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PA > Abdomen > Flashcards

Abdomen Flashcards

1
Q

location of the abdomen

A

extends from the diaphragm down to the brim of the pelvis.

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2
Q

linea alba

A

the tendinous seam/median line on the anterior abdominal wall between the two rectus muscles

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3
Q

costal margin

A

the lower edge of the chest (thorax) formed by the bottom edge of the rib cage

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4
Q

7 solid viscera

A

these maintain a characteristic shape

liver
pancreas
spleen
adrenal glands
kidneys
ovaries
uterus
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5
Q

what is the abdomen bordered by in the back? in the sides and front?

A

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

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6
Q

5 hollow viscera

A
  1. stomach
  2. gallbladder
  3. small intestines
  4. colon
  5. bladder
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7
Q

location of the liver

A

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

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8
Q

location of the pancreas

A

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

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9
Q

location of the spleen

A

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

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10
Q

location of the kidneys

A

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)

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11
Q

when are the ovaries palpable?

A

only on a bimanual examination during a pelvic examination (one hand in vagina, one hand on outer side of the abdomen)

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12
Q

location of the stomach

A

just below the diaphragm between the liver and the spleen

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13
Q

location of the gallbladder

A

under the posterior surface of the liver, just lateral to the right midclavicular line

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14
Q

location of the small intestines

A

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)

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15
Q

location of the aorta relative to the abdominal region

A

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

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16
Q

7 components of the right upper quadrant of the abdomen

A
  1. liver
  2. gallbladder
  3. duodenum
  4. head of the pancreas
  5. right kidney and adrenal gland
  6. part of the ascending and transverse colon
  7. hepatic flexure of colon
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17
Q

7 components of the left upper quadrant of the abdomen

A
  1. stomach
  2. spleen
  3. left lobe of liver
  4. body of pancreas
  5. left kidney and adrenal gland
  6. part of the transverse and descending colon
  7. splenic flexure of colon
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18
Q

5 components of the right lower quadrant of the abdomen

A
  1. cecum
  2. appendix
  3. right ovary and tube
  4. right ureter
  5. right spermatic cord
  6. part of the ascending colon
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19
Q

4 components of the left lower quadrant

A
  1. part of the descending colon
  2. sigmoid colon
  3. left ovarian tube/left spermatic cord
  4. left ureter
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20
Q

what are the 4 layers of large, flat muscles that form the ventral abdominal wall?

A
  1. External oblique
  2. internal oblique
  3. transversus muscles
  4. rectus abdominis
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21
Q

what are all the internal organs inside the abdomen cavity called?

A

viscera

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22
Q

what is Heartburn?

A

a burning sensation in the epigastric 
area radiating into the throat; often associated 
with regurgitation

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23
Q

what is Anorexia?

A

loss of appetite – NOT the same as anorexia nervosa

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24
Q

what are signs that patient has excessive gas or flatus?

A

needing to belch or pass gas by the rectum; patients often state they feel bloated

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25
Q

what is Regurgitation?

A

the reflux of food and stomach acid back into the mouth; brine-like taste

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26
Q

what is retching?

A

spasmodic movement of the chest and diaphragm like vomiting, but no stomach contents are passed

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27
Q

What is Blood or coffee ground emesis known as?

A

hematemesis

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28
Q

5 different colors/type of vomit

A 
food
green- or yellow-colored bile
mucus
blood 
coffee ground emesis (often old blood)
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29
Q

what is visceral abdominal pain, and what does it feel like?

A

when hollow organs (stomach, colon) forcefully contract or become distended

usually gnawing, cramping, or aching and is often difficult to localize (hepatitis)

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30
Q

what is parietal abdominal pain and how is it characterized?

A

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)

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31
Q

what is Referred abdominal pain and how is it characterized?

A

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.

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32
Q

melena

A

dark sticky feces containing partly digested blood

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33
Q

what can white or gray stools indicate?

A

liver or gallbladder disease

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34
Q

What are relevant PMH to abdomen?

A

Hepatitis, cirrhosis, gallbladder problems, or pancreatitis

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35
Q

How should the patient be positioned during the abdominal exam?

A

Supine position with knees bent, arms at sides or folded over chest

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36
Q

When should you examine areas that are painful to the patient?

A

At the END of the exam

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37
Q

What is the order for the physical assessment of the abdomen?

A
  1. Inspect
  2. Auscultate
  3. Percuss
  4. Palpate
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38
Q

what is an umbilical hernia?

A

occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles

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39
Q

what are the 6 components of abdominal inspection?

A 
Demeanor
Contour
Skin
Hair Distribution
Pulsation or Movement
Umbilicus
40
Q

what is an incisional hernia?

A

a type of hernia caused by an incompletely-healed surgical wound

41
Q

what side of the stethoscope do you use to auscultate bowel sounds, and where do you begin?

A

Use diaphragm

Begin at ileocecal valve in RLQ

42
Q

3 options for character/frequency of bowel sounds

A

Normal
Hyperactive
Hypoactive

43
Q

True or false: Epigastric systolic bruit may be normal

A

True

44
Q

What do arterial bruits with both systolic and diastolic components suggest?

A

partial occlusion of aorta or large arteries

45
Q

what vascular sounds do you auscultate?

A

Aorta
Left and right renal arteries
Left and right iliac arteries
Left and right femoral arteries

46
Q

What are the 5 reasons for finding a large area of dullness when percussing the abdomen?

A 
Mass or enlarged organ
Fluid
Feces
Fetus
Fibroid
47
Q

when percussing the abdomen, what sound should predominate?

A

Tympany

48
Q

when would one perform a liver scratch test?

A

to define liver borders when abdomen is distended or muscles tense

49
Q

How do you perform a liver scratch test?

A

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)

50
Q

why do we percuss the kidneys?

A

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

51
Q

What are the 2 relaxation techniques to assess voluntary guarding?

A

Tell the patient to breathe out deeply

Tell the patient to breathe through the mouth with the jaw dropped open

52
Q

what is Rebound tenderness?

A

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

53
Q

what is voluntary vs involuntary guarding, and when do you assess for them?

A

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

54
Q

what are the 10 normally palpable abdominal structures?

A
  1. xiphoid process
  2. normal liver edge
  3. right kidney, lower pole
  4. cecum/ascending colon
  5. uterus (gravid)
  6. pulsatile aorta
  7. rectus muscles, lateral borders
  8. sacral promontory
  9. sigmoid colon
  10. full bladder
55
Q

6 abnormalities on palpation?

A
  1. enlarged bladder
  2. enlarged spleen
  3. enlarged nodular liver
  4. enlarged gallbladder
  5. enlarged kidney
  6. aortic aneurism
56
Q

What is Ascites and how do we assess for it?

A

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

57
Q

4 ways we assess for appendicitis

A

Rebound tenderness
Rovsing’s sign
Psoas sign
Obturator test

58
Q

Rovsing’s sign

A

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

59
Q

Psoas sign

A

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

60
Q

Obturator test

A

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.

61
Q

What is acute cholecystitis, and how do we assess for it?

A

inflammation of the gallbladder, occurs when bile becomes trapped in the gallbladder

test: Murphy’s sign

62
Q

Murphy’s sign

A

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

63
Q

What is the preferred order for examination of the abdomen?

A

Inspection, auscultation, percussion, palpation

64
Q

A sign which confirms the presence of peritonitis is:

A

Rebound tenderness

65
Q

What is dysphagia?

A

Trouble swallowing - something mechanical is going on – it takes more time and effort to move food or liquid from your mouth to your stomach

66
Q

What is the medical time span for constipation?

A

Beyond 3 days

67
Q

What happens when chocolate and alcohol relax the cardiac sphincter?

A

this means you’re going to regurgitate some of the acid up into the esophagus

68
Q

If a patient complains of visceral pain in the epigastric area, what organs might be affected?

A

stomach, the duodenum, or the pancreas

69
Q

If a patient complains of visceral pain in the right upper quadrant, what organs might be affected?

A

usually gallbladder or could be liver

70
Q

If a patient complains of visceral pain in the periumbilical area, what organs might be affected?

A

usually the small intestine but appendicitis can start there before it moves into right lower quadrant

71
Q

If a patient complains of visceral pain in the subprapubic area or sacral pain in the back, what organs might be affected?

A

rectum - also the same kind of area for the colon, the bladder, or the uterus

72
Q

diverticulitis

A

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

73
Q

appendicitis can start in the ____ before it moves into the _____

A

periumbilical region ; right lower quadrant

74
Q

What abdominal issues can cause problems in the shoulder?

A

pancreatitis, perforated ulcers

75
Q

2 associated signs of bowel movements?

A

jaundice

icteric (yellow) sclerae

76
Q

What is the most common reason for pancreatitis?

A

gallstones, and then alcohol – this is an extreme pain

77
Q

What is familial polyposis?

A

an inherited disorder characterized by cancer of the large intestine (colon) and rectum

78
Q

What is a scaphoid abdomen?

A

Concave

79
Q

Typical public hair growth shape

A

females tend to have a triangle shape of hair near vagina, men have diamond

80
Q

What are lipomas?

A

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

81
Q

Where is it normal to see the aortic pulse, and why might the amplitude increase?

A

in the epigastric area

the amplitude of that may increase if someone had an abdominal aneurism

82
Q

How long do you have to listen to bowel sounds before you can definitively say there are none present?

A

3-5 minutes

83
Q

What are hyperactive bowel sounds like?

A

high pitched, tinkling – people with diarrhea, early intestinal obstruction

84
Q

When are hypoactive bowel sounds common?

A

most patients after abdominal surgery - very important to keep your eye on that – anything that’s causing peritonitis will contribute to hypoactive bowel sounds

85
Q

If the patient has fluid in the abdomen, where will it fall when they lie flat?

A

to the flanks

86
Q

Mono and malaria can enlarge the….

A

spleen

87
Q

Where do you percuss for the liver span on man vs. woman, and what are the normal lengths?

A

at mid-clavicular line for man, 6-12 cm

sternal border for woman 4-8cm

88
Q

What diseases would cause the liver to be enlarged?

A

Congestive heart failure, hepatitis

89
Q

How to percuss the spleen?

A

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

90
Q

What is CVA tenderness caused by?

A

Kidney infection

91
Q

How to palpate the liver

A

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

92
Q

Where are most aortic aneurysms (95%) located?

A

below the renal arteries but above the belly button

you’ll hear a bruit, femoral pulses will be decreased, greater than 5cm

93
Q

borborygmi

A

audible stomach gurgling

94
Q

Pain from the liver or a perforated duodenal ulcer can often be referred to the

A

Right shoulder

95
Q

Pancreatitis pain can be referred to the

A

Left shoulder, lower back

96
Q

Pain from rectal lesions is often referred to the

A

Sacrum

PA (10 decks)

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