Abdomen Flashcards
What is the alimentary system
GI tract (27ft long) Includes mouth, esophagus, stomach, SI, LI
Function of the alimentary system
- Ingest/digest food
- Absorb nutrients, electrolytes, and h20
- Excrete waste products
How are food and products moved through the alimentary system
Via peristalsis/ANS control
What does the stomach secrete
HCL acids, breaks down food
How long is the SI
21ft long
Function of SI
Breakdown food with pancreatic enzymes and bile. Absorbs nutrients. Villi increases surface area
3 parts of the SI
- Duodenum
- Jejunum
- Ileum
What 2 ducts enter at the duodenum
- common bile duct
2. pancreatic duct
How long is the LI
4.5-5ft
Function of LI
- Absorb water
2. Transport waste
What is the hepatobiliary tract
System of organs that works together to form bile and aid in digestion
How many lobes does the liver have
4, each containing lobules
What is the liver lobule made of
Liver cells that radiate around a central vein
Path of bile secretion
Liver cells - bile ducts - hepatic duct - joins cystic duct (GB) - forms the common bile duct
which liver veins dump back into the IVC
hepatic veins
What vein receives blood from the intestine and spleen
The portal vein
Where is the GB located
Inferior surface of the liver
Function of the liver
- Metabolizes carbs, fats, proteins
- Glucose is converted and stored as glycogen
- Amino acid conversion to glucose (glucogenesis)
- Converts cholesterol to bile salts
- Stores vitamins
- Detoxifies
- Protein production
what 2 ducts for the common bile duct
cystic and hepatic ducts
What does the GB do
stores and releases bile salts to aid in digestion
Where is the pancreas
Behind and under the stomach, head rests in curve of duodenum
What kind of gland is the pancreas
exocrine(enzymes for digestion) and endocrine(insulin)
What are the cells in the pancreas
acinar cells and islet cells
What do acinar cells do
Produce enzymes for digestion of fat, protein and carbs
what is another name for pancreatic duct
duct of wirsung
What are they islet cells responsible for
Insulin and glucagon (insulin)
Where is the spleen
LUQ, above L kidney
What is the spleen made up
white pulp, very fragile (lymphoid tissue) and red pulp
What does the white pulp do
Filters blood and makes lymphocytes/monocytes
What does the red pulp do
Stores and releases blood
Why do you auscultate 2nd in abdominal exam?
Because percussion and palpation may alter the frequency and intensity of the bowel sounds
What are the types of venous patterns
- normal
- portal hypertension
- IVC obstruction
Which way should venous return be above the umbilicus
Toward the head
Which way should venous return patterns be below the umbilicus
toward the feet
What do you look for on INSPECTION of the abdomen
- symmetry
- shape/contour
- color
- deformities (hernia, masses)
- Movement (aortic pulsation, peristalsis)
- Skin - striae, moles
- inverted/everted umbilicus
What are purple striae indicative of
cushing syndrome
What does a blue umbilicus suggest
intraperitoneal hemorrhage - cullen sign
Borborygmi
Loud prolonged gurgles
Frequency of bowel sounds
5-35/min
If no bowel sounds are heard, how long should you auscultate for
5 mins
What other things do you auscultate for in the abdomen
- Friction rubs over liver or spleen
- bruits
- venous hum - bell of stethoscope over epigastric region
What does a venous hum indicate
increased collateral venous circulation between the portal and systemic venous system
2 sounds generally heard during percussion
tympany and dullness
What sound is not good in auscultation
high pitched tinkling - indicates air or fluid under pressure (obstruction)
What does decreased (or absent) bowel sounds during auscultation mean
peritonitis and paralytic ileus
How do you percuss the kidneys
Pt sitting upright and blunt percussion
What are the measurements of the liver
4-8 cm midsternal line
6-12cm midclavicular line
What does tenderness at the CVA indicate
kidney stone, kidney infection, etc
2 types of palpation
light - in all 4 quadrants
deep - delineates abd organs
when would you be able to palpate the right kidney
during expiration
almost impossible to feel the left
What sound would you hear over ascites
dullness
shifting dullness
test done to assess for ascites. Identify areas of tympany and dullness first, then have patient lie on side. test for dullness and tympany. Dullness will go towards the bottom
Fluid wave
another ascites test. place one hand on pt side, strike the other side and feel for wave of fluid
Possible causes of pain in RUQ
- hepatitis
- cholecystitis
- duodenal ulcer
Possible causes of pain in RLQ
- appendicitis
- salpingitis/ovarian cyst
- ureteral stone
- hernia
Possible causes of pain in periumbilical
- intestinal obstruction
- acute pancreatitis
- AAA
Possible causes of pain in LUQ
- ruptured spleen
- gastric ulcer
- perforated colon
Possible causes of pain in LLQ
- sigmoid diverticulitus
- salpingitis/ovarian cyst
- ureteral stone
- ulcerative colitis
Pain in rt shoulder could indicate
cholecystitis
pain radiating from abdomen to back
acute pancreatitis
pain in lower abd and pain when sitting
prostatitis
What does a cullen sign test for
hemorrhage in abd, pancreatitis. Blue belly button
Ballottement test
Quick palpation movement, to push fluid out of way to feel for organ. Tests for ascites
Grey turner sign
blue discoloration on flank, indicative of peritoneal bleeding
murphy sign
Pt will stop breathing on inspiration during palpation. indicates cholecystitis
Rovsing sign
RLQ pain intensified when pushing on theLLQ. Indicates appendicitis or peritoneal inflammation
Psoas sign
Pain in RLQ when leg is lifted. Peritonitis or appendicitis
McBurney sign
Rebound tenderness and pain at mcburney site. appendicitis
Obturator sign
Pain in hypogastric region, could be irritation of obturator muscle or ruptured appendix or pelvic abscess
Blumberg sign
rebound tenderness, peritonitis or appendicitis
Heel jar test
abd pain when heel strikes the floor. appendicitis, peritonitis
hematochezia
bloody stool, Lower GI bleeding
hematemesis
vomiting blood
melena
black tarry stool, upper GI bleeding
Globus
Sensation of having a lump in throat
singultus
hiccups, usually transient spasm of diaphragm
gastroparesis
delayed gastric emptying, disorder of motility of stomach.
Eructation
Belching, oral evacuation of air/gas from abd
Tenesmus
rectal urgency
Icterus
Jaundice
Pruritis
Itchiness (associated with gallbladder)