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What are the names when diving the abdomen into nine sections?
What abt when dividing it into 4 sections?
- Epigastric, Umbilical, hypogastric/suprepubic
- Right and left Upper quadrant, and Right and Left lower quadrant.
Where are the following organs locater? quadrant and region?
- Appendix: Right Lower Quadrant -- Hypogastric
- Colon: ALL -- Unbelical (large part of it)
- Gallbladder: RUQ -- Epigastric
- Liver: RUQ -- Epigastric
- Pancreas: RUQ -- Epigastric
- Small intestine: RUQ & LUQ -- umbilical
- Spleen: LUQ -- Epigastric
- Stomach: LUQ -- Epigastric
what is a sign which confirms the presence of peritonitis (inflammation of the peritoneum) is?
What is the preferred order for examination of the abdomen?
Inspection, auscultation, percussion, palpation.
When auscultating the abdomen, you would ...?
Use the diaphragm for high-pitched bowel sounds and the bell for low-pitched vascular sounds.
What are normal clicks and gurgles when auscultating a pt? What is hyperactive? hypoactive? or absent?
What could they mean?
- Normal: A gurgles every 2-10 secs
- Hyperactive: Less than 2-10 secs gastroenteritis, early obstruction, hunger.
- Hypoactive: more than 10 sec, Peritonitis or paralytic ileum.
- Absent: Inability to hear any sounds after 5 minutes of continuous listening.
What is Borborygmi?
Very loud, stomach growling (hunger sounds)
The predominant percussion sound over the abdomen is?
Tympany (air-hallow organs)
Where would you find Tympanic percussion sounds in the body? Resonance? Dullness?
- Tympany: musical note, higher pitch, hollow, over air-filled viscera (whole abdomen pretty much)
- Hyperressonance: pitch b/t tympany and resoncance, base of lungs gaseous distention of bowel.
- Resonance: Sustained note of moderate pitch, over (air) lung and sometimes stomach.
- Dullness: short, high pitched, over solid organs, distended bladder, mass (organs, mass, something solid)
How can you determine the border of the liver? what about the top border?
How do you palpate for the liver?
- Percussess up the right midclavicular line until impanel changes to dullness.
- Same for the top but starting from top.
- 3 ways to palpate for liver.
- A: fingers are extended, with tips on right midclaviculine below the dullness and pointing to the head.
- B: Fingers parallel to the costal margin. hands in like a duck position.
- C: Hook your fingers over the right costal margin below the border of liver dullness.
What is Meconium? What could be problematic?
- First stool in new borns.
- If meconium doesn't happen in the first 24 hrs, Consider CF (cystic fibrosis) or hirschsprung's disease.
What is Visceral, Parietal, and referred pain?
- Visceral: When hollow organs (stomach, colon) forcefully contact/become distanced. Gnawing, cramping, or aching and difficult to localize (hepatitis)
- Parietal: Inflammation from hollow or solid organs and affect the parental peritoneum. More severe and easily localized (appendicitis)
- Referred pain: Originates at different sites but shares innervation from the same spinal level (gallbladder pain in the shoulder).
Common characteristics in children when doing an abdominal examination?
- Spleen is active in blood formation for the 1st yr, and then function as lymphatic organ for immunological response.
- Umbilical cord falls off within 2 weeks.
- Umbilical hernias - Most disappear by 1 yr and nearly 5 yrs.
- Liver takes up more space in the abdomen compared with later in life.
What is Hirschsprung disease? Celiac disease?
- Hirschsprung: Blockage of the large intestine due to improper muscle movement in the bowel.
- Celiac: Malabsorption in the small intestine.
What does a bruit suggests when auscultating?
- It suggests vascular occlusive disease.
- When found in an area that has the two, systolic and diastolic components, suggests renal arterial stenosis/artheriosclerotic arterial disease as the cause of HTN.
What is the murphy's sign?
- Inflamed gallbladder.
- Palpate lower liver and then have pt take a deep breath, + when pt has a sharp pain at inspiration.
- Normal or - when no pain.
What are Ascites?
- Pathologic increase in fluid in the peritoneal cavity, usually due to liver issues.
- Dullnes and resonance, shifting dullness, fluid wave.
What is the McBurney's pt test? what is it used for?
Rebound tenderness, for appendicitis.
What is Rovsing-Markel-heel jar?
On toes, pain when heel hits floor.
What is the iliopsoas muscle test?
- Raise the R leg, fleeing at the hip, while u push downward.
- Flexion of the hip causes contraction of the posts muscle.
- Performed when u suspect appendicitis.
- + posts sign= pain.
Obturator Muscle test?
- Right leg reflex 90 degrees
- grasp the ankle, rotate the leg laterally and medially.
- Pain in the right hypogastric region is a + sign.
- Performed when u suspect a ruptured appendix or a pelvic abcess.