Abdomen HA Exam #4

has it changed
over what time period
significant weight change

difficulty swallowing -> how long has it been happening
neuro trauma, obstruction
infection -> strep throat, thrush

gluten allergies and intolerance
pork intolerance
lactose intolerance
could be gas and bloating or anaphylaxis

emesis
how much, how often, what are you throwing up, describe

how often -> is it typical for them
need to know color and consistency
rock pebbles = constipation

history peptic ulcer disease
history of constipation
hernia
ulcers

NSAIDS eat at the lining of stomach
Alcohol and Smoking increase risk of peptic ulcer disease and H. pylori

condiments, sauces, and drinks

Empty bladder
Lighting and draping
Proper draping -> only expose area assessing

Stethoscope
Measuring tape

Inspection
Auscultation
Percussion
Palpation

prevent from affecting bowel sounds
prevent from causing abdominal pain in areas that are tender

STUDY QUDRANTS

dips in
malnourished

Rounded and Protuberant

right vs left
masses
hernia
scars

everted -> protruding out that happens with ascites and distended

bluish color of the umbilicus
can represent a bleed

note scars
striae -> stretch marks
silvery white = old
pinkish blue = fresh/new
^ tend to fade

thin person can see laying supine
larger person can see could be aortic aneurysm or hypertension

males = diamond
females = upside down triangle

normal -> relaxed, supine
abnormal -> curled up

Patient that could have underlying issues
Mark where you measure for consistency with measuring

Bowel sounds -- all 4 quadrants
5-30/minute
Gurgling
Irregular
Diaphragm
Light Pressure
BEGIN IN RLQ

loud, rushing, tingling sounds
indicate increased motility
more loose bowel movements

stomach growling like when hungry
fairly common

hypoactive or absent (silent abdomen)
listen at least 5 minutes and you can't hear anything before deciding they are absent
usually after abdominal surgery

Vascular sounds (bruits) in areas of blood vessels
Note location, pitch and timing
Use bell with firm pressure in 7 areas
listen for pulsation and absence of bruit

aorta
left renal artery
iliac artery
femoral artery
listen bilaterally

abdominal aortic aneurysm

All 4 quadrant
Using defined pattern
Same technique as thorax
*Normal--tympany*

Right MCL
percuss from lung resonance down to sound changes to dull sound (upper)
percuss from tympany (abdomen) to sound changes to dull sound (lower)
Measure Distance

6 to 12 cm
Mean 10.5 = males
Mean 7 cm = females

Costovertebral angle

Indirect fist percussion
Place hand: 12th rib, costovertebral angle
Thump hand with ulnar edge of other first

feel thud, no pain

sharp pain with inflammation of kidney
kidney infection

Use first four fingers close together
Depress skin about 1 cm
Gentle rotary motion
Overall impression of skin surface and superficial musculature

Resistance of very large or obese abdomen
Bimanual technique
Avoid deep palpation in area where felt pain during light palpation

no pain

Location
Size (measure lateral by vertical)
Shape
Consistency: soft, firm, hard
Surface: smooth, nodular
Mobility: including movement with respirations
Pulsatility
Tenderness

RUQ
Place left hand under back (11-12th rib) -> hook fingers under rib while they take a deep breath
Right hand on RUQ
Push deeply
Ask patient to take deep breath

feel firm edge of liver hit your fingers as diaphragm pushes it down during inhalation
or **not palpable**

Ask patient to take deep breath
Can you feel firm edge of liver
**Varies by patient**

Left hand behind left side (11-12th rib)
Place right hand just inferior to rib margin
Push deeply down and under left costal margin
Ask patient to take a deep breath

Not palpable
enlarged 3x normal size to be palpated = splenomegaly

Place hands together and press together
Ask patient to take deep breath
May feel lower pole of kid or *not palpable*

1 cm higher than right kidney
Ask patient to take deep breath in
Normal: not palpable

Palpate upper abdomen slightly to left of midline
Normal: 2.5 to 4 cm wide in adult; pulsates in anterior direction (out to front of belly)

Blumberg's sign
peritoneal inflammation
appendicitis

Abdominal pain or elicit tenderness during palpation
Push hand down slowly and deeply
Then, life up quickly (happens when lift hand NOT when pressing)
Pain on release of pressure-rebound tenderness (peritoneal irritation)

McBurney Point Tenderness
Iliopsoas Muscle Test
Obturator Test

Murphy's Sign

between belly button and pelvic bone
pain = sign of appendicitis

lay down lift right leg and push on right knee
positive appendicitis test

less specific
bending at knee and turing inward

tenderness right upper quadrant