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what is total absence of bowel sounds a sign of
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PDX Abdomen
PDX Abdomen for exam 3
| Question | Answer |
|---|---|
| what is total absence of bowel sounds a sign of | intra abdominal emergency |
| how long must you listen to bowel sounds for | 2-5 minutes |
| peritonitis | inflammation of the peritoneum lining the abdominal wall and covering the abdominal organs |
| adynamic ileus | "as silent as the grave" - failure of passage of enteric contents thru small bowel and colon; paralysis of intestinal motility |
| ascites | excessive fluid within the abdomen. could be a sign of liver disease or cirrhosis |
| ballottement | palpation technique used to evaluate a structure that is floating by bouncing it gently and feeling it rebound |
| borborygmi | prolonged, audible abdominal sounds produced by gas moving thru the intestines. hyper peristalsis or stomach growling |
| calculi | stones or solid lumps such as gallstones or kidney stones |
| colic | attacks of abdominal pain, caused by muscle spasms in the intestines. |
| constipation | diagnosed if pt has 2 or more of following symptoms over course of 3 mos: straining during a bowel mvmnt more than 25% of the time; hard stools more than 25% of the time; incomplete evacuation more than 25% of the time; two or fewer bowel mvmnts in a week |
| possible causes of constipation | poor diet, dehydration, hypothyroidism, IBS, depression, colon cancer, overuse of laxatives |
| dyspepsia | indigestion - symptoms include heartburn, nausea, bloating and gas |
| dysphagia | problems swallowing food or liquids. usually caused by blockage or injury to esophagus |
| encopresis | accidental passage of bowels |
| hematemesis | vomiting of blood. comes from GI tract, not lung. redder it is, the fresher. usual causes are bleeding problems of the esophagus and stomach. |
| coffee ground emesis (type of hematemesis) | blood that has mixed with acid is dark and clumped |
| high pitched bowel sounds | may be a sign of early bowel obstruction |
| hypoactive bowel sounds | reduction in loudness, tone, or regularity of the sounds indicates intestinal activity has slowed. NL during sleep. often caused by meds. following abdominal surgery. often indicates constipation |
| hyperactive bowel sounds | seen in acute obstruction: hernia, diarrhea, early obstruction - high pitched. also seen in hyperactive intestinal peristalsis |
| melena | passage of dark-colored, tarry stools. due to the presence of blood altered by the intestinal juices |
| peristalsis | a wavelike mvmnt of mm in the GI tract. moves food and liquid thru the GI tract |
| puritis | itching. occurs with incr bilirubin. may occur before jaundice. |
| reflux | condition that occurs when gastric juices or small amounts of food from the stomach flow back into the esophagus and mouth. aka: regurgitation |
| steatorrhea | yellow, fatty stools. caused by malabsorption syndrome. fat malabsorption is the most obvious. stools are frequent, fatty (yellow), foul smelling, flushing resistant |
| tenesmus | straining to have a bowel mvmnt. may be painful and continue for a long time without a bowel mvmnt occurring. |
| varices | stretched veins such esophageal varices from cirrhosis |
| xerostomia | dry mouth. caused by or associated with RA, diabetes, kidney failure, HIV, meds, radiation tx for mouth or throat CA |
| regions of the abdomen | if divided into 9: epigastric is upper region, umbilical is middle region, and hypogastric or suprapubic is lower region. otherwise just the 4 quadrants |
| what organs are in the RUQ | liver, gallbladder, duodenum, R kidney and adrenal, hepatic flexure of colon, head of pancreas, ascending and transverse colon |
| what organs are in the LUQ | stomach, spleen, liver, body of pancreas, L kidney and adrenal, hepatic flexure of the colon, transverse and descending colon |
| what organs are in the RLQ | cecum, appendix, R ovary, R spermatic cord, R ureter |
| what organs are in the LLQ | descending colon, sigmoid colon, L ovary, L spermatic cord, L ureter |
| what are two important differences that must take place for an abdominal exam | auscultation must be performed prior to palpation. pt must also have an empty bladder prior to the start of the exam. |
| causes of distention of the abdomen | fluid, fat, feces, flatus, fatal growth, fetus |
| scaphoid abdomen | severe weight loss, seen with debilitating disease |
| venous distention in abdominal area | occurs with blockage of blood flow from SVC, IVC or hepatic portal vein |
| for auscultation of the abdominal area, what do you use the diaphragm for | the 4 quadrants. listen for borborygmi, incr or decr bowel sounds |
| for auscultation of the abdominal area, what do you use the bell for | abdominal aorta, renal aa, common iliac aa, femoral aa. listen for any bruits. also listen to the liver and spleen for any friction rubs |
| name the order of abdominal palpation | light palpation of all 4 quadrants starting w the quad farthest from the pain. deep palpation of all 4 quads. aortic pulse. McBurney's point. kidney. spleen. Murphy's sign. rebound tenderness. ascites. |
| McBurney's point | between the umbilicus and ASIS and corresponds with where the appendix is. |
| Murphy's sign | performed by asking patient to breathe out and gently place hand below costal margin on right side at mid-clavicular line (approx location of gallbladder). pt is then instructed to inspire. pos if pain and stops inspiring - cholecystitis |
| what are some common misdiagnosed tumors of the abdomen | pregnant tumors, sacral promontory, feces in sigmoid colon, floating rib cartilage |
| what is the flick the flank test, or puddle sign, used for | to determine dull percussion of ascites |
| normal liver findings | inspection: can't see. auscultation: silent. percussion: 6-12cm of dullness at midclavicular line, down 2cm w inspiration. palpation: occasionally palpable in a healthy person |
| findings of enlarged liver | inspection: can possibly see. auscultation: venous hum may occur if there's incr superficial collateral blood flow. percussion: incr span. palpation: enlarged w right heart failure, enlarged & tender w hepatitis, nodular & maybe non tender in liver CA |
| liver cancer findings | insp: nl or may be enlarged and seen. ausc: hepatic bruit and friction rubs. percuss: incr span. palp: enlarged w R heart failure. enlarged & tender w hepatitis. nodular & maybe non tender in liver carcinoma |
| what could be the causes of a hypomobile liver | pneumonia - pus filled lung - empyema. painful problem below the diaphragm (gallbladder). phrenic nerve related problems |
| what is considered a hypomobile liver | liver movement of less than 2cm on inspiration. liver is moved by the diaphragm |
| normal appendix findings | insp: no abnormal findings. ausc: nl bowel sounds, no friction, no ribs, no bruit. percuss: no percussive change (resonant). palp: no placatory discomfort (neg McBurney's, rebound tenderness, Rosvings. special: neg posts and obturator |
| acute appendicitis | insp: sick pt, antalgia, possible air accumulation (distention). ausc: bowel sound may be nl or reduced (adynamic ileus). percuss: may be too tympanic if air accumulation. palp: tenderness in RLQ at McBurney's - often the pain of maximal tenderness |
| additional maneuvers for acute appendicitis | Rovsings - pain in RLQ w pressure in LLQ. rebound tenderness - pain at McBurney's w sudden pressure withdrawal locally (elsewhere in the abdomen). passively stretch psoas: would cause pain in area (& not just a stretch pain) |
| additional maneuvers for acute appendicitis: obturator sign | passive knee and hip flexion with external rotation - a localizing peritoneal sign - pain at McBurney's point |
| irritable bowel syndrome | lg intestine is not damaged but has a functional problem. symptoms: chronic, cramping, abdominal pain, abdominal bloating, gas, diarrhea, constipation, mucus in stool. exam findings vary depending upon type |
| risk factors of irritable bowel syndrome | female, family history and less than 45 yo |
| triggers of irritable bowel syndrome | foods, stress, hormones, gastroenteritis - general term for stomach ache |
| ulcerative colitis | an inflammatory bowel disease in which the rectum and or colon develop ulcers. unknown cause - maybe hereditary or immune compromise. |
| symptoms of ulcerative colitis | abdominal pain, diarrhea w blood or puss, rectal bleeding, anemia, fatigue, weight loss, loss of appetite. |
| physical exam of ulcerative colitis | obs: finger clubbing unrelated to cardiovascular. ausc: nl bowel sounds but hyperactive bowel sounds when active. percuss: may be more resonant. palp: rigidity noted over the abdomen & may be painless or painful. |
| special tests for ulcerative colitis | pos rebound tenderness and pos Rovsings - push on L abdomen and pain on R where appendix is and vice versa |
| active Crohns disease | type of irritable bowel disease that causes inflammation of intestinal lining. MC effects ileum and colon. |
| risk factors of crohns disease | family hx, immune compromise, less than 30 yo, NSAID use, smoking, poor diet, stress |
| ssx of crohns disease | diarrhea, fever, fatigue, abdominal pain and cramps, bloody stools, anorexia, weight loss, mouth sores |
| phys exam of crohns disease | obs: abdominal bloating, oral apthous ulcers. ausc: normal bowel sounds. percuss: resonance unless disease is caused by an underlying tumor. palp: diffuse abdominal tenderness, local pain over affected region; mass palpated bc of thickened/inflamed bowel |
| phys exam of peritoneum (appendicitis can be under this term also, but can also be separate) | insp: cannot see. ausc: cannot hear. percuss: cannot percuss. palp: cannot palpate, non tender |
| phys exam of peritonitis | insp: pt may have antalgia and have guarded mvmnts, if they move at all. ausc: friction rubs may occur. percuss: may cause dullness if peritoneal fluid accumulates. palp: severe mm guarding (boardlike rigidity) may accomany |
| phys exam of small intestines (1 of 2) | insp: NL - no distention, peristaltic activity is occasionally seen on very thin ppl. ausc: there is NL frequency and intensity of bowel sounds (5-30/min). they are high pitched sounds that incr after meals |
| phys exam of small intestines (2 of 2) | percuss: there's nl air in gut - so tympany predominates throughout the abdomen. palp: the soft squishy tubes are not nl palpable |
| phys exam of sm intestine obstruction | insp: distention. ausc: incr bowel sounds heard in early obstruction & hypoactive or silent later in obstruction. percuss: hyper-tympanic. palp: mm guarding and pain |
| small intestine bowel sounds | partial or early obstruction: hyperactive and loud. late partial or total obstruction: hypoactive. paralytic ileus: silent as the grave |
| phys exam of sigmoid colon | insp: nl cannot see. ausc: nl bowel sounds. percuss: tympanic to dull depending on sigmoid contents. palp: nl tender to palpate, feces may be palpable. |
| hernias | protrusion of the intestinal contents. more apparent with higher intra abdominal pressure (cough). occurs in areas of abdominal wall weakness. groin is MC. scars and umbilicus are also common. |
| phys exam of hernias | insp: bulge worse w incr intra-abdominal pressure (cough). ausc: bowel sounds may be incr early, or decr late. percuss: NONE! palp: bulge worse w incr intra abdominal pressure |
| phys exam of gallbladder | insp: none. ausc: nl bowel sounds, no friction rubs, no bruit. percuss: no percussive changes. palp: no palpatory discomfort. so shouldn't be able to feel, palpate, see nor hear it. |
| murphy's sign (of the gallbladder) | an inspiratory rest sign. a sign of an abnormally tender gallbladder. pt stops inspiration due to incr pain as they breath in. thumb/fingertip pressure is directed toward the gallbladder under the rib margin. very focal pain, no radiation |
| acute cholecystitis | occurs when bile becomes trapped in gallbladder. often happens bc gallstones block cystic duct leading to swelling and infection. |
| risk factors of cholecystitis | female (4:1), fertile, pregnancy, >40yo, obesity, flatulent |
| cholelithiasis | formation of calculi within the gallbladder. "lith" means "stone" |
| ssx of cholecystitis | sharp, cramping pain in RUQ lasting min of 30 min. midback pain or below R shoulder blade. clay-colored stools. fever, nausea & vomiting. yellowing of skin and whites of eyes (jaundice) |
| phys exam of cholecystitis | insp: nl to slight bloating. ausc: nl bowel sounds, no bruit or friction rubs. percuss: pain when percussing over R midclavicular line. palp: pain when palpating the liver. pos Murphy's sign |
| phys exam of stomach | normally cannot see. ausc: contributes to bowel sounds. percuss: very tympanic bc of gastric air bubble (magenblase) - typical size and location - NL <2" behind the lower ribs on the L |
| stomach GERD | when the cardiac sphincter allows stomach contents to reflux into esophagus causing irritation. |
| ssx of stomach GERD must happen 2x/week | heartburn - throat and chest burning. acidic taste in mouth. dry cough - clearing of throat - not a true cough. trouble swallowing. however, no outward observations, no ausculatory changes, no percussive changes, no palpatory changes. |
| peptic ulcers | breakdown in the lining of the stomach or duodenum. |
| risk factors of peptic ulcers | excessive alcohol. reg use of aspirin, ibuprofen, naproxen or other NSAIDs. smoking cigarettes or chewing tobacco. |
| ssx of peptic ulcers | upper abdominal pain. abdominal pain that wakes the pt at night. feeling of fullness. hunger w/in 1-3 hrs after eating. nausea decr after vomiting. bloody vomit. bloody stools (look black or tarry). fatigue. weight loss. |
| what happens if a peptic ulcer becomes too deep | it can bleed and then become infected and sometimes can be cancerous |
| phys exam of peptic ulcers | insp: nl. ausc: nl. percuss: nl. palp: may have burning tenderness in epigastrum, many false positives |
| phys exam of spleen | insp: nl can't see. ausc: nl no sound. percuss: nl dull at T8-T10 ribs post to midaxillary line. palp: nl not palpable - a palpable spleen is a red flag |
| phys exam of splenomegaly | insp: may see w deep inspiration. ausc: the spleen remains silent. percuss: area of dullness may expand ant inf as the spleen grows. palp: only becomes palpable if 3x nl size - NEVER squeeze bc it may rupture. |
| how do you palpate the spleen | bimanual w pt supine and or slightly on their left lateral side. use cephalad hand to lift up flank and caudal hand to press down on the area. |
| special spleen maneuver: splenic percussion sign | lowest rib interspace, anterior axillary line, should stay tympanic when pt breaths in. tap all the way down and it'll go from being very resonant to a very hollow sound as they're taking a breath in if positive |
| ruptured speen | MC if splenomegaly. causes acute blood loss. may irritate the left diaphragm. may cause elevation of the left testicle - Kerr's sign |
| what is Kerr's sign | when the spleen ruptures and it causes elevation of the left testicle |
| kidney phys exam | insp: nl can't see. ausc: nl the kidney and its vessels are silent. percuss: nl not tender to fist percussion (Murphy's punch). palp: occasionally the R kidney may be palpable on very thin ppl using bimanual deep palpation |
| heel-jar test | a special kidney maneuver - pt standing on toes and suddenly drops weight to their heels |
| fist percussion | a special kidney manuever - firm strike to the CVA of the involved side is abnormally tender compared to the nl side. indicates sensitivity of the caps - typically due to inflammation (kidney infection) or obstruction (hydronephrosis) |
| kidney enlargement phys exam | insp: may fill in the flank. ausc: no change. percuss: there may be incr sensitivity to fist percussion. palp: may become palpable |
| kidney stones - nephrolithiasis | MC stones consist of crystals made up of Ca oxalate or Ca phosphate |
| risk factors of kidney stones | dam history, 40+ yo, male, dehydration, diet - high protein, sugar and sodium; obesity, irritable bowel syndrome, chronic diarrhea |
| six of kidney stones | extreme back or flank pain - renal colic. groin or testicular pain. fever or chills. vomiting. blood in urine. cloudy urine. foul smelling urine. burning urination sensation |
| kidney stone phys exam | obs: no abnormal findings. ausc: hypoactive. percuss: painful kidney punch. palp: during early obstruction may be able to palpate an enlarged kidney (hydronephrotic). placatory tenderness, tenderness at the costovertebral angle |
| bacterial urinary tract infection (UTI) | UTIs occur when bacteria ascend the urethra to the bladder. if the bacteria ascends the ureter to the kidneys, it is called pyelonephritis |
| ssx of UTIs | incr urge and frequency of urination. burning sensation. cloudy urine. bloody urine. could smelling urine. pelvic pain. |
| phys exam of UTIs | obs: no abdominal findings. ausc: no alterations. percuss: no alterations (painful). palp: suprapubic tenderness or pain |
| arteries of the abdomen | abdominal aorta, renal aa, common iliac aa. normally no sounds are produced. abnormal arterial flow causes sounds to be produced - low pitched listened with the bell. |
| risk factors of abdominal aortic aneurysms | age 65+. smoking. male. genetics. |
| ssx of abdominal aortic aneurysms | severe abdominal or back pain. sweating. nausea, vomiting. dizziness, syncope - temp loss of consciousness caused by a fall in blood pressure. tachycardia - rapid, shallow heart rate. |
| veins of the abdomen | normally no sounds are produced. when too much blood flows thru the vv, a "hum" occurs. continuous low pitched sound. suggest incr venous blood flow. liver is commonly involved area. |
Created by:
bptotheeng