abdomen Flashcards
Abdominal wall divided into four quadrants
Right upper (RUQ)
Left upper (LUQ)
Right lower (RLQ)
Left lower (LLQ)
Layer of Abdomen
Skin
Subq
Muscle
Fascia
peritoneum
occurs when the parietal peritoneum becomes inflamed, as in appendicitis or peritonitis. This type of pain tends to localize more to the source and is characterized as a more severe and steady pain.
parietal pain
occurs at distant sites that are innervated at approximately the same levels as the disrupted abdominal organ. This type of pain travels, or refers, from the primary site and becomes highly localized at the distant site.
E.g. pancreatitis – pain felt in the shoulder
Referred pain
occurs when hollow abdominal organs, such as the intestines, become distended or contract forcefully or when the capsules of solid organs such as the liver and spleen are stretched. Poorly defined or localized and intermittently timed, this type of pain is often characterized as dull, aching, burning, cramping, or colicky
Visceral Pain
When did the pain begin?
Onset
Point to the area where you have the pain.
Location
How long the pain last- prolonged/intermittent
Duration
how bad the pain
Severity
when does the pain occur
pattern
pain associated with other symptoms
Associated factor
ACUTE or chronic gastric disorder—hyperacidity, gastroesophageal reflux(GERD) , peptic ulcer disease, stomach cancer
Indigestion
Often described as “feeling sick to my stomach,” may progress to retching and vomiting.
Triggered by any particular activities, events, or other factors ( smells, eating food, riding car,boat, strenous physical activities
Dietary intolerance, menstruation, pregnancy, psychological triggers
Motion – inner ear
nausea
describes involuntary spasm of the stomach, diaphragm, and esophagus that precedes and culminates in
Retching
the forceful expulsion of gastric contents out of the mouth.
Associated with impaired gastric motility or reflex mechanism
Description of vomitus(emesis) –clue of source
BRIGHT HEMATEMESIS- bleeding esophageal varices, ulcers in stomach or duodenum
DARK HEMATEMESIS- Intestine
Vomiting
general complaint often associated with digestive orders, chronic syndromes, cancers, and psychological disorders.
Carefully correlate appetite changes with dietary history and weight monitoring
Anorexia
A decrease in the frequency of bowel movement or the passage of hard and possibly painful stools.
-Signs and symptoms that accompany constipation may be a clue to the cause.
Constipation
Frequency of bowel movement producing unformed or liquid stool.
Diarrhea
not actually vomit but raise esophageal or gastric contents without nausea or retching, called
Regurgitation
Methods(in order)
IAperpal
a physical exam finding of ecchymoses, or bruising, around the umbilicus. This sign indicates either intraperitoneal or retroperitoneal hemorrhaging.
Cullen’s Sign
Classically, it is associated with severe acute pancreatitis but can be associated with a number of other conditions causing retroperitoneal bleeding such as ruptured abdominal aortic aneurysm.
Grey Turner’s Sign
6Fs major causes of abdominal distention
FATS ,FECES, FETUS,FIBROIDS, FLATULENCEAND FLUIDS
occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened area in theabdominalwall.Herniasare most common in theabdomen, but they can also appear in the upper thigh,bellybutton, and groin areas
Hernia
occurs when the bowel protrudes through the separation between the 2 rectus abdominis muscles
Appear only when the client raises the head or coughs.
-little significance
DIASTASIS RECTI
is thesoundthat gas makes as it moves through the intestines.
It’s often called “stomach growling” or “stomach rumbling.”
Borborygmi
are considered as one every three to five per minutes diminished bowel motility
HYPOACTIVE BOWEL SOUNDS
can sometimes be heard even without a stethoscope.Hyperactive bowel soundsmean there is an increase inintestinal activity. Thismayhappen with diarrhea,gastroenteritis, use of laxatives or after eating
INCREASED (HYPERACTIVE)bowel sounds
not normally heard but may be normal to some client – confined to systole
bruits
—whoosing sound
ANEURYSM OR RENAL ARTERIAL STENOSIS—
technique to ascertain the location and size of the liver and spleen
-useful if abdomen is rigid, distended, obese or too tender to palpate
Scratch test
Stand in the right of the clients chest. Curl (hook) the fingers of both hands over the edge of the right costal margin. ask the client to take a deep breath and gently pull firmly pull inward and upward with the fingers.
Hooking technique
The client has rebound tenderness when he or she perceives sharp, stabbing pain as the examiner releases pressure from the abdomen
Blumberg’s Sign
pain in the RLQ during pressure in the LLQ is positive rovsing’s sign
Rovsing’s Sign
pain in the RLQ when leg is hyperextended. It is associated with irritation of the iliopsoas muscle due to appendicitis
- Ask the client to lie on the left side. Hyperextend the client’s right leg.
Psoas Sign
pain in RLQ when the hip and knee are flexed and leg is rotated internally and externally due to irritation of the obturator muscle
Obturator’s Sign
positive and may indicate appendicitis if pain or an exaggeration sensation felt in the RLQ
Hypersensitivity Test
positive if pain felt when pressure is applied under the liver border at the right costal margin (RUQ) and the client hold his /her breath (inspiratory arrest)
Murphy’s Sign
