HPI questions for chief complaint of abdominal issue
○Abdominal pain-OLDCARTS
○When did the pain start?
○Where is the pain in your
... [Show More] stomach?
○Does the pain radiate to other locations?
○Have experience nausea/vomiting, indigestion or increase in belching.
○What medications have you used to treat your symptoms?
○Have you had any diarrhea or constipation?
○Do you have to use laxative frequently?
○What is your regular dietary habits?
inspection of abdomen
-Abdominal contour
-Symmetry
-Umbilicus
-Skin Color
-Vascularity
-Scars
-Striae
-Lesions or rashes
-Abdominal movement when breathing
-Aortic pulsation
-Have patient raise head while laying down and look for masses hernia or muscle separation
Abdominal assessment order
inspection, auscultation, percussion, palpation
Always auscultate prior to percussion and palpation as it can change sound.
Abdomen Auscultation
Bowel sounds in all four quadrants- note frequency and character
listen for friction rubs over liver and spleen
listen for bruits over the aortic, renal, illiac and femoral arteries
listen for venous hum around epigastric area above the belly button
Abdominal findings abdomen
○Bruits- A swishing sound heard over the aortic, renal iliac, and femoral arteries, indicating narrowing or aneurysm.
○Pop/Tinkles- High pitch sound suggesting intestinal fluid and air under pressure, as in early obstruction.
○Rushes- Rushes of high-pitched sounds that coincide with cramping suggests intestinal obstruction.
○Borborygmi- Increased prolonged gurgles occur with gastroenteritis, early intestinal obstruction, and hunger.
○Rubs- Grating sounds that vary with respiration. Indicate inflammation of the peritoneal surface of an organ from tumor, infection, or splenic infarct.
○Venous Hum- A soft humming noise often heard in hepatic cirrhosis that is caused by increased collateral circulation between portal and systemic venous system.
○Succussion splash- A splashing noise produced by shaking the body when there is both gas and fluid in a cavity or free air in the peritoneum or thorax.
○Decreased/absent bowel sounds- Occurs with peritonitis or paralytic ileus.
How to percuss to estimate the liver span
o First, determine the lower border of the liver by percussing up from an area of tympany along the right midclavicular line. Mark the point where tympany changes to dullness, which usually occurs at or slightly below the costal margin.
o Second, determine the upper border of the liver by percussing down from an area of resonance along the right midclavicular line. Mark the point where resonance changes to dullness, which usually is in the fifth intercostal space.
o Third, measure the distance between the marks. The vertical liver span usually ranges from 6 to 12 cm.
Blumberg Sign
Rebound tenderness, RLQ, appendicitis, peritoneal irritation
Cullen sign
ecchymosis around umbilicus
-hemoperitoneum, pancreatitis, ectopic pregnancy
Dance sign
Absence of bowel sounds, RLQ, intussusception, bowel obstruction
Grey Turner's sign
Ecchymosis of the flanks. Possible rupture of the spleen. Hemoperitoneum, pancreatitis, pain may radiate to the left shoulder
Kehr's sign
Abdominal pain radiated to the left shoulder, splenic rupture, renal calculi, ectopic pregnancy
Markle Sign (heel jar)
Tests for peritoneal irritation, appendicitis, jarring to the body. Stand with straight legs, then stand on your toes, then relax. Positive if this causes pain.
McBurney's sign
rebound tenderness to the epigastric area associated with appendicitis
Rovsing's sign
RLQ pain increases with LLQ pressure.
Appendicitis, peritoneal irritation
Obturator sign
pain in the lower abdomen or inside of thigh when the hip is flexed and internally rotated; a sign of appendicitis or abdominal abscess
The examiner observes venous return on the abdomen of the patient that moves upward from the pubis to the chest. This finding should make the examiner consider
inferior vena cava obstruction
Which of the following questions would help an examiner determine whether a patient has an intrabdominal infection?
A. Where is the pain?
B. Would you like something to eat?
C. What does your urine look like?
D. Is there a history of this problem in your family?
B.
Mrs. Cody is 36 weeks pregnant and states her stomach muscle feels like its splitting. A light protrusion of the abdomen midline is observed. This is recognized as
Diastasis Recti
diastasis recti
midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles
In which of the following patients would a slight pulsation of the epigastric area be considered a normal finding?
A. a very thin patient
B. an obese patient
C. a patient with ascites
D. an older patient
A.
The examiner palpates an organ in the left costal margin. Which technique should be used to differentiate between an enlarged left kidney and an enlarged spleen
Percussion, listening for dullness
A hiatal hernia is best described as
Meeting resistance while performing deep palpation
A history of chest pain is collected as part of an abdominal history because it may be...
Perceived as esophagus and stomach pain
you note that the midclavicular liver span of an adult male patient is 18 cm. With palpation you note that the liver is enlarged, hard, and nontender. What does this suggest?
Cirrhosis
The examiner is unable to palpate the liver or kidney on the patient. Which of the following techniques will help assess tenderness to these organs?
A. Direct, continuous firm pressure of the organ for several minutes
B. Percussion for tympany
c. Percussion for size
D. Indirect fist percussion
D.
In which age group is abdominal palpation easiest and most accurate?
A. young children
B. adolescents
c. young adults
D. older adults
D.
Which of the following techniques is used to confirm presence of abdominal ascites?
A. Auscultation of fluid movement in abdomen
B. palpation of rebound tenderness
c. palpation of pitting edema on the abdomen
D. Percussion of dullness over the dependent areas of the abdomen
D.
A 5-week-old male infant is brought to the clinic for 2-day history of projectile vomiting. For what specific finding should the examiner assess?
A. abdominal pain with palpation
b. palpation of small round mass
c. auscultation of tinkering bowel sounds
D. Auscultation of a bruit over renal artery
B.
Which of the following examination findings is indicative of peritoneal irritation or appendicitis?
A. Palpation of rebound tenderness
B. Percussion of shifting dullness over the abdomen
C. Auscultation of a bruit over the abdominal aorta
D. Percussion of dullness over the suprapubic area
A.
A 32-year-old female patient tells the examiner that when she goes running, she dribbles urine. Which type of problem should be considered?
A. Hydronephrosis
B. Renal abscess
C. Stress incontinence
D. Overflow incontinence
C.
A 61-year-old man has a presenting complaint of frequent constipation. He tells you there has been a change in his bowel movement habits - he gets constipated easily, the stool is very "skinny looking", and it is a different color than normal. What do these symptoms suggest?
A. Diverticulitis
B. Hepatitis B
C. Colon or rectal cancer
D. Pancreatitis
C.
The functional ability of the gastrointestinal tract most severely affected by aging is
A. motility
B. metabolism
c. digestion
d. catabolism
A.
Which rule states that the farther away from the navel abdominal pain occurs, the more likely it is to be of physical importance?
A. Reglan law
B. Apley rule
C. Applegate rule
D. Romberg rule
B.
An absence of bowel sounds in the right lower quadrant is referred to as the ________________ sign.
a. Cullen
b. Striae
c. Ballance
d. Dance
D.
Peritoneal irritation is associated with which of the follow?
A. Aaron
B. Balance
C. Blumberg
D. Dance
C.
Abdominal pain radiating to the left shoulder is indicative of which of the following?
A. Appendicitis
B. Intussusception
C. Pancreatitis
D. Splenic rupture
C.
Diverticulitis S/S
Acute onset of LLQ pain
Nausea and vomiting
Low grade fever
Chills
Tachycardia
ESR & WBC increased (sign of infection)
Hgb & Hct decreased [Show Less]