問題一覧
1
Clinical Manifestations
> Abdominal pain/tenderness > Diarrhea > Constipation > Nausea/Vomiting > Bloody stool/vomitus > Bloating/distention
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Ask Client about History of Pre-Existina GI Conditions
> Gl conditions > Past surgery > Family History
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inspect Abdomen for Skin Integrity (Normal______)
Pale skin tone
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inspect Abdomen for Skin Integrity ASSESS FOR
> Discoloration > Contour, symmetry > Vascularity, striae > Pulsation > Visible peristalsis
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Flat, evenly rounded, symmetric
Normal
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Cachexia, wt loss, starvation, terminal illness, cancer
Sunken (Scaphoid)
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flat, feces, fetus/pregnancy, fluid, flatulence, fibroids, mass, cyst, tumor
Abdominal distention
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organ enlargement, large mass, bowel obstruction
Assymetric
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Normal: Pale, pinkish skin tone, @midline
Inspect Umbilicus
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Deviated laterally > Abdominal pressure > Mass, fluid, hernia > Organ enlargement
Inspect Umbilicus
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1. Yellowish discoloration (bilirubin) 2. skin, eyes, mucuos memb., palms, sole 3. liver diseases, gall bladder disorder
JAUNDICE
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1. ecchymosis, bluish to purplish discoloration, bruising on the flanks 2. pancreatitis, internal hemorrhage, abdominal bleeding, abdominal trauma
GREY TURNER SIGN
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Characteristics- Taut skin, rounded and bulging abdomen Other signs- (+) fluid wave, shifting dullness Cause- Fluid accumulation, build up in abdomen Clinical Indication- liver cirrhosis, heart failure
ASCITES
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Characteristics- Stretch marks
STRIAE
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pregnancy, weight gain, obesity, ascites
Old silvery white
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Cushing syndrome
Pink/Dark blue
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Observe Vascular Pattern, Peristalsis, Pulsation - Slight pulsation in epigastrium
Normal
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- Intestinal obstruction
Increase/Visible Peristalsis
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- abdominal aortic aneurysm
Wide exaggerated bounding pulsating mass
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- normally, visible and scattered fine veins.
Normal
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- liver cirrhosis, carcinoma, ascites, portal hypertension
Dilated veins (Caput medusae)
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- liver cirrhosis, portal hypertension
Spider angioma
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Auscultate for Bowel Sounds - 5-30 clicks/gurgles per minute
NORMAL
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- growling sound, Increase bowel motility, diarrhea, gastroenteritis, early BO
Hyperactive (Borborygmic)
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- Decrease bowel motility, late BO
Hypoactive
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- No bowel motility, paralytic ileus, peritonitis
Absent
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Auscultate for Abnormal Bowel Sounds - bowel obstruction
Tinkling
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- splenic infection, infarction, abscess, tumor
Rub (left lower costal)
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- hepatic abscess, metastasis
Rub (right lower costal)
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- murmur, arterial occlusion, renal artery stenosis, aneurysm
Bruit
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- collateral circulation, portal hypertension, liver cirrhosis
Venous hum (epigastric)
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PERCUSS THE ABDOMEN Begins - ________
LLQ, RLQ, RUQ, LUQ ((ends)
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- air in abdomen
Tympany
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- decrease tympanic sound Liver, spleen, organ enlargement, mass, ascites, bladder distention
Dullness
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- increase tympanic sound, gaseous abdominal distention
Hyperresonance
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PERCUSS THE LIVER - 6-12 cm (Midclavicular line), 4-8 cm (Midsternal line)
Normal liver span
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- liver atrophy
Decrease liver span
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- hepatomegaly, tumor, cirrhosis and abscess
Increased liver span
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PALPATE ABDOMEN - LLQ, LUQ, RUQ, RLQ ((ends)
Begins
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- relaxed, smooth, soft, even, nonrigid, nontender, no abdominal guarding
Light palpation (1 cm)
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- no tenderness, nontender, no palpable mass
Deep palpation (Bimanual)
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- nodules, firm, hard,
Abnormal
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A positive ________ is when significant pain is elicited by palpating this area in the RLQ. This could mean appendicitis.
McBurney's Sign
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- a.k.a. rebound tenderness - Pain upon removal of pressure rather than application of pressure to the abdomen - Peritonitis and/ or appendicitis
BLUMBERG'S SIGN
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is when there is brief worsening of pain after releasing pressure while palpating This indicates possible peritonitis,
REBOUND TENDERNESS
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Pain elicited in RLQ Suggestive of acute appendicitis
Rovsing's Sign
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P.E
Ans.