Abdomen Flashcards
location of the abdomen
extends from the diaphragm down to the brim of the pelvis.
linea alba
the tendinous seam/median line on the anterior abdominal wall between the two rectus muscles
costal margin
the lower edge of the chest (thorax) formed by the bottom edge of the rib cage
7 solid viscera
these maintain a characteristic shape
liver pancreas spleen adrenal glands kidneys ovaries uterus
what is the abdomen bordered by in the back? in the sides and front?
bordered in the back by the vertebral column and the vertebral muscles. bordered in the sides and front by the lower ribcage and the abdominal muscles
5 hollow viscera
- stomach
- gallbladder
- small intestines
- colon
- bladder
location of the liver
fills most of the right upper quadrant and extends over to the left clavicular line
the lower edge of the clavicular and the right kidney could be palpable normally
location of the pancreas
soft lobulated gland located behind the stomach
stretches obliquely across the posterior abdominal wall to the left upper quadrant
when we do an ultrasound, you often can’t see the pancreas
location of the spleen
soft mass of lymphatic tissue on the posterolateral wall of the abdominal cavity, immediately under the diaphragm
lies kind of obliquely - long axis is parallel to the 10th rib, behind the mid-axillary line
usually not palpable, only when it’s swollen (mono, etc.) it pushes down and towards the belly button
location of the kidneys
both kidneys are retroperitoneal - posterior to the abdominal contents
left kidney: lies at the 11th and 12th ribs, where the 12th rib forms the costovertebral angle with the vertebral column
right kidney is 1-2cm lower than the left kidney (only palpable with tumor or superthin person)
when are the ovaries palpable?
only on a bimanual examination during a pelvic examination (one hand in vagina, one hand on outer side of the abdomen)
location of the stomach
just below the diaphragm between the liver and the spleen
location of the gallbladder
under the posterior surface of the liver, just lateral to the right midclavicular line
location of the small intestines
lie in all 4 quadrants
extends from stomach’s pyloric valve to the ileocecal valve in the right lower quadrant (very important spot, where we listen for bowel sounds)
location of the aorta relative to the abdominal region
just to the left of midline in the upper part of the abdomen - 2 cm below the bellybutton it bifurcates into the left and right common iliac arteries - that’s about where the 4th vertebrae is on the back
7 components of the right upper quadrant of the abdomen
- liver
- gallbladder
- duodenum
- head of the pancreas
- right kidney and adrenal gland
- part of the ascending and transverse colon
- hepatic flexure of colon
7 components of the left upper quadrant of the abdomen
- stomach
- spleen
- left lobe of liver
- body of pancreas
- left kidney and adrenal gland
- part of the transverse and descending colon
- splenic flexure of colon
5 components of the right lower quadrant of the abdomen
- cecum
- appendix
- right ovary and tube
- right ureter
- right spermatic cord
- part of the ascending colon
4 components of the left lower quadrant
- part of the descending colon
- sigmoid colon
- left ovarian tube/left spermatic cord
- left ureter
what are the 4 layers of large, flat muscles that form the ventral abdominal wall?
- External oblique
- internal oblique
- transversus muscles
- rectus abdominis
what are all the internal organs inside the abdomen cavity called?
viscera
what is Heartburn?
a burning sensation in the epigastric area radiating into the throat; often associated with regurgitation
what is Anorexia?
loss of appetite – NOT the same as anorexia nervosa
what are signs that patient has excessive gas or flatus?
needing to belch or pass gas by the rectum; patients often state they feel bloated
what is Regurgitation?
the reflux of food and stomach acid back into the mouth; brine-like taste
what is retching?
spasmodic movement of the chest and diaphragm like vomiting, but no stomach contents are passed
What is Blood or coffee ground emesis known as?
hematemesis
5 different colors/type of vomit
food green- or yellow-colored bile mucus blood coffee ground emesis (often old blood)
what is visceral abdominal pain, and what does it feel like?
when hollow organs (stomach, colon) forcefully contract or become distended
usually gnawing, cramping, or aching and is often difficult to localize (hepatitis)
what is parietal abdominal pain and how is it characterized?
Parietal pain: when there is inflammation from the hollow or solid organs that affect the parietal peritoneum
Parietal pain is more severe and is usually easily localized (appendicitis)
what is Referred abdominal pain and how is it characterized?
Referred pain originates at different sites but shares innervation from the same spinal level (gallbladder pain in the shoulder)
when a person gives a history of abdominal pain, the pains location may not necessarily be directly over the involved organ.
melena
dark sticky feces containing partly digested blood
what can white or gray stools indicate?
liver or gallbladder disease
What are relevant PMH to abdomen?
Hepatitis, cirrhosis, gallbladder problems, or pancreatitis
How should the patient be positioned during the abdominal exam?
Supine position with knees bent, arms at sides or folded over chest
When should you examine areas that are painful to the patient?
At the END of the exam
What is the order for the physical assessment of the abdomen?
- Inspect
- Auscultate
- Percuss
- Palpate
what is an umbilical hernia?
occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles
what are the 6 components of abdominal inspection?
Demeanor Contour Skin Hair Distribution Pulsation or Movement Umbilicus
what is an incisional hernia?
a type of hernia caused by an incompletely-healed surgical wound
what side of the stethoscope do you use to auscultate bowel sounds, and where do you begin?
Use diaphragm
Begin at ileocecal valve in RLQ
3 options for character/frequency of bowel sounds
Normal
Hyperactive
Hypoactive
True or false: Epigastric systolic bruit may be normal
True
What do arterial bruits with both systolic and diastolic components suggest?
partial occlusion of aorta or large arteries
what vascular sounds do you auscultate?
Aorta
Left and right renal arteries
Left and right iliac arteries
Left and right femoral arteries
What are the 5 reasons for finding a large area of dullness when percussing the abdomen?
Mass or enlarged organ Fluid Feces Fetus Fibroid
when percussing the abdomen, what sound should predominate?
Tympany
when would one perform a liver scratch test?
to define liver borders when abdomen is distended or muscles tense
How do you perform a liver scratch test?
Place stethoscope over liver
Start in RLQ and scratch with finger tip upward
When sound becomes magnified, you’ve crossed from hollow organ to solid (liver edge)
why do we percuss the kidneys?
checking for Costovertebral (CVA) tenderness
note that pressure from fingertips or a thrust of fist may produce tenderness due to a kidney infection but may also be musculoskeletal
What are the 2 relaxation techniques to assess voluntary guarding?
Tell the patient to breathe out deeply
Tell the patient to breathe through the mouth with the jaw dropped open
what is Rebound tenderness?
Rebound tenderness occurs during deep palpation if pain increases when the examiner decreases the pressure against the abdomen
is a sign which confirms the presence of peritonitis
what is voluntary vs involuntary guarding, and when do you assess for them?
voluntary guarding: patient consciously flinches when you touch him
involuntary guarding: muscles spasm when you touch the patient, but he cannot control the reaction
assess during light palpation
what are the 10 normally palpable abdominal structures?
- xiphoid process
- normal liver edge
- right kidney, lower pole
- cecum/ascending colon
- uterus (gravid)
- pulsatile aorta
- rectus muscles, lateral borders
- sacral promontory
- sigmoid colon
- full bladder
6 abnormalities on palpation?
- enlarged bladder
- enlarged spleen
- enlarged nodular liver
- enlarged gallbladder
- enlarged kidney
- aortic aneurism
What is Ascites and how do we assess for it?
A protuberant abdomen with bulging flanks is suspicious for ascites (fluid in the abdomen from diseases such as cancer).
Percuss the abdomen for areas of tympany and dullness.
Due to gravity, dullness should be located along the lateral sides (flanks) of the abdomen, while the anterior portion should be tympanic.
can be caused by cancer, liver failure, heart failure
4 ways we assess for appendicitis
Rebound tenderness
Rovsing’s sign
Psoas sign
Obturator test
Rovsing’s sign
If palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing’s sign and may have appendicitis
Psoas sign
passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip – if abdominal pain results, it can be a sign of appendicitis
Obturator test
test for acute appendicitis: The patient lies on her/his back with the hip and knee both flexed at ninety degrees. The examiner holds the patient’s ankle with one hand and knee with the other hand. The examiner rotates the hip by moving the patient’s ankle away from the patient’s body while allowing the knee to move only inward. This is flexion and internal rotation of the hip.
What is acute cholecystitis, and how do we assess for it?
inflammation of the gallbladder, occurs when bile becomes trapped in the gallbladder
test: Murphy’s sign
Murphy’s sign
a sign of gallbladder disease consisting of pain on taking a deep breath when the examiner’s fingers are on the approximate location of the gallbladder
What is the preferred order for examination of the abdomen?
Inspection, auscultation, percussion, palpation
A sign which confirms the presence of peritonitis is:
Rebound tenderness
What is dysphagia?
Trouble swallowing - something mechanical is going on – it takes more time and effort to move food or liquid from your mouth to your stomach
What is the medical time span for constipation?
Beyond 3 days
What happens when chocolate and alcohol relax the cardiac sphincter?
this means you’re going to regurgitate some of the acid up into the esophagus
If a patient complains of visceral pain in the epigastric area, what organs might be affected?
stomach, the duodenum, or the pancreas
If a patient complains of visceral pain in the right upper quadrant, what organs might be affected?
usually gallbladder or could be liver
If a patient complains of visceral pain in the periumbilical area, what organs might be affected?
usually the small intestine but appendicitis can start there before it moves into right lower quadrant
If a patient complains of visceral pain in the subprapubic area or sacral pain in the back, what organs might be affected?
rectum - also the same kind of area for the colon, the bladder, or the uterus
diverticulitis
An inflammation or infection in one or more small pouches in the digestive tract
women/people over 50 having pain in the left lower quadrant
appendicitis can start in the ____ before it moves into the _____
periumbilical region ; right lower quadrant
What abdominal issues can cause problems in the shoulder?
pancreatitis, perforated ulcers
2 associated signs of bowel movements?
jaundice
icteric (yellow) sclerae
What is the most common reason for pancreatitis?
gallstones, and then alcohol – this is an extreme pain
What is familial polyposis?
an inherited disorder characterized by cancer of the large intestine (colon) and rectum
What is a scaphoid abdomen?
Concave
Typical public hair growth shape
females tend to have a triangle shape of hair near vagina, men have diamond
What are lipomas?
a benign tumor composed of adipose tissue (body fat). It is the most common benign form of soft tissue tumor. Lipomas are soft to the touch, usually movable, and are generally painless
Where is it normal to see the aortic pulse, and why might the amplitude increase?
in the epigastric area
the amplitude of that may increase if someone had an abdominal aneurism
How long do you have to listen to bowel sounds before you can definitively say there are none present?
3-5 minutes
What are hyperactive bowel sounds like?
high pitched, tinkling – people with diarrhea, early intestinal obstruction
When are hypoactive bowel sounds common?
most patients after abdominal surgery - very important to keep your eye on that – anything that’s causing peritonitis will contribute to hypoactive bowel sounds
If the patient has fluid in the abdomen, where will it fall when they lie flat?
to the flanks
Mono and malaria can enlarge the….
spleen
Where do you percuss for the liver span on man vs. woman, and what are the normal lengths?
at mid-clavicular line for man, 6-12 cm
sternal border for woman 4-8cm
What diseases would cause the liver to be enlarged?
Congestive heart failure, hepatitis
How to percuss the spleen?
get to about the 9th rib and percuss- it should be tympanic
have the patient take a deep breath, which will push the diaphragm and then the spleen down
if the note changes to dull, the spleen is too large
What is CVA tenderness caused by?
Kidney infection
How to palpate the liver
put left hand under rib cage, then right hand on upper quadrant
push gently in and up, ask patient to take a deep breath which will push the liver down towards your hand and you’ll feel the edge of the liver
should feel soft, rather sharp - you don’t want to feel any nodules
hooking method - can use when someone has a lot of adipose tissue
Where are most aortic aneurysms (95%) located?
below the renal arteries but above the belly button
you’ll hear a bruit, femoral pulses will be decreased, greater than 5cm
borborygmi
audible stomach gurgling
Pain from the liver or a perforated duodenal ulcer can often be referred to the
Right shoulder
Pancreatitis pain can be referred to the
Left shoulder, lower back
Pain from rectal lesions is often referred to the
Sacrum
