abdomen Flashcards
internal anatomy
Divided into 4 quadrants
Right and left and upper and lower (RUQ,LUQ, RLQ & LLQ)
Midline organs—aorta, uterus if enlarged and bladder if distended
pregnant women - nausea and vomiting
morning sickness
Cause unknown; may be due to hormone changes, such as production of human chorionic gonadotropin (hCG)
“Acid indigestion” or heartburn (pyrosis) caused by esophageal reflux
pregnant women - constipation
Gastrointestinal motility decreases, which prolongs gastric emptying time, decreases absorption, and leads to constipation
developmental competence: the aging adult
Changes of the GI system occur with aging, but most do not significantly affect function if no disease is present
Salivation decreases, leading to a dry mouth and decreased sense of taste
Esophageal emptying and gastric acid secretion are delayed (exam)
Incidence of gallstones increases with age
Although liver size decreases, most liver functions remain normal; however, drug metabolism is impaired
Aging adults frequently report constipation
lactose intolerance
Lactase is a digestive enzyme necessary for absorption of carbohydrate lactose (milk sugar)
* These people are lactose intolerant and have abdominal pain, bloating, and flatulence when milk products are consumed
Ethnic variation seen
Lactase non-persistance affects estimate
* 21% of whites, 51% of Hispanic/Latinos, 75% of blacks and 79% American Indians & between 15-100% of Asian Americans
celiac disease
Autoimmune disorder
Intolerant of gluten
Gluten-free diet (GFD)
subjective data
Appetite
Dysphagia
Food intolerance
Abdominal pain
Nausea/vomiting
Bowel habits
Past abdominal history
Medications
Nutritional assessment
bowel habits (exam)
are you having any black tarry stools? (likely old blood, upper GI bleed)
Are you having normal bowel movements?
medications (exam)
ask if they are on iron
preparation for collecting objective data
Adequate lighting
Expose abdomen so that it is fully visible; drape genitalia and female breasts
Position for comfort to enhance abdominal wall relaxation
* Empty bladder prior to examination with specimen saved if needed.
* Lying on back with knees bent
* Warm stethoscope and examine areas identified as painful last to prevent
guarding
auscultate when? (exam)
Auscultate prior to palpation and percussion
Inspect, AUSCULTATE, percuss, palpate
what equipment is needed to collect objective data
Stethoscope, small centimeter ruler, and skin-marking pen
Alcohol wipe to clean endpiece
contour of the abdomen
Determine profile from rib margin to pubic bone; contour describes nutritional state and normally ranges from flat to rounded
symmetry of the abdomen
Abdomen should be symmetric bilaterally
umbilicus of the abdomen
Normally it is midline and inverted, with no sign of discoloration, inflammation, or hernia
skin of the abdomen
Surface smooth and even, with homogeneous color; assess skin turgor
Inspect for pigment change and presence of lesions or scars
Common pigment change striae (linea albicantes) & pigmented nevi (moles)
inspection - pulsation or movement (exam)
Pulsation or movement
Normally you may see pulsations from aorta beneath skin in epigastric area, particularly in thin persons with good muscle wall relaxation
inspection hair distribution
Hair distribution
Pattern of pubic hair growth normally has diamond shape in adult males and an inverted triangle shape in adult females
inspection - demeanor
Demeanor
A comfortable person is relaxed quietly on examining table and has a benign facial expression and slow, even respirations
why is auscultation done first
This is done first because percussion and palpation can increase peristalsis,
which would give a false interpretation of bowel sounds
how to auscultate for bowel and vascular sounds
Hold stethoscope lightly against skin; pushing too hard may stimulate more
bowel sounds
Begin in RLQ at ileocecal valve area because bowel sounds are normally always present here
bowel sounds
Note character and frequency of bowel sounds
Bowel sounds originate from movement of air and fluid through small intestine
Bowel sounds are high pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute
hypoactive
Hypoactive—decreased, can follow abdominal surgery or with
inflammation
hyperactive
Hyperactive—loud, high-pitched signal increased motility
Borborygmus
is the sound of hyper peristalsis (stomach growling)
Perfectly “silent abdomen” is
uncommon
you must listen for 5
minutes by your watch before deciding bowel sounds are completely absent
costovertebral angel tenderness
To assess kidney, place one hand over 12th rib at costovertebral angle on back
Thump that hand with ulnar edge of your other fist
A person normally feels thud but no pain
what does a positive finding for costovertebral angle tenderness mean
there is probably inflammation of the kidney
palpation: light to deep
Note location, size, consistency, and mobility of any palpable organs and presence of any abnormal enlargement, tenderness, or masses
Making sense of what you are feeling is more difficult than it looks
Be aware of voluntary guarding
Inexperienced examiners complain that abdomen “all feels same,” as if they are pushing their hand into a soft sofa cushion
Helps to memorize anatomy and visualize what is under each quadrant as you palpate
Also remember that some structures are normally palpable
Mild tenderness normally present when palpating sigmoid colon
Any other tenderness should be investigated
If you identify a mass, first distinguish it from a normally palpable structure or an enlarged organ
palpation of the spleen
Normally spleen is not palpable and must be enlarged three times its normal size to be felt
To search for it, reach your left hand over abdomen and behind left side at the 11th and 12th ribs
Lift up for support; place your right hand obliquely on
LUQ with fingers pointing toward left axilla and just inferior to rib margin
Push your hand deeply down and under left costal margin, and ask the person to take deep breath
You should feel nothing firm
enlargement of the spleen is seen with
Enlargement seen with:
Mononucleosis, leukemia and lymphomas, portal HTN and HIV infection
Normally spleen is not palpable and must be enlarged three times its normal size to be felt
An alternative position is to roll a person onto his or her right side to displace spleen more forward and downward
if the spleen is palpable what should you do (exam)
If palpable, do not continue to palpate as it is friable and can rupture
palpation of the aorta
Using your opposing thumb and fingers, palpate aortic pulsation in upper abdomen slightly to left of midline
Normally it is 2.5 to 4 cm wide in adult &
pulsates in an anterior direction
Widened in the presence of abdominal aortic
aneurysm
abnormal findings: abdominal distension
Obesity
Air or Gas
Ascites
Ovarian Cyst (large)
Pregnancy
Feces
Tumor
ascites (exam)
fluid on the abdomen
- has a very protuberant appearance
- can be caused by cirrhosis
patient history and symptoms of intestinal obstruction
Patient hx and symptoms
Hx of previous abdominal surgery with adhesions
Vomiting or fever
Absence of stool or gas passage
Colicky pain from strong peristalsis above the obstruction
physical exam findings of intestinal obstruction
Restless, ill appearing patient
Distended abdomen/tenderness to palpation
Hyperactive bowel sounds in early obstruction
hypoactive or silent in late
obstruction
Progression to hypovolemic shock
diagnostic tests for intestinal obstruction
Evidence to support dehydration, electrolyte loss & possible sepsis
Imaging studies -> accumulation of fluid & gas in bowel proximal to obstruction
abnormal findings on inspection
Inspection
Umbilical Hernia
Epigastric Hernia
Incisional Hernia
abnormal bowel sounds
Abnormal Bowel Sounds
Succussion Splash
* Marked peristalsis +projectile vomiting in newborn = pyloric stenosis
Hypoactive Bowel Sounds
Hyperactive Bowel Sounds
palpation: murphy’s sound
a positive murphy’s sign can be acute cholecystitis
- is when there may be significant pain that may be sharp when inhaling
abdomen examination
Inspection
Contour, symmetry, umbilicus, skin, pulsation or movement, hair distribution &demeanor
Auscultation
Bowel sounds; note any vascular sounds
Percussion (Usually by physician)
All four quadrants and borders of liver & spleen
Palpation
Light and deep palpation in all four quadrants, & palpate for liver and spleen
occult blood
melana
