Exam 4 Notes Essay

Submitted By privatescrub50
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Assessment of the abdomen
Subjective Data * Appetite – anorexia: lack of eating * Dysphagia: difficulty swallowing * Foot intolerance – pyrosis: heart burn eructation: belching * Pain: question if sudden * N/V * Bowel habits: (color, consistency, frequency) * Past abdominal history: ulcers, hx of hepatitis, gb prob, C-diff * Medications: (history of antacid abuse) and smoking: irritating to lining of esoph and stomach * Nutritional assessment: diet, what they eat, how much, how many meals
Referred Abdominal Pain – Pain perceived from one area distant from point of origin

Types of Abdominal Pain – also pain travels via nerve roots * Pain from Organs (Hollow Viscera) * Crampy/paroximal (sporadic comes and goes) * Often poorly localized * Related to peristalsis * Patient writhing on exam table (twisting, moving back and forth) * Pain from the Lining (peritoneum) serous membrane lines entire abd wall of body * Steady/constant * Often localized * Patient lies still with knees up
Pain radiating to back * Perforated ulcer * Bilary colic – spasm in bile tract-gb * Renal colic – spasm in kidney – caused by stone in kidney or ureter * Dysmenorrhea/labor * Renal colic (groin) – stone in bladder
Acute Appendicitis – age 10-30 common age/can be fatal in adults if rupture * Diffuse periumbilical pain/anorexia early – pain around belly button, don’t want to eat * Pain localizes to RLQ as peritonitis develops – inflammation of lining of peritoneal wall * Low grade fever, N/V may not be present * X-rays and labs (WBC will be ck and ck again to see if rises) are often negative
Acute cholecystitis –90% stones, 10% tumors. stone stuck in bile duct, sclera could be yellow * Localized or diffuse RUQ pain * Radiation to right scapula * Vomiting (green bile) and constipation (clay stools) * Low grade fever
Acute Renal Colic – kidney stone – genetic – 20-30 yr/old more common in men * Severe flank pain – posterior portion b/w side and back * Radiation to groin * Vomiting and urinary symptoms * Blood in urine
Preparation
* Have patient void before exam (bladder may be in way and muscles could be tight) * Elevate the bed for you * Patient should be supine w/pillow under head * Drape the patient so only abdomen is exposed * Palpate painful are LAST otherwise could make whole abdomen painful RUQ RLQ * Liver Appendix * Gallbladder Cecum * Hepatic flexure of colon Right ovary * Right kidney Fallopian tube * Right adrenal gland Right spermatic cord * Duodenum Right ureter * Head of pancreas
LUQ LLQ * Stomach Left ovary * Spleen Left fallopian tube * Body of pancreatic Left spermatic cord * Left kidney/adrenal gland Left ureter * Left Splenic flexure/colon Sigmoid colon

Midline * Urethra * Bladder
Assessment techniques – Must do in this order * Inspection * Auscultation * Percussion * Palpation (if palpate first then causes thing to move around and changes sounds
Inspection
* Observe Contour – rounded, flat, distended, round, scaphoid (hollow out/sunken in), enlarged, protruding, pendulous (hangs down and swings freely, excess abd hangs over groin) * Symmetry – Symmetrical, asymmetrical (one side look like other side) * Surface motion - No movement, bounding, peristalsis, bounding pulsations (can see in aorta) * Appearance of skin - Scars, Striae (stretch marks), hernias, vascular changes, lesions, or rashes, umbilicus (turned out ie pregnant, or sunken in due to obesity) * Attachments – tubes, dressings, drain, intestinal and urinary diversions
Abdominal Distention – 7 F’s * Fat (obesity) * Fetus (pregnancy) * Fluid (ascites…