoneal cavity

Where do you feel spleen? What do you see with a ruptured spleen?

Usually NOT felt; may be felt at left costal margin. If > 1 cm below check for infection, erythroblastosis fetalis

-Rupture - suspect with breech that presents with anemia NOT associated with jaundice in 1st 24-72 hrs

Where do you feel kidneys? When are concerned?

Difficult to palpate after 1st few hours

Left easily to palpate than R (bc liver)

Ideally immediately after birth before they eat / intestines fill with air

Do @ end (disturbing) of exam

Normal - equal in size and smooth to touch

Concerned? Nodular or enlarged kidney

Adrenal glands - risks at delivery

Relatively large @ birth and vulnerable to trauma

-Hemorrhage is usually unilateral and more commonly on R (bc liver/spine might compress)

-Incidence increases with organomegaly

Bladder - where is it felt; what problems might you have if its frequently distended?

Start palpating 1-4 cm above symphysis pubis

-Feel bladder between fingers

-Continuous/frequent distention may be d/t CNS defects or urethral obstruction

What is an inguinal hernia? MC on which side of body? Who is it most common in?

Muscle wall defect, bowel enters scrotal sac in males or soft tissue in females --> MC in males

-R more often than L (if L involved, likely bilateral)

-Frequent in preemies, seen when infant gets stronger (more active & stooling more)

If you see a bulge in the labia majora you're thinking....

Inguinal hernia vs ovary vs testis - possible hermaphrodite

How often should you try to reduce an inguinal hernia?

DON'T do regularly, only need to determine if it remains without discoloration or change in consistency. Be sure it's soft & not discolored. If you see changes - then try to reduce

incarcerations/strangulation = surgery

What is your main concern with a baby with oligo?

Main concern is LUNGS

May not develop well with minimal fluid

How is oligohydramnios related to renal function? What do you see with oligo? What syndrome has NO fluid?

Little fluid = little urine from baby in utero. Either PIH or baby renal problem

--> will see flattened facies, malformed ears, contraction deformities of limbs

--> a/c CV, neuro, GI, and musculoskeletal systems

Potter - NO fluid, contorted

When does a healthy nbn void?

healthy nbn - 1st 24 hrs

99% of all nbn - by 48 hrs

No urine for 36 hrs? possible renal dx, obstruction, renovascular accident or malformation of urinary tract

Normal UOP

LOW during 1st 2 days

25-60 ml total in 24 hrs

Increases to 100-300 ml by 3-10 days

Normal output: 1-2 ml/kg/hr on DOB-DOL2

3-4 ml/kg/hr thereafter

UOP rule of thumb for term baby

Day 1 - 1 wet diaper

Day 2 - 2 diapers

Day 3 - 3 diapers

*DOCUMENT void in DR if it happens

How long is a little bit of vaginal blood normal in term girls?

Around day 5

After 1 week - abnormal

When does rugae begin to form on ventral surface of scrotum

36 weeks

Term scrotum looks like ?

Scrotum fully rugated and more deeply pigmented than surrounding skin

When do testes descend?

Prior to 28 weeks - testes in abdomen

28-30 weeks - begin to descend

Term - should be in scrotum

IMPORTANT: keep on finger on inguinal ring to prevent pushing testis back into inguinal canal

2 testes up at birth? May not be a boy

Is the prepuce easily retractable?

Prepuce (foreskin) may NOT be retractable which is normal. It is usually tight. Don't worry if peeing

Phimosis - nonretractable foreskin. NORMAL in young males

Pull skin forward and see if it will pucker at meatus

Antenatal testicular torsion

Twisting of spermatic cord

-results into acute ischemia with its resultant sequelae such as abnormality of testicular function and fertility

Hypoplastic urethra

assess adequacy of skin circumferentially paying attention to ventral side - if you can see catheter #s through skin, should NOT be circ'ed


A variant of hypospadias

Occurs with a normal foreskin

Does not need foreskin for repair (can be fixed once older)

Normal penis length

3.5 cm +/- 0.7 cm

Erections are normal

Observe force and direction of urine stream

Chordee vs penile torsion

Chordee - bent shaft, sometimes also see hypospadias

Torsion - VERY crooked, needs surgery

Where do you check for hypospadias?




Epispadias and exstrophy of bladder

Usually go together... :)

Cremasteric reflex

Contraction of cremaster muscle

Gently stroke inner thigh longitudinally = drawing up of the ipsilateral testes (some say not present until 3 mo but can illicit in full term)


Peritoneal fluid enters scrotal sace

Cause: incomplete obliteration of processus vaginalis - connection between peritoneal cavity and scrotum

Appearance - fluid filled sac in an enlarged scrotum

Brightly transluminates

*Inguinal could transilluminate if bowel filled with air


May interfere with fertility / become malignant

-Undescended tests in an extrascrotal position

-Common in male sexual differentiation

-Descend by 3 months corrected age

-Increased in preemies

-Other anomalies + ambiguous genitalia = get karyotype

Ectopic testes

Testes missed scrotal sac entirely


-Superficial ectopic

-Transverse scrotal



What does a normal female genitalia look like for 1st 8 weeks of life

Prominent labia

Meatus difficult to visualize

White vaginal discharge and / or bleeding (all d/t maternal estrogen)

Breech? may be edematous & ecchymotic

Preterm vs term labia

Preemie - labia minora and clitoris are prominent and labia majora small

Term - labia majora larger, more adipose tissue. Labia majora coveres clitoris & minora

Can the urethra be easily visualized?

Not always dt tissue estronization from maternal hormones

also look for clitoris and check for voiding

What are you looking for when palpating labia, inguinal, and suprapubic area?

masses / hernias

What are you looking for when assessing female perineum?


No dimples/fistulas

Full term (wide as fingertip at least)

Urethral and anal orifices


thick avascular membrane with central orifice, tag is common (tag typically involutes)


Vagina is obstructed, incise the area