Flashcards
Abdominal Assessment
Cards in this deck (40)
- 1 Right Upper Quadrant (RUQ)liver, gallbladder, duodenum, right kidney and hepatic flexure of colon
- 2Right Lower Quadrant (RLQ)cecum, appendix (in case of female, right ovary & tube)
- 3Left Lower Quadrant (LLQ)sigmoid colon (in case of female, left ovary & tube)
- 4Left Upper Quadrant (LUQ)stomach, spleen, left kidney, pancreas (tail), splenic flexure of colon
- 5Epigastric Areastomach, pancreas (head and body), aorta
- 6Inspect all 5 abdominal regionsskin (pallor, scars, striae, dilated veins, rashes and lesions),abdominal contour,masses,enlarged organs,symmetry
visible peristalsis,hydration,
pulsations - 7AuscultateEpigastric Area
Note: Bowel sounds
Renal artery bruits right & left of epigastrum (especially in patients with hypertension)
Aortic bruits in the midline - 8Percuss all 5 abdominal areasTympany,Dullness.RUQ – Height of liver along mid clavicular line. You will need to percuss the liver edges from above and below. Should be noted in centimeters. There are not solid structures on the left side of the abdomen. If you find dullness to percussion on the left side, think about abnormalities, such as an enlarged spleen.
- 9Palpate all 5 abdominal areas – begin in quadrant furthest from primary complaintNote: Tenderness (deep, superficial,rebound)
Masses
Organomegaly
Rigidity - 10Palpate all 5 abdominal areas 2Ask patient to inhale in order to palpate lower edge of both liver and spleen as each organ descends.
- 11Palpate all 5 abdominal areas 3Please note the following:
A normal kidney is not palpable
A normal liver edge may be palpable
A palpable spleen is considered enlarged
The aorta may be palpable. If it is wide, think about an abdominal aortic aneurysm - 12The exam technique sequence is as follows:Inspection
Auscultation
Percussion
Palpation - 13Begin assessment at patient’s right and proceed to examine all 5 abdominal regions:RUQ LLQ
RLQ Epigastric area
LUQ - 14What could it be 1Gastroenteritis-Bewareinelderly
• UTI • Constipation
• Biliarycolic • Renalcolic
• Pyelenephritis
• Irritable bowel syndrome
• Diverticulitis • Haemorrhoids
• Mesenteric adenitis- young children age 6-11 - 15RED FLAG 1Appendicitis
• Peptic ulcer disease- GI bleed
• Abdominal aneurysm
• Strangulated hernia
• Torsion testes/Ruptured Ovarian cyst
• Bowel Obstruction• Malignancy - 16RED FLAG 2Pancreatitis • Diabetic Ketoacidosis
• AGE
• Older- mesenteric ischaemia/emboli, perforation-GI bleed
• Infant: volvulus, Child-intersussception - 17History of the S&S 1Pain OPQRST) • Onset
• Palliative and precipitating (aggravating) factors- progression of pain i.e poorly localised to sharp & better localised beware involvement parietal peritoneum• Quality, Location,• Radiation (e.g. back, shoulder, groin)• Sudden or gradual,Severity,any similar episodes
• Symptoms associated e.g. melaena, urinary, dyspnoea, chest pain, fever, chills, sweating• Timing - 18History of S&S 2AMPLE
• Allergies
• PMH: Diabetes, AF, CHD, previous abdominal surgery
• Medication: NSAIDS, corticosteroids, anticoagulants
• Last ate
• Fever & chills
• D&V - 19History of S&S 3Rectal bleeding
• Weight loss
• Associated bowel or urinary symptoms - 20History of S&S 4Menstrual History in females - (i) Missed period- ectopic pregnancy
(ii) Mid of period-ovulation pain (Mittel- schmerz), (iii) With heavy periods- endometriosis - 21DRUG HISTORYCorticosteroids – mask pain
• Anticoagulants – can lead to an intramural haematoma of the gut causing obstruction
• Oral Contraceptives - rupture of hepatic adenomas
• NSAIDs - erosive gastritis & peptic ulcers - 22examAnxious Patient lying motionless: (i) Acute appendicitis (ii) Peritonitis
b. Rolling in bed & restless: (i) Ureteric Colic
(ii) Intestinal colic
c. Writhing in Pain: Not always in elderly Mesenteric Ischemia - 23exam2d. Bending Forward: Chronic Pancreatitis
e. Jaundiced:
CBD obstruction f. Dehydrated
(i) Peritonitis
(ii) Small Bowel obstruction - 24Exam 4Low grade temp. is seen with - Appendicitis
- Acute cholecystitis
High grade temp. is seen with
- Salpingitis - Abscess - 25exam 5Very High Grade Temp.with increasing lethargy seen in imminent septic shock
- Peritonitis
- Acute cholangitis - Pyonephrosis - 26Systemic ExaminationInspection
- Scaphoid or flat in peptic ulcer
- Distended in ascites or intestinal obstruction- Visible peristalsis in a thin or malnourished patient (with obstruction)
• NB hard enlarged left supraclavicular nodes= troisiers sign=gastric CA - 27Systemic ExaminationErythema or discolouration
a. Peri-umbilical - Cullen sign
b. Inguinal,Fox sign
c. Flanks - Grey Turner sign
Seen in Hemorrhagic pancreatitis
or any other cause of haemoperitoneum - 28Systemic ExaminationAny Visible masses
Any visible cough impulse at hernia site - 29Percussion & auscultationDo first so as to identify changes re percussion note can alter on movement when palpate • Bowel sounds-
• Borborygmi- increased peristalsis ,vigorous load noises- IBS - 30Percussion & auscultationNone- adynamic ileus or advanced bowel obstruction
• High pitched- early bowel obstruction
• tinkling- just prior to bowel obstruction - 31Systemic Examination PalpationBe gentle
• Start away from site of pathology then towards
• Check for Hernia sites
• Tenderness
• Rebound tenderness - 32Systemic Examination PalpationRebound tenderness
• Guarding- involuntary spasm of muscles during palpation
• Rigidity- when abdominal muscles are tense & board-like. Indicates peritonitis. - 33Medico Legal pitfallsRelying on classical presentation descriptions when diagnosing acute abdomen.• Relying on presence of leukocytosis or fever as sign infection
• Diagnosing gastroenteritis or constipation
• Allow patient to be admitted to wrong service e.g. medical when surgical diagnosis - 34Assessment FindingsRovsing- press on left lower quadrant,pain on right lowerquadrant (McBuneys point) intensified.
• Cullen/Grey Turner/- echymosis
• Murphy sign: Abrupt cessation of inspiration when palpate right hypochondrium( gall bladder) - 35Assessment FindingsMarkle (Heel jar)- stand with straightened knees, raise to tip toe, relax put heels back to floor- pain if peritoneal irritation/appendicitis
• Romberg-Howship- Pain down medial aspect of thigh to knee or down leg (Strangulated obturator hernia caused by nerve compression) - 36the psoas sign is an indicator of irritation to the iliopsoas group of hip flexors in the abdomen. Passively extend the thigh of a patient with knees extended. In other words, the patient is positioned on
his/her left side, and the right leg is extended behind the patient. If pain in abdomen-positive psoas sign.
Because the right iliopsoas muscle lies under the appendix when the patient is supine, a "positive psoas sign" may suggest appendicitis. - 37Abdominal
- 38Red flags that raise suspicion of serious pathologyHypotension.Confusion/impaired consciousness.Signs of shock.
Systemically unwell/septic-looking.
Signs of dehydration.Rigid abdomen.
Patient lying very still or writhing.
Absent or altered bowel sounds.
Associated testicular pathology.
Marked involuntary guarding/rebound tenderness.Tenderness to percussion.
History of haematemesis/melaena or evidence of latter on examination per rectum (PR).Suspicion of a medical cause for abdominal pain. - 39Major causes 1Acute cholecystitis.
Acute appendicitis or Meckel's diverticulitis.
Acute pancreatitis.
Ectopic pregnancy.Diverticulitis.
Peptic ulcer disease. Pelvic inflammatory disease.
Intestinal obstruction, including paralytic ileus (adynamic obstruction). - 40Major causes 2Gastroenteritis.
Acute intestinal ischaemia/infarction or vasculitis.
Gastrointestinal (GI) haemorrhage.
Renal colic or renal tract pain.
Acute urinary retention.
Abdominal aortic aneurysm.
Testicular torsion.Non-surgical disease - eg, myocardial infarction, pericarditis, pneumonia, sickle cell crisis, hepatitis,inflammatory bowel disease, opiatewithdrawal, typhoid, acute intermittentporphyria, HIV-associatedlymphadenopathy or enteritis
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- Flashcards on Abdominal Assessment, created by frenchfry99 on 24/03/2015.
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- frenchfry99 · Mar 2015
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- Feb 4, 2018
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