Abdomen Flashcards by B -

Abdomen

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STRUCTURE AND FUNCTION

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SURFACE LANDMARKS

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The abdomen is a large, oval cavity extending from the diaphragm down to the brim of the pelvis. It is bordered in back by the vertebral column and paravertebral muscles and at the sides and front by the lower rib cage and abdominal muscles.
A)true
B)false

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The ________ is a large, oval cavity extending from the diaphragm down to the brim of the pelvis. It is bordered in back by the vertebral column and paravertebral muscles and at the sides and front by the lower rib cage and abdominal muscles

abdomen

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________It is bordered in back by the vertebral column and paravertebral muscles and at the sides and front by the lower rib cage and abdominal muscles.

The abdomen

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The abdomen is a large, oval cavity extending from the diaphragm down to the brim of the pelvis.
A)true
B)false

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Four layers of large, flat muscles form the ventral abdominal wall, are joined at the midline by a tendinous seam, the linea alba.
A)true
B)false

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Four layers of large, flat muscles form the ventral abdominal wall.
A)true
B)false

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___________ are joined at the midline by a tendinous seam, the linea alba..

Four layers of large, flat muscles form the ventral abdominal wall

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Four layers of large, flat muscles form the________ abdominal wall. These are joined at the midline by a tendinous seam, the linea alba

ventral

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INTERNAL ANATOMY

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Inside the abdominal cavity, all the internal organs are called the viscera.
A)true
B)false

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all the internal organs in the Inside the abdominal cavity,are called the viscera
A)true
B)false

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The solid viscera are those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus).
A)true
B)false

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solid viscera maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus).
A)true
B)false

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liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus. Area

The solid viscera those that maintain a characteristic shape.

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The liver fills most of the right upper quadrant (RUQ) and extends over to the left midclavicular line. The lower edge of the liver and the right kidney normally may be palpable.
A)true
B) false

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The _______ fills most of the right upper quadrant (RUQ) and extends over to the left midclavicular line.

liver

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The lower edge of the liver and the right kidney normally may be palpable
A)true
B)false

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The ovaries normally are palpable only on bimanual examination during the pelvic examination.
A)true
B)false

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The _________ normally are palpable only on bimanual examination during the pelvic examination.

ovaries

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The shape of the hollow viscera (stomach, gallbladder, small intestine, colon, and bladder) depends on the contents.
A)true
B)false

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The shape of the hollow viscera depends on the contents.
A) true
B)false

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stomach, gallbladder, small intestine, colon, and bladder. Are

The shape of the hollow viscera (stomach, gallbladder, small intestine, colon, and bladder) depends on the contents.

They usually are not palpable, although you may feel a colon distended with feces or a bladder distended with urine. A) true B) false

Hollow viscera are usually not palpable, although you may feel a colon distended with feces or a bladder distended with urine. A) true B) false

The stomach is just below the diaphragm, between the liver and spleen. The gallbladder rests under the posterior surface of the liver, just lateral to the right midclavicular line. A)true B)false

The ________ is just below the diaphragm, between the liver and spleen.

stomach

The ________ rests under the posterior surface of the liver, just lateral to the right midclavicular line.

gallbladder

small intestine is located in all four quadrants. A)true B)false

It extends from the stomach's pyloric valve to the ileocecal valve in the right lower quadrant (RLQ), where it joins the colon

Small intestine

The spleen is a soft mass of lymphatic tissue on the posterolateral wall of the abdominal cavity, immediately under the diaphragm. It lies obliquely with its long axis behind and parallel to the tenth rib, lateral to the midaxillary line. Its width extends from the ninth to the eleventh rib,about 7 cm A)true B)false

The _______ is a soft mass of lymphatic tissue on the posterolateral wall of the abdominal cavity, immediately under the diaphragm. It lies obliquely with its long axis behind and parallel to the tenth rib, lateral to the midaxillary line. Its width extends from the ninth to the eleventh rib,about 7 cm

spleen

It is not palpable normally. If it becomes enlarged, its lower pole moves downward and toward the midline.

Spleen

The spleen is not palpable normally. If it becomes enlarged, its lower pole moves downward and toward the midline. A)true B)false

The aorta is just to the left of midline in the upper part of the abdomen. It descends behind the peritoneum, and at 2 cm below the umbilicus, it bifurcates into the right and left common iliac arteries opposite the fourth lumbar vertebra. A)true B)false

The ______ is just to the left of midline in the upper part of the abdomen. It descends behind the peritoneum, and at 2 cm below the umbilicus, it bifurcates into the right and left common iliac arteries opposite the fourth lumbar vertebra.

aorta

You can palpate the aortic pulsations easily in the upper anterior abdominal wall. The right and left iliac arteries become the femoral arteries in the groin area. Their pulsations are easily palpated as well, at a point halfway between the anterior superior iliac spine and the symphysis pubis. A)true B)false

You can palpate the aortic pulsations in the upper anterior abdominal wall. A)true B)false

The right and left iliac arteries become the femoral arteries in the groin area. Their pulsations are easily palpated as well, at a point halfway between the anterior superior iliac spine and the symphysis pubis. A)true B)false

The right and left iliac arteries become the __________ in the groin area. Their pulsations are easily palpated as well, at a point halfway between the anterior superior iliac spine and the symphysis pubis.

femoral arteries

The pancreas is a soft, lobulated gland located behind the stomach. It stretches obliquely across the posterior abdominal wall to the left upper quadrant. A)true B)false

The ________ is a soft, lobulated gland located behind the stomach. It stretches obliquely across the posterior abdominal wall to the left upper quadrant

pancreas

The bean-shaped kidneys are retroperitoneal, or posterior to the abdominal contents. They are well protected by the posterior ribs and musculature. A)true B)false

The bean-shaped ________ are retroperitoneal, or posterior to the abdominal contents. They are well protected by the posterior ribs and musculature

kidneys

The bean-shaped kidneys are located retroperitoneal, They are well protected by the posterior ribs and musculature. A)true B) false

The twelfth rib forms an angle with the vertebral column, the costovertebral angle.CVA A)true B)false

The left kidney lies here at the eleventh and twelfth ribs. Because of the placement of the liver, the right kidney rests 1 to 2 cm lower than the left kidney and sometimes may be palpable. A)true B)false

The left kidney lies at the eleventh and twelfth ribs. A)true B)false

Because of the placement of the liver, the right kidney rests 1 to 2 cm lower than the left kidney and sometimes may be palpable. A)true B)false

sometimes the right kidney may be palpable. It lies 1-2 cm lower than the left because of the liver A)true B)false

For convenience in description, the abdominal wall is divided into four quadrants by a vertical and a horizontal line bisecting the umbilicus . A)true B)false

epigastric for the area between the costal margins. A)true B)false

Area above the costal margins is called epigastric A)true B)false

hypogastric or suprapubic for the area above the pubic bone. A)true B)false

The anatomic location of the organs by quadrants is as follows:

``` Liver Gallbladder Duodenum Head of pancreas Right kidney and adrenal Hepatic flexure of colon Part of ascending and transverse colon Is located at ```

RIGHT UPPER QUADRANT (RUQ)

``` Stomach Spleen Left lobe of liver Body of pancreas Left kidney and adrenal Splenic flexure of colon Part of transverse and descending colon Are located what body region ```

LEFT UPPER QUADRANT (LUQ

``` Part of descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord Are located what region of the body ```

LEFT LOWER QUADRANT (LLQ

``` Cecum Appendix Right ovary and tube Right ureter Right spermatic cord Are located what region of the body ```

RIGHT LOWER QUADRANT (RLQ)

Aorta Uterus (if enlarged) Bladder (if distended) Are located what region of the body

Bladder (if distended)

DEVELOPMENTAL COMPETENCE | Infants and Children

In the newborn, the umbilical cord shows prominently on the abdomen. It contains two arteries and one vein. A) true B)false

umbilical cord on a newborn shows prominently, it contains two artifices and one vein. A)true B)false

The liver takes up proportionately more space in the abdomen at birth than in later life. In healthy term neonates, the lower edge may be palpated 0.5 to 2.5 cm below the right costal margin. A) infants B)adult

The liver takes up proportionately more space in the abdomen at birth than in later life. In healthy neonates, the lower edge of the liver may be palpated 0.5 to 2.5 cm below the right costal margin. A)infants B)adult

The urinary bladder is located higher in the abdomen than in the adult. It lies between the symphysis and the umbilicus. Also, during early childhood, the abdominal wall is less muscular, so the organs may be easier to palpate. A) true B) false

The urinary bladder is located higher in the abdomen of an infant. It lies between the symphysis and the umbilicus. A)true, infant B)false,infant

during early childhood, abdominal wall is less muscular, so its easier to palpate the organs. A)true B)false

DEVELOPMENTAL COMPETENCE | The Pregnant Woman

Nausea and vomiting, or "morning sickness:' is an early sign of pregnancy for most pregnant women, starting between the first and second missed periods. The cause is unknown but may be due to hormone changes such as the production of human chorionic gonadotropin (hCG). A)true B)false

Nausea and vomiting, or "morning sickness" is an early sign of pregnancy, starting between the first and second missed periods. A)true B)false

Nausea and vomiting, of early pregnancy is also called .

Morning sickness

Another symptom is "acid indigestion" or heartburn (pyrosis) caused by esophageal reflux. A)pregnant woman B)adult

Gastrointestinal motility decreases, which prolongs gastric emptying time. The decreased motility causes more water to be reabsorbed from the colon, which leads to constipation. A)pregnant woman true B)false

The constipation, as well as increased venous pressure in the lower pelvis, may lead to hemorrhoids in an pregnant woman A)true B)false

The enlarging uterus displaces the intestines upward and posteriorly. Bowel sounds are diminished. A)true pregnant woman B)false

The intestines in an pregnant woman is located upward and posteriorly. And bowel sounds are diminished also A)true B)false

Traditional thinking was that the appendix was displaced upward and to the right. But the appendix does not move. A)true B)false

clinical evidence has have shown that pregnancy does not change the location of the appendix. A)true B)false

Any appendicitis-related pain during pregnancy would still be felt in the right lower quadrant. A)true B)false

skin changes on the abdomen, such as striae and linea nigra are present doing pregnancy A)true B)false

DEVELOPMENTAL COMPETENCE | The Aging Adult

Aging alters the appearance of the abdominal wall. A)true B)false

During and after middle age, some fat accumulates in the suprapubic area in females as a result of decreased estrogen levels. A)true B)false

as a result of decreased estrogen levels, some fat accumulates in the suprapubic area in females as a result of decreased estrogen levels. A)true B)false

Males also show some fat deposits in the abdominal area, resulting in the "big belly." This accentuates in adults with a more sedentary lifestyle. A) true B)false

Aging adults with sedentary lifestyle. Males show some fat deposits in the abdominal area, resulting in the "big belly." A) true B)false

With further aging, adipose tissue is redistributed away from the face and extremities and to the abdomen and hips. The abdominal musculature relaxes. A) true B)false

In the aging adult fat in accumulated in the abdomen and in the hips. And also the abdominal muscles are relax. A)true B)false

Changes of aging occur in the gastrointestinal system but do not significantly affect function as long as no disease is present. A)true B)false

No great changes occur in the GI in aging adults unless, disease is present A)true B)false

Salivation decreases in aging adult causing a dry mouth and a decreased sense of taste. A)true B)false

Esophageal emptying is delayed. If an aging person is fed in the supine position, this increases risk for aspiration. A)true B)false

Esophageal emptying is delayed. So do not feed the patient in the supine position, because of increase risk of aspiration. A)aging adult B) false

Gastric acid secretion decreases with aging. This may cause pernicious anemia (because it interferes with vitamin B12 absorption), iron deficiency anemia, and malabsorption of calcium. A)true B)false

Gastric acid secretion decreases with aging. This may cause pernicious anemia, iron deficiency anemia, and malabsorption of calcium. A)true B)false

The incidence of gallstones increases with age, occurring in 10% -20% of middle-aged and older adults, being more common in females. A) true B)false

gallstones increases with age, occurring in 10% -20% of middle-aged and older adults, being more common in females. A) true B)false

Liver size decreases by 25% between the ages of 20 and 70 years, although most liver function remains normal. A)true B)false

Drug metabolism by the liver is impaired, in part because by age 65, blood flow through the liver is decreased by 33%. Therefore the liver metabolism that is responsible for the enzymatic oxidation, reduction, and hydrolysis of drugs is substantially decreased with age. A)true B)false

Prolonged liver metabolism causes increased side effects (e.g., older people taking benzodiazepines scored lower on functional status measures and had increased risk for hip fracture). A)true, aging adult B)false

enzymatic oxidation, reduction, and hydrolysis of drugs is substantially decreased with an aging adult. A)true B)false

Aging persons frequently report constipation; most prevalence estimates are between 12% and 19%. A)true, aging adult B)false,aging adult

Because there is confusion as to what defines constipation, the Rome criteria have been developed as standardized symptom criteria. These symptoms include reduced stool frequency (less than 3 bowel movements per week), as well as other common and troubling associated symptoms (i.e., straining, lumpy or hard stool, feeling of incomplete evacuation, feeling of anorectal blockage, use of manual maneuvers). A)true, aging adult B)false, aging adult

Rome criteria have been developed as standardized symptom criteria for constipation. These symptoms include reduced stool frequency (less than 3 bowel movements per week), as well as other common and troubling associated symptoms (i.e., straining, lumpy or hard stool, feeling of incomplete evacuation, feeling of anorectal blockage, use of manual maneuvers). A)true B)false

symptoms of ___________include reduced stool frequency (less than 3 bowel movements per week), as well as other common and troubling associated symptoms (i.e., straining, lumpy or hard stool, feeling of incomplete evacuation, feeling of anorectal blockage, use of manual maneuvers).

Constipation

Common causes of constipation include decreased physical activity, inadequate intake of water, a low-fiber diet, side effects of medications (opioids, tricyclic antidepressants), irritable bowel syndrome, bowel obstruction, hypothyroidism, and inadequate toilet facilities (i.e., difficulty ambulating to the toilet may cause the person to deliberately retain the stool until it becomes hard and difficult to pass). A)true for aging adults B)false for aging adults

Common causes of constipation include decreased physical activity, inadequate intake of water, a low-fiber diet, side effects of medications, irritable bowel syndrome, bowel obstruction, hypothyroidism, and inadequate toilet facilities. A)true B)false

CULTURE AND GENETICS

Lactase is the digestive enzyme necessary for absorption of the carbohydrate lactose (milk sugar). A)true B)false

In some racial groups, lactase activity is high at birth but declines to low levels by adulthood. These people are lactose intolerant and have abdominal pain, bloating, and flatulence when milk products are consumed. A)true B)fase

lactose intolerant people may experience abdominal pain, bloating, and flatulence when milk products are consumed. A) true B)false

A In some racial groups, lactase activity is high at birth but declines to low levels by adulthood. These people are lactose intolerant and have abdominal pain, bloating, and flatulence when milk products are consumed

Millions of American adults have the potential for lactose-intolerance symptoms, and traditional estimated rates were that 15% of whites, 50% of Mexican Americans, and 80% of African Americans had the condition. A)true B)false

Lactose insolence is at risk for crucial nutrients because dairy foods meet crucial nutritional requirements including calcium, magnesium, and potassium. A)true B)false

Obesity is the accumulation of excess body fat. A)true B)false

Obesity is caused by a complex interaction of genetic predisposition, dietary intake, physical inactivity, and what is now called an "obesogenic" environment (one that encourages large portions of high-fat, energy-dense food) A)true B)false

Among children, Mexican-American boys had a greater prevalence of overweight than had white or Black boys. A)true B)false

Mexican-American and Black girls were significantly more likely to be overweight than white girls. A)true B)false

No differences were found in overweight rates in men of various racial groups. A)true B)false

in adult women, Mexican Americans and African Americans were significantly more likely to be obese than were whites. A)true B)false

Obesity in adults results in comorbidities of type 2 diabetes and cardiovascular disease. A)true B)false

Obese children have an increased risk for asthma, diabetes, liver disease, cardiovascular disease, sleep apnea, and joint problems, and they risk becoming obese adults. A)true B) false

SUBJECTIVE DATA

1. Appetite 2. Dysphagia 3. Food intolerance 4. Abdominal pain 5. Nausea/vomiting 6. Bowel habits A)subjective data B)objective data

Appetite

Any change in appetite? Is this a loss of appetite? Any change in weight? How much weight gained or lost? Over what time period? Is the weight loss due to diet? A)Anorexia is a loss of appetite from gastrointestinal (GI) disease, as a side effect to some medications, with pregnancy, or with psychological disorders. B)false

________is a loss of appetite from gastrointestinal (GI) disease, as a side effect to some medications, with pregnancy, or with psychological disorders.

Anorexia

Dysphagia

Dysphagia. • Any difficulty swallowing? When did you first notice this? A)Dysphagia occurs with disorders of the throat or esophagus. B)false

________occurs with disorders of the throat or esophagus.

Dysphagia

Food Intolerance

Food intolerance. • Are there any foods you cannot eat? What happens if you do eat tl1em: allergic reaction, heartburn, belching, bloating, indigestion? A)Food intolerance (e.g., lactase deficiency resulting in bloating or excessive gas after taking milk products) B)false

Food intolerance can be lactase deficiency resulting in bloating or excessive gas after taking milk products. A)true B)false

Do you use antacids? How often? A)Pyrosis (heartburn), a burning sensation in esophagus and stomach, from reflux of gastric acid. B)false

__________(heartburn), a burning sensation in esophagus and stomach, from reflux of gastric acid.

Pyrosis

burning sensation in esophagus and stomach, from reflux of gastric acid.

Pyrosis

Abdominal Pain

Abdominal pain. Any abdominal pain? Please point to it. • Is the pain in one spot, or does it move around? How did it start? How long have you had it? Constant, or does it come and go? Occur before or after meals? Does it peak? When? A)Abdominal pain may be visceral from an internal organ (dull, general, poorly localized); parietal from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement); or referred from a disorder in another site B)none

Abdominal pain may be visceral from an internal organ (dull, general, poorly localized); A) true B)false

parietal from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement); A) true abdominal pain B) false

How would you describe the character: cramping (colic type), burning in pit of stomach, dull, stabbing, aching? A)Acute pain requiring urgent diagnosis occurs with appendicitis, cholecystitis, bowel obstruction, or a perforated organ. B)false

Is the pain relieved by food, or worse after eating? A)Chronic pain of gastric ulcers occurs usually on an empty stomach; pain of duodenal ulcers occurs 2 to 3 hours after a meal and is relieved by more food. B)false

Chronic pain of gastric ulcers occurs usually on an empty stomach; A)true B) false

pain of duodenal ulcers occurs 2 to 3 hours after a meal and is relieved by more food. A)true B)false

Is the pain associated with menstrual period or irregularities, stress, dietary indiscretion, fatigue, nausea and vomiling, gas, fever, rectal bleeding, frequent urination, vaginal or penile discharge? A)assessing for abdominal pain B)false

What makes the pain worse: food, position, stress, medication, activity? What have you tried to relieve pain: rest, heating pad, change in position, medication? A)assessing for abdominal pain B)false

Nausea/Vomitting

Nausea/vomiting. • Any nausea or vomiting? How often? How much comes up? What is the color? Is there an odor? A)Nausea/vomiting is common with GI disease, many medications, and with early pregnancy. B)false

Nausea/vomiting is common with GI disease, many medications, and with early pregnancy. A)true B)false

Is it bloody? A)Hematemesis occurs with stomach or duodenal ulcers and esophageal varices. B)false

Hematemesis occurs with stomach or duodenal ulcers and esophageal varices. A)true B)false

Is the nausea and vomiting associated with colicky pain, diarrhea, fever, chills? A)assessing for nausea and vomiting B) false

What foods did you eat in the past 24 hours? Where? At home, school, restaurant? Is there anyone else in the family with same symptoms in past 24 hours? A)Consider food poisoning. B)false

Bowel Habits

Bowel habits. How often do you have a bowel movement? A)Assess usual bowel habits B)false

What is the color? Consistency? Any diarrhea or constipation? How long? • Any recent change in bowel habits? Use laxatives? Which ones? How often do you use them? A)Black stools may be tarry due to occult blood (melena) from GI bleeding or nontarry from iron medications. Gray stools occur with hepatitis. B)false

Black stools may be tarry due to occult blood (melena) from GI bleeding or nontarry from iron medications. A)true B)false

Gray stools occur with hepatitis. A)true B)false

Red blood in stools occurs with GI bleeding or localized bleeding around the anus. A)true B)false

Past Abdominal History

Past abdominal history. Any history of gastrointestinal problems: ulcer, gallbladder disease, hepatitis/jaundice, appendicitis, colitis, hernia? • Ever had any operations in the abdomen? Please describe. Any problems after surgery? • Any abdominal x-ray studies? How were the results? A)assessing for abdominal history B)false

Medications

Medications. What medications are you currently taking? A)Peptic ulcer disease occurs with frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, smoking, and Helicobacter pylori infection B)false

Peptic ulcer disease occurs with frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, smoking, and Helicobacter pylori infection. A)true B)false

How about alcohol-how much would you say you drink each day? Each week? When was your last alcoholic drink? • How about cigarettes-do you smoke? How many packs per day? For how long? A) assessing B)false

Nutritional Assessment

Nutritional assessment. Now I would like to ask you about your diet. Please tell me all the food you ate yesterday, starting with breakfast. A)Nutritional assessment via 24-hour recall B)false

What fresh food markets are located in your neighborhood? A)Many inner-city neighborhoods are fresh food "deserts" lacking markets but full of fast-food restaurants. B)false

Additional History for Infants and Children

Are you breastfeeding or bottle-feeding the baby? If bottle-feeding, how does baby tolerate the formula? A)assessing B)false

What table foods have you introduced? How does the infant tolerate the food? A)Consider a new food as a possible allergen. Adding only one new food at a time to the infant's diet helps identify allergies B)false

How often does your toddler/child eat? Does he or she eat regular meals? How do you feel about your child's eating problems? • Please describe all that your child had to eat yesterday, starting with breakfast. What foods does the child eat for snacks? A)Irregular eating patterns are common and a source of parental anxiety. As long as the child shows normal growth and development and only nutritious foods are offered, parents may be reassured. B)false

Irregular eating patterns are common and a source of parental anxiety. A)infants B)adults

Does toddler/child ever eat nonfoods: grass, dirt, paint chips? A)assessing for pica B)Pica: Although a toddler may attempt nonfoods at some time, he or she should recognize edibles by age 2 years. C)both a and b

Pica: Although a toddler may attempt nonfoods at some time, he or she should recognize edibles by age 2 years. A)true B)false

Does your child have constipation? How long? • What is the number of stools/day? Stools/week? • How much water, juice is in the diet? • Does the constipation seem to be associated with toilet training? • What have you tried to treat the constipation? A)assessing for constipation B)false

Does the child have abdominal pain? Please describe what you have noticed and when it started. A)This symptom is hard to assess with young children. Many conditions of unrelated organ systems are associated with vague abdominal pain (e.g., otitis media). They cannot articulate specific symptoms and often focus on "the tummy." B)Abdominal pain accompanies inflammation of the bowel, constipation, urinary tract infection, and anxiety. C) both a and b

Abdominal pain accompanies inflammation of the bowel, constipation, urinary tract infection, and anxiety. A)true B)false

For the overweight child: How long has weight been a problem? At what age did the child first seem overweight? Did any change in diet pattern occur then? • Describe the diet pattern now. A)Reduced physical activity and food marketing practices contribute to current obesity epidemic. B)false

Do any others in family have a similar problem? A)assessing for Family history of obesity. B)false

How does child feel about his or her own weight? A)Assess body image B)false

Additional History for Adolescents

What do you eat at regular meals? Do you eat breakfast? What do you eat for snacks? A)Adolescent takes control of eating and may reject family values (e.g., skipping breakfast, consuming junk foods, soda pop). The only control parents have is to control what food is in the house. B)false

How many calories do you figure you consume? A)You probably cannot change adolescent eating pattern, but you can supply nutritional facts. B)false

What is your exercise pattern? A)Boys need an average 4000 cal/day to maintain weight; more calories if exercise is pursued. Girls need 20% fewer calories and the same nutrients as boys. Fast food is high in fat, calories, and salt and has no fiber. B)false

Boys need an average 4000 cal/day to maintain weight; more calories if exercise is pursued. A)true B)false

Girls need 20% (3200) fewer calories and the same nutrients as boys. A)true B)false

Fast food is high in fat, calories, and salt and has no fiber. A)true B)false

If weight is less than body requirements: How much have you lost? By diet, exercise, or how? A)Screen any extremely thin teenage girl for anorexia nervosa, a serious psychosocial disorder that includes loss of appetite, voluntary starvation, and grave weight loss. This person may augment weight loss by purging (self-induced vomiting) and use of laxatives. B)false

Screen any extremely thin teenage girl for _____________, a serious psychosocial disorder that includes loss of appetite, voluntary starvation, and grave weight loss. This person may augment weight loss by purging (self-induced vomiting) and use of laxatives

anorexia nervosa

How do you feel? Tired, hungry? How do you think your body looks? A)Denial of these feelings is common. Though thin, this person insists she looks fat, "disgusting." Distorted body image. B)false

What is your activity pattern? A)The anorectic may have healthy activity and exercise but often is hyperactive. B) false

Is the weight loss associated with any other body change, such as menstrual irregularity? A)Amenorrhea is common with anorexia nervosa B)false

Amenorrhea is common with anorexia nervosa A)true B)false

What do your parents say about your eating? Your friends? A)This is a family problem involving control issues. Anyone at risk warrants immediate referral to a physician or psychologist. B)false

Additional History for the Aging Adult

How do you acquire your groceries and prepare your meals? A)Assess risk for nutritional deficit: limited access to grocery store, income, or cooking facilities; physical disability (impaired vision, decreased mobility, decreased strength, neurologic deficit) B)false

Do you eat alone or share meals with others? A)Assess risk for nutritional deficit if living alone; may not bother to prepare all meals; social isolation; depression B)false

Please tell me all that you had to eat yesterday, starting with breakfast. A) NOTE: 24-hour recall may not be sufficient because daily pattern may vary. Attempt week-long diary of intake. Food -pattern may differ during the month if monthly income (e.g., Social Security check) runs out. B)false

Do you have any trouble swallowing these foods? What do you do right after eating: walk, take a nap? A)assessing B)false

How often do your bowels move? If the person reports constipation: What do you mean by constipation? How much liquid is in your diet? How much bulk or fiber? • Do you take anything for constipation, such as laxatives? Which ones? How often? A)assessing B)false

What medications do you take? A)Consider GI side effects (e.g., nausea, upset stomach, anorexia, dry mouth). B)false

OBJECTIVE DATA

PREPARATION

Expose the abdomen so that it is fully visible. Drape the genitalia and female breasts. A)true B) false

The following measures will enhance abdominal wall relaxation:

* The person should have emptied the bladder, saving a urine specimen if needed. * Keep the room warm to avoid chilling and tensing of muscles. • Position the person supine, with the head on a pillow, the knees bent or on pillow, and the arms at the sides or across the chest. (Note: Discourage the person from placing his or her arms over the head because this tenses abdominal musculature.) * To avoid abdominal tensing, the stethoscope endpiece must be warm, your hands must be warm, and your fingernails must be very short. * Inquire about any painful areas. Examine such an area last to avoid any muscle guarding. * Finally, learn to use distraction: Enhance muscle relaxation through breathing exercises; emotive imagery; your low, soothing voice; engaging in conversation or the person relating his or her abdominal history while you palpate.

The following measures will enhance abdominal wall relaxation:

EQUIPMENT NEEDED

Stethoscope Small centimeter ruler Skin-marking pen Alcohol wipe (to clean endpiece)

INSPECT THE ABDOMEN

Contour of the abdomen. Stand on the person's right side and look down on the abdomen. Then stoop or sit to gaze across the abdomen. Your head should be slightly higher than the abdomen. Determine the profile from the rib margin to the pubic bone. The contour describes the nutritional state and normally ranges from flat to rounded. A) true B)false

To check the contour of the abdomen. Determine the profile from the rib margin to the pubic bone. The contour describes the nutritional state and normally ranges from flat to rounded. A) true B)false

Scaphoid abdomen caves in. Protuberant abdomen and abdominal distention A)abnormal findings of the contour of the abdomen B)false

Symmetry

Shine a light across the abdomen toward you, or shine it lengthwise across the person. The abdomen should be symmetric bilaterally. Note any localized bulging, visible mass, or asymmetric shape. Even small bulges are highlighted by shadow. Step to the foot of the examination table to recheck symmetry. A)true B)false

Bulges, masses in the abdomen are abnormal findings A)true B)false

Hernia-protrusion of abdominal viscera through abnormal opening in muscle wall. A)abnormal finding B)normal finding

________-protrusion of abdominal viscera through abnormal opening in muscle wall

Hernia

Ask the person to take a deep breath to further highlight any change. The abdomen should stay smooth and symmetric. Or ask the person to perform a sit-up without pushing up with his or her hands. A)Note any localized bulging. B)Hernia, enlarged liver or spleen may show. C)both a and b

Ask the person to take a deep breath to further highlight any change. The abdomen should stay smooth and symmetric. Or ask the person to perform a sit-up without pushing up with his or her hands. Note any localized bulging. An abnormal finding would be a Hernia, or enlarged liver or spleen may show. A)true B)false

Another symptom is "acid indigestion" or heartburn (pyrosis) caused by esophageal reflux. Gastrointestinal motility decreases, which prolongs gastric emptying time. The decreased motility causes more water to be reabsorbed from the colon, which leads to constipation. The constipation, as well as increased venous pressure in the lower pelvis, may lead to hemorrhoids. A)true, pregnant women B)false

Umbilicus

Normally it is midline and inverted, with no sign of discoloration, inflammation, or hernia. It becomes everted and pushed upward with pregnancy. A)umbilicus B)false

It becomes everted and pushed upward with pregnancy.

Umbilicus

The umbilicus that is Everted in a normal person occurs with ascites or underlying mass A)true B)false

The umbilicus is a common site for piercings in young women. The site should not be red or crusted. A)true B)false

An abnormal finding in the umbilicus would be Deeply sunken with obesity. Enlarged, everted with umbilical hernia. A)true B)false

Umbilicus that is deeply sunken mostly like means the person obese. A)true B)false

Umbilicus that is enlarge and everted most likely mean the person has a hernia. A)true B)false

Bluish periumbilical color occurs (though rarely) with intra-abdominal bleeding (Cullen sign). A)true B)false

Cullen sign shows Bluish periumbilical color occurs (though rarely) with intra-abdominal bleeding. A)true B)false

Skin

The surface is smooth and even, with homogeneous color. This is a good area to judge pigment because it is often protected from sun. A)skin B)umbilicus

The skin appears as Redness with localized inflammation. A)true B)false

Jaundice (yellowing of skin and sclera) shows best in natural daylight. A)abnormal finding of the skin B)abnormal finding of the umbilicus

Skin that appears glistening and taut occurs with ascites. A)true B)false

One common pigment change is striae (lineae albicantes)-silvery white, linear, jagged marks about 1 to 6 cm long. They occur when elastic fibers in the reticular layer of the skin are broken after rapid or prolonged stretching, as in pregnancy or excessive weight gain. Recent striae are pink or blue; then they turn silvery white. A)true B)false

They occur when elastic fibers in the reticular layer of the skin are broken after rapid or prolonged stretching, as in pregnancy or excessive weight gain. Recent striae are pink or blue; then they turn silvery white.

One common pigment change is striae (lineae albicantes)-silvery white, linear, jagged marks about 1 to 6 cm long.

Abnormal finding of Striae also occur with ascites. A)true B)false

Striae look purple-blue with Cushing syndrome (excess adrenocortical hormone causes the skin to be fragile and easily broken from normal stretching). A)abnormal finding of the skin B)false

________ look purple-blue with Cushing syndrome (excess adrenocortical hormone causes the skin to be fragile and easily broken from normal stretching).

Striae

``` Cushing syndrome (excess adrenocortical hormone causes the skin to be fragile and easily broken from normal stretching). A)true B) false ```

``` Pigmented nevi (moles)- circumscribed brown macular or papular areas, are common on the abdomen. A)true,skin B)false, skin ```

Abnormal finding would be that Unusual color or change in shape of mole occurs on the skin A)true B)false

Petechiae is a small red or purple spot caused by bleeding into skin. A)true, abnormal B)false, normal

Normally, no lesions are present, although you may note well-healed surgical scars. If a scar is present, draw its location in the person's record, indicating the length in centimeters . A)true for skin B)false for skin

Note: Infrequently, a person may forget a past operation while providing the history. If you note a scar now, ask about it.) A)true B)false

A surgical scar alerts you to the possible presence of underlying adhesions and excess fibrous tissue. A)true B)false

``` Cutaneous angiomas (spider nevi) on the skin occur with portal hypertension or liver disease. A)true B)false ```

________\_ (spider nevi) on the skin occur with portal hypertension or liver disease.

Cutaneous angiomas

Underlying adhesions are inflammatory bands that connect opposite sides of serous surfaces after trauma or surgery. A)true,skin B)false,skin

Underlying adhesions are inflammatory band that occur after trauma or surgery. A)true B)false

Veins usually are not seen, but a fine venous network may be visible in thin persons. A)true B)false

Prominent, dilated veins occur with portal hypertension, cirrhosis, ascites, or vena caval obstruction. A)true B)false

Veins are more visible with malnutrition as a result of thinned adipose tissue. A)true B)false

Veins are more visible with malnutrition. A)true B)false

Good skin turgor reflects healthy nutrition. Gently pinch up a fold of skin; then release to note the skin's immediate return to original position. A)true B)false

Poor turgor occurs with dehydration, which often accompanies Gl disease. A)true B)false

Poor turgor occurs with dehydration. A)true B)false

Pulsation or Movement

Normally, you may see the pulsations from the aorta beneath the skin in the epigastric area, particularly in thin persons with good muscle wall relaxation. Respiratory movement also shows in the abdomen, particularly in males. A)true B)false

Normally, you may see the pulsations from the aorta beneath the skin in the epigastric area, particularly in thin persons with good muscle wall relaxation. A)true B)false

Respiratory movement also shows in the abdomen, particularly in males. A)true B)false

Finally, waves of peristalsis sometimes are visible in very thin persons. They ripple slowly and obliquely across the abdomen. A)true B)false

Marked pulsation of aorta occurs with widened pulse pressure (e.g., hypertension, aortic insufficiency, thyrotoxicosis) and with aortic aneurysm. A)abnormal finding B)normal finding

Marked pulsation of aorta occurs with widened pulse pressure which is hypertension, aortic insufficiency, thyrotoxicosis and aortic aneurysm. A)true B)false

Marked visible peristalsis, together with a distended abdomen, indicates intestinal obstruction. A)abnormal finding B)normal finding

Hair Distribution

The pattern of pubic hair growth normally has a diamond shape in adult males. A)true B)false

pubic hair shape shows an inverted triangle shape in adult females A)true B)false

Patterns alter with endocrine or hormone abnormalities, chronic liver disease. A)Hair Distribution, abnormal finding B)false

Demeanor

A comfortable person is relaxed quietly on the examining table and has a benign facial expression and slow, even respirations. A)true B)false

Restlessness and constant turning to find comfort occur with the colicky pain of gastroenteritis or bowel obstruction. A)abnormal finding of dmenour B)false

Restlessness and constant turning to find comfort occur with the colicky pain of ___________ or ___________.

gastroenteritis or bowel obstruction.

Absolute stillness, resisting any movement, occurs with the pain of peritonitis A)true B)false

Absolute stillness, resisting any movement, occurs with the pain of _________

peritonitis

Knees flexed up, facial grimacing, and rapid, uneven respirations also indicate pain. A)true B)false

Knees flexed up, facial grimacing, and rapid, uneven respirations also indicate _______.

pain

AUSCULTATE BOWEL SOUNDS AND VASCULAR SOUNDS

Depart from the usual examination sequence and auscultate the abdomen next. This is done because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds. A)true B)false

Inspection is first then auscultation is next because of palpitation and percussion can increase peristalsis which can give false test result. A)true B)false

Use the diaphragm end piece because bowel sounds are relatively high-pitched. Hold the stethoscope lightly -against the skin; pushing too hard may stimulate more bowel sounds A)true B)false

Hold the stethoscope lightly -against the skin; pushing too hard may stimulate more bowel sounds A)true B)false

Begin in the RLQ at the ileocecal valve area because bowel sounds are normally always present here. A)true B)false

RLQ at the ileocecal valve area bowel sounds are normally always present here. A)true B)false

Bowel Sounds

Bowel sounds originate from the movement of air and fluid through the small intestine. A)true B)false

Bowel sounds are high-pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute. Do not bother to count them. Judge if they are normal, hypoactive, or hyperactive A)true B)false

One type of hyperactive bowel sounds is fairly common. This is the hyperperistalsis when you feel your "stomach growling," termed borborygmus. A)true B)false

One type of hyperactive bowel sounds is fairly common. This is the hyperperistalsis when you feel your "stomach growling," is termed ______.

borborygmus

A perfectly "silent abdomen" is uncommon; you must listen for 5 minutes by your watch before deciding bowel sounds are completely absent. A)true B)false

A perfectly "silent abdomen" is uncommon; you must listen for 5 minutes before deciding bowel sounds are completely absent. A)true B)false

Two distinct patterns of abnormal bowel sounds may occur. Hypoactive and hyperactive A)true B)false

Hyperactive sounds are loud, highpitched, rushing, tinkling sounds that signal increased motility. A)true B)false

_________ Bowel sounds are loud, highpitched, rushing, tinkling sounds that signal increased motility.

Hyperactive

Hypoactive or absent sounds follow abdominal surgery or with inflammation of the peritoneum. A)true B)false

______ bowel sounds follow abdominal surgery or with inflammation of the peritoneum

Hypoactive or absent

Vascular Sounds

As you listen to the abdomen, note the presence of any vascular sounds or bruits. Using firmer pressure, check over the aorta, renal arteries, iliac, and femoral arteries, especially in people with hypertension. A)true B)false

Usually, no such sound is present. However, a small number of healthy persons (usually younger than 40 years) may have a normal bruit originating from the celiac artery.This is systolic, medium to low in pitch, and heard between the xiphoid 30 process and the umbilicus. A)true B)false

celiac artery.This is systolic, medium to low in pitch, and heard between the xiphoid process and the umbilicus. A)true B)false

Note location, pitch, and timing of a vascular sound. A)true B)false

A systolic bruit is a pulsatile blowing sound and occurs with stenosis or occlusion of an artery. A)true B)false

A _________ bruit is a pulsatile blowing sound and occurs with stenosis or occlusion of an artery.

systolic

Venous hum and peritoneal friction rub are rare . A)true B)false

PERCUSS GENERAL TYMPANY, LIVER SPAN, AND SPLENIC DULLNESS

Percuss to assess the relative density of abdominal contents, to locate organs, and to screen for abnormal fluid or masses. A)true B)false

General Tympany

First, percuss lightly in all four quadrants to determine the prevailing amount of tympany and dullness. A)true B)false

Move clockwise. When percussing. A)true B)false

Tympany should predominate because air in the intestines rises to the surface when the person is supine. A)true B)false

Dullness occurs over a distended bladder, adipose tissue, fluid, or a mass. A)true B)false

_________ Sound on the abdomen occurs over a distended bladder, adipose tissue, fluid, or a mass.

Dullness

Hyperresonance is present with gaseous distention. A)true B)false

______ Sound is present with gaseous distention.

Hyperresonance

Liver Span

Measure the height of the liver in the right midclavicular line. (For a consistent placement of the midclavicular line landmark, remember to palpate the acromioclavicular and the sternoclavicular joints and judge the line at a point midway between the two.) A)true B)false

Begin in the area of lung resonance, and percuss down the interspaces until the sound changes to a dull quality. Mark the spot, usually in the fifth intercostal space. A)liver span B)heart span

Then find abdominal tympany and percuss up in the midclavicular line. Mark where the sound changes from tympany to a dull sound, normally at the right costal margin. A)liver span B)heart span

Measure the distance between the two marks; the normal liver span in the adult ranges from 6 to 12 cm A)true B)false

6 to 12 cm for normal adult liver span A)true B)false

The height of the liver span correlates with the height of the person; taller people have longer livers. Also males have a larger liver span than females of the same height. A)true B)false

taller people have longer livers. Also males have a larger liver span than females of the same height. A)true B)false

An enlarged liver span indicates liver enlargement or hepatomegaly. A)true B)false

An enlarged liver span indicates hepatomegaly. A)true B)false

Accurate detection of liver borders is confused by dullness above the fifth intercostal space, which occurs with lung disease (e.g., pleural effusion or consolidation). A)true B)false

Accurate detection at the lower border if the liver is confused when dullness is pushed up with ascites or pregnancy or with gas distention in the colon, which obscures the lower border. A)true, B)false

Accurate detection at the lower border of the liver is confused when dullness of ascites, pregnancy, gas distention in the colon, which obscures the lower border. A)true B)false

One variation occurs in people with chronic emphysema, in which the liver is displaced downward by the hyperinflated lungs. Although you hear a dull percussion note well below the right costal margin, the overall span is still within normal limits. A)TRUE B)false

people with chronic emphysema, the liver is displaced downward by the hyperinflated lungs. Although you hear a dull percussion note well below the right costal margin, the overall span is still within normal limits. A)true B)false

Clinical estimation of liver span screens for hepatomegaly and monitors changes in liver size. However, this measurement is a gross estimate; the liver span usually is underestimated because of inaccurate detection of the upper border. A)true B)false

the liver span usually is underestimated because of inaccurate detection of the upper border. A)true B)false

Scratch Test. Although traditionally taught, this technique does not work to identify the liver border. It uses a repeated scratching sound from your fingernail along the patient's abdomen; when the sound is magnified in the stethoscope, it was thought to define the lower liver border. However, evidence shows no correlation whatsoever between the liver edge by auscultation of scratches and the actual liver edge by ultrasound, A)true B)false

Splenic Dullness

Often the spleen is obscured by stomach contents, but you may locate it by percussing for a dull note from the ninth to eleventh intercostal space just behind the left midaxillary line. A)true B)false

The area of splenic dullness normally is not wider than 7 cm in the adult and should not encroach(include) on the normal tympany over the gastric air bubble. A)true B)false

A dull note forward of the midaxillary line indicates enlargement of the spleen, as occurs with mononucleosis, trauma, and infection. A)true B)false

Now percuss in the lowest interspace in the left anterior axillary line. Tympany should result. Ask the person to take a deep breath. Normally, tympany remains through full inspiration. A)true for spleen B)false

Now percuss in the lowest interspace in the left anterior axillary line of the spleen. Tympany should result. Ask the person to take a deep breath. Normally, tympany remains through full inspiration. A)true B)false

In this site, the anterior axillary line, a change in percussion from tympany to a dull sound with full inspiration is a positive spleen percussion sign, indicating splenomegaly. A)true B)false

the anterior axillary line, that has a change in percussion from tympany to a dull sound with full inspiration is a positive spleen percussion sign, indicating splenomegaly. A)true B)false

This method will detect mild to moderate splenomegaly before the spleen becomes palpable, as in mononucleosis, malaria, or hepatic cirrhosis.

positive spleen percussion sign,

the spleen becomes palpable, as in mononucleosis, malaria, or hepatic cirrhosis. A)true B)false

Costovertebral Angle Tenderness

Indirect fist percussion causes the tissues to vibrate instead of producing a sound. To assess the kidney, place one hand over the twelfth rib at the costovertebral angle on the back. A)true B)false

Place hand in region of CVA. Thump that hand with the ulnar edge of your other fist. The person normally feels a thud but no pain. (Although this step is explained here with percussion techniques, its usual sequence in a complete examination is with thoracic assessment, when the person is sitting up and you are standing behind.) A)assessing the kidney B)assessing the spleen

Sharp pain on percussion of CVA occurs with inflammation of the kidney or paranephric area. A)true B)false

Special Procedures

At times, you may suspect that a person has ascites (free fluid in the peritoneal cavity) because of a distended abdomen, bulging flanks, and an umbilicus that is protruding and displaced downward. You can differentiate ascites from gaseous distention by performing two percussion tests. A)true B)false

Ascites occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and cancer. A)true B)false

_________occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and cancer.

Ascites

Fluid Wave. First, test for a fluid wave by standing on the person's right side. Place the ulnar edge of another examiner's hand or the patient's own hand firmly on the abdomen in the midline. (This will stop transmission across the skin of the upcoming tap.) Place your left hand on the person's right flank. With your right hand, reach across the abdomen and give the left flank a firm strike. A)true B)false

If ascites is present, the blow will generate a fluid wave through the abdomen and you will feel a distinct tap on your left hand. If the abdomen is distended from gas or adipose tissue, you will feel no change. A)true B)false

If the abdomen is distended from gas or adipose tissue, you will feel no change.in a fluid wave test A)true B)false

A positive fluid wave test occurs with large amounts of ascitic fluid. A)true B)false

Shifting Dullness. The second test for ascites is percussing for shifting dullness. In a supine person, ascitic fluid settles by gravity into the flanks, displacing the air-filled bowel upward. You will hear a tympanitic note as you percuss over the top of the abdomen because gas-filled intestines float over the fluid. Then percuss down the side of the abdomen. If fluid is present, the note will change from tympany to dull as you reach its level. Mark this spot. A)true B)false

Now turn the person onto the right side (roll the person toward you). The fluid will gravitate to the dependent (in this case, right) side, displacing the lighter bowel upward. Begin percussing the upper side of the abdomen and move downward. The sound changes from tympany to a dull sound as you reach the fluid level, but this time the level of dullness is higher, upward toward the umbilicus. Mark the spot.This shifting level of dullness indicates the presence of fluid A)true B)false

Shifting dullness is positive with a large volume of ascitic fluid: it will not detect less than 500 ml of fluid. A)true B)false

A positive Shifting dullness is with a large volume of ascitic fluid: it will not detect less than 500 ml of fluid. A)true B)false

Both tests, fluid wave and shifting dullness, are not completely reliable. Ultrasound study is the definitive tool. A)true B)false

PALPATE SURFACE AND DEEP AREAS

Because most people are naturally inclined to protect the abdomen, you need to use additional measures to enhance complete muscle relaxation.;

1. Bend the person's knees. 2. Keep your palpating hand low and parallel to the abdomen. Holding the hand high and pointing down would make anyone tense up. 3. Teach the person to breathe slowly (in through the nose, and out through the mouth).

Help relax abdomen

4. Keep your own voice low and soothing. Conversation may relax the person. 5. Try "emotive imagery." For example, you might say, "Now I want you to imagine you are dozing on the beach, with the sun warming your muscles and the sound of the waves lulling you to sleep. Let yourself relax."

To relax the abdomen

6. With a very ticklish person, keep the person's hand under your own with your fingers curled over his or her fingers. Move both hands around as you palpate; people are not ticklish to themselves. A)true B)false

7. Alternatively, perform palpation just after auscultation. Keep the stethoscope in place and curl your fingers around it, palpating as you pretend to auscultate. People do not perceive a stethoscope as a ticklish object. You can slide the stethoscope out when the person is used to being touched.

To relax the abdomen

light and Deep Palpation of the abdomen

Begin with light palpation. With the first four fingers close together, depress the skin about 1 cm. Make a gentle rotary motion, sliding the fingers and skin together. Then lift the fingers (do not drag them) and move clockwise to the next location around the abdomen. A)true B)false

Do not drag fingers when percussing A)true B)false

The objective here is not to search for organs but to form an overall impression of the skin surface and superficial musculature. A)palpating the abdomen B)palpating the spleen

Save the examination of any identified tender areas until last. This method avoids pain and the resulting muscle rigidity that would obscure deep palpation later in the examination. A)true B)false

Muscle guarding. Rigidity. Large masses. Tenderness. Are all abnormal finding when palpating the abdomen light and deep surface. A)true B)false

As you circle the abdomen, discriminate between voluntary muscle guarding and involuntary rigidity. A)true B)false

Voluntary guarding occurs when the person is tense, or ticklish. It is bilateral, and you will feel the muscles relax slightly during exhalation. Use the relaxation measures to try to eliminate this type of guarding, or it will interfere with deep palpation. If the rigidity persists, it is probably involuntary. A)true B)false

If the rigidity persists on the palpitation of the abdomen even with the respiration technique, it is probably involuntary. A)true B)false

Involuntary rigidity is a constant, boardlike hardness of the muscles. It is a protective mechanism accompanying acute inflammation of the peritoneum. It may be unilateral, and the same area usually becomes painful when the person increases intra-abdominal pressure by attempting a sit-up. A)true B)false

____________ rigidity is a constant, boardlike hardness of the muscles. It is a protective mechanism accompanying acute inflammation of the peritoneum. It may be unilateral, and the same area usually becomes painful when the person increases intra-abdominal pressure by attempting a sit-up.

Involuntary | Abnormal finding

Now perform deep palpation using the same technique described earlier, but push down about 5 to 8 cm (2 to 3 inches). Moving clockwise, explore the entire abdomen. A)true B)false

To overcome the resistance of a very large or obese abdomen, use a bimanual technique. Place your two hands on top of each other. The top hand does the pushing; the bottom hand is relaxed and can concentrate on the sense of palpation. A) true B)fals

With either technique, note the location, size, consistency, and mobility of any palpable organs and the presence of any abnormal enlargement, tenderness, or masses. A)true B)false

Inexperienced examiners complain that the abdomen "all feels the same," as if they are pushing their hand into a soft sofa cushion. It helps to memorize the anatomy and visualize what is under each quadrant as you palpate. Also remember that some structures are normally palpable,. A)true B)false

Mild tenderness normally is present when palpating the sigmoid colon. Any other tenderness should be investigated. A)true B)false

Tenderness occurs with local inflammation, with inflammation of the peritoneum or underlying organ, and with an enlarged organ whose capsule is stretched. A)true,abnormal finding when palpating the abdomen B)false

If you identify a mass, first distinguish it from a normally palpable structure or an enlarged organ. Then note the following:

l. Location 2. Size 3. Shape 4. Consistency (soft, firm, hard) 5. Surface (smooth, nodular) 6. Mobility (including movement with respirations) 7. Pulsatility 8. Tenderness

Liver

Next, palpate for specific organs, beginning with the liver in the RUQ. A)true B)false

Place your left hand under the person's back parallel to the eleventh and twelfth ribs and lift up to support the abdominal contents. Place your right hand on the RUQ, with fingers parallel to the midline. Push deeply down and under the right costal margin. Ask the person to breathe slowly. With every exhalation, move your palpating hand up 1 or 2 cm. A)true B)false

It is normal to feel the edge of the liver bump your fingertips as the diaphragm pushes it down during inhalation. It feels like a firm, regular ridge. Often, the liver is not palpable and you feel nothing firm. A)true B)false

Except with a depressed diaphragm, a liver palpated more than 1 to 2 cm below the right costal margin is enlarged. Record the number of centimeters it descends and note its consistency (hard, nodular) and tenderness. A)abnormal finding of the the liver B)normal finding of the liver

a depressed diaphragm, makes the liver palpated more than 1 to 2 cm below the right costal margin is enlarged. Record the number of centimeters it descends and note its consistency (hard, nodular) and tenderness. A)abnormal finding of the liver B)normal finding of the liver

Hooking Technique. An alternative method of palpating the liver is to stand up at the person's shoulder and swivel your body to the right so that you face the person's feet. Hook your fingers over the costal margin from above. Ask the person to take a deep breath. Try to feel the liver edge bump your fingertips. A)true B)false

Spleen

Normally, the spleen is not palpable and must be enlarged three times its normal size to be felt. A)true B)false

To search for the spleen, reach your left hand over the abdomen and behind the left side at the eleventh and twelfth ribs. Lift up for support. Place your right hand obliquely on the LUQ with the fingers pointing toward the left axilla and just inferior to the rib margin. Push your hand deeply down and under the left costal margin and ask the person to take a deep breath. You should feel nothing firm. A)true B)false

The spleen enlarges with mononucleosis, trauma, leukemias, and lymphomas. A)true B)false

If you feel an enlarged spleen, refer the person but do not continue to palpate it. An enlarged spleen is friable and can rupture easily with over palpation. A)true B)false

Describe the number of centimeters that the spleen extends below the left costal margin. A)abnormal finding results B)normal finding results

When enlarged, the spleen slides out and bumps your fingertips. It can grow so large that it extends into the lower quadrants. When this condition is suspected, start low so you will not miss it. An alternative position is to rolI the person onto his or her right side to displace the spleen more forward and downward. Then palpate as described earlier. A)true B)false

When the spleen is enlarged it slides out and bumps your fingertips. It can grow so large that it extends into the lower quadrants. When this condition is suspected, start low so you will not miss it. An alternative position is to rolI the person onto his or her right side to displace the spleen more forward and downward. Then palpate as described earlier. A)true B)false

Kidneys

Search for the right kidney by placing your hands together in a "duck-bill" position at the person's right flank. Press your two hands together firmly (you need deeper palpation than that used with the liver or spleen) and ask the person to take a deep breath. In most people, you will feel no change. A)true B)false

Occasionally, you may feel the lower pole of the right kidney as a round, smooth mass slide between your fingers. Either condition is normal. A)true B)false

Enlarged kidney. Kidney mass. Are abnormal findings on palpating A)true B)false

The left kidney sits 1 cm higher than the right kidney and is not palpable normally. A)true B)false

Search the left kidney by reaching your left hand across the abdomen and behind the left flank for support. Push your right hand deep into the abdomen and ask the person to breathe deeply. You should feel no change with the inhalation. A)true B)false

Aorta

Using your opposing thumb and fingers, palpate the aortic pulsation in the upper abdomen slightly to the left of midline. Normally, it is 2.5 to 4 cm wide in the adult and pulsates in an anterior direction. A)true B)false

Abnormal finding of the aorta is Widened with aneurysm. A)true B)false

Prominent lateral pulsation with aortic aneurysm pushes the examiner's two fingers apart. A)abnormal finding of the aorta B)normal findings of the aorta

Special Procedures for Advanced Practice

``` Rebound Tenderness (Blumberg Sign). Assess rebound tenderness when the person reports abdominal pain or when you elicit tenderness during palpation. A)true B)false ```

Rebound Tenderness ( _____________). Assess rebound tenderness when the person reports abdominal pain or when you elicit tenderness during palpation

Blumberg Sign

Choose a site away from the painful area. Hold your hand 90 degrees, or perpendicular, to the abdomen. Push down slowly and deeply; then lift up quickly. This test is called Blumberg Sign (rebound) A)true B)false

Choose a site away from the painful area. Hold your hand 90 degrees, or perpendicular, to the abdomen. Push down slowly and deeply; then lift up quickly. This test is called

Blumberg Sign (rebound)

This makes structures that are indented by palpation rebound suddenly. A normal, or negative, response is no pain on release of pressure. Perform this test at the end of the examination, because it can cause severe pain and muscle rigidity.

Blumberg Sign (rebound)

Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation. Peritoneal inflammation accompanies appendicitis. A)true B)false

Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation. A)true B)false

. Peritoneal inflammation accompanies appendicitis. A)true B)false

Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation. Peritoneal inflammation accompanies appendicitis. This is a positive Blumberg Sign A)true B)false

Cough tenderness that is localized to a specific spot also signals peritoneal irritation. Refer the person with suspected appendicitis for computed tomography (CT) scanning. A)true B)false

Cough tenderness that is localized to a specific spot also signals peritoneal irritation. A)true B)false

Refer the person with suspected appendicitis for computed tomography (CT) scanning. A)true B)false

``` Inspiratory Arrest (Murphy Sign). Normally, palpating the liver causes no pain. In a person with inflammation of the gallbladder (cholecystitis), pain occurs. A)true B)false ```

``` Inspiratory Arrest (Murphy Sign). In a person with inflammation of the gallbladder (cholecystitis), pain occurs. A)true B)false ```

(Murphy Sign).is positive. In a person with inflammation of the gallbladder (cholecystitis), pain occurs A)true B)false

Hold your fingers under the liver border. Ask the person to take a deep breath. A normal response is to complete the deep breath without pain. (Note: This sign is Less accurate in patients older than 60 years; evidence shows that 25% of them do not have any abdominal tenderness. A)Murphy sign test B)false

When the test is positive, as the descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway. This test is called

Murphy sign

Iliopsoas Muscle Test. Perform the iliopsoas muscle test when the acute abdominal pain of appendicitis is suspected. A)true B)false

. Perform the ________[_ when the acute abdominal pain of appendicitis is suspected

Iliopsoas Muscle Test

With the person supine, lift the right leg straight up, flexing at the hip; then push down over the lower part of the right thigh as the person tries to hold the leg up. When the test is negative, the person feels no change.testing for appendicitis. This test is called

Iliopsoas Muscle Test

(Note: Evidence shows that the Obturator Test, another technique that stretches the obturator muscle, does not work to diagnose appendicitis. A)true B)false

( Obturator Test, does not work to diagnose appendicitis) A)true B)false

When the iliopsoas muscle is inflamed (which occurs with an inflamed or perforated appendix), pain is felt in the right lower quadrant. A)true B)false

When the iliopsoas muscle is inflamed (which occurs with an inflamed or perforated appendix), pain is felt in the right lower quadrant. This a positive sign of iliopsoas muscle test A)true B)false

DEVELOPMENTAL COMPETENCE | The Infant

Inspection. The contour of the abdomen is protuberant because of the immature abdominal musculature. The skin contains a fine, superficial venous pattern. This may be visible in lightly pigmented children up to the age of puberty A)infant B)adult

Scaphoid shape of infant occurs with dehydration. A)true B)false

Dilated veins on the abdomen of the infant is an abnormal finding. A)true B)false

Inspect the umbilical cord throughout the neonatal period. At birth, it is white and contains two umbilical arteries and one vein surrounded by mucoid connective tissue, called Wharton's jelly. A)true B)false

umbilical arteries and one vein are surrounded by mucoid connective tissue, called Wharton's jelly. A)true B)false

The umbilical stump dries within a week, hardens, and falls off by 10 to 14 days. Skin covers the area by 3 to 4 weeks. A)true B)false

The presence of only one artery in the umbilical signals the risk for congenital defects. A)true B)false

Inflammation. Drainage after cord falls off. Is abnormal finding of the infant umbilical cord A)true B)false

The abdomen should be symmetric, although two bulges are common. You may note an umbilical hernia. It appears at 2 to 3 weeks and is especially prominent when the infant cries. The hernia reaches maximum size at 1 month (up to 2.5 cm or 1 inch) and usually disappears by 1 year. A)true B)false

The abdomen should be symmetric, although two bulges are common. In an infant A)true B)false

You may note an umbilical hernia. It appears at 2 to 3 weeks and is especially prominent when the infant cries. The hernia reaches maximum size at 1 month (up to 2.5 em or 1 inch) and usually disappears by 1 year. A)true B)false

Another common variation is diastasis recti, a separation of the rectus muscles with a visible bulge along the midline. The condition is more common with Black infants, and it usually disappears by early childhood. A)true B)false

Another common variation is __________, a separation of the rectus muscles with a visible bulge along the midline. The condition is more common with Black infants, and it usually disappears by early childhood. A)true B)false

diastasis recti

a separation of the rectus muscles with a visible bulge along the midline. The condition is more common with Black infants, and it usually disappears by early childhood.

diastasis recti

diastasis recti is common among black infants A)true B)false

Refer any umbilical hernia larger than 2.5 cm; continuing to grow after 1 month; or lasting for more than 2 years in a white child or for more than 7 years in a Black child. A)true B)false

Refer any umbilical hernia larger than 2.5 cm continuing to grow after 1 month; A)abnormal finding B)normal finding

Refer any umbilical hernia larger than 2.5 cm lasting for more than 2 years in a white child A)abnormal finding B)normal finding

Refer any umbilical hernia larger than 2.5 cm for more than 7 years in a Black child. A)abnormal finding B)normal finding

The abdomen shows respiratory movement. The only other abdominal movement you should note is occasional peristalsis, which may be visible because of the thin musculature. A)infant B)adult

In the infant, The abdomen shows respiratory movement. The only other abdominal movement you should note is occasional peristalsis, which is because of the thin musculature. A)true B)false

Marked peristalsis with pyloric stenosis in an abnormal finding of an infant A)true B) false

Auscultation. Auscultation yields only bowel sounds, the metallic tinkling of peristalsis. No vascular sounds should be heard. A)assessing an infant B)assessing an adult

In an infant, Auscultation yields only bowel sounds, the metallic tinkling of peristalsis. No vascular sounds should be heard. A)true B)false

Bruit. Venous hum. On the abdomen of an infant is an abnormal finding. A)true B)false

. Percussion finds tympany over the stomach (the infant swallows some air with feeding) and dullness over the liver. Percussing the spleen is not done. The abdomen sounds tympanitic, although it is normal to percuss dullness over the bladder. This dullness may extend up to the umbilicus. A)true, infant B)false

In an infant Percussion finds tympany over the stomach (the infant swallows some air with feeding) and dullness over the liver. A)true B)false

Percussing the spleen is not done. On an infant. A)true B)false

The abdomen sounds tympanitic, although it is normal to percuss dullness over the bladder. This dullness may extend up to the umbilicus. A)in an infant B)in an adult

Aid palpation of the abdomen by flexing the baby's knees with one hand while palpating with the other. A)true B)false

Alternatively, you may hold the upper back and flex the neck slightly with one hand. for palpating the abdomen.Offer a pacifier to a crying baby. A)true B)false

The liver fills the RUQ. It is normal to feel the liver edge at the right costal margin or 1 to 2 cm below. A)true for an infant B)false for an infant

Normally, you may palpate the spleen tip and both kidneys and the bladder. A)true for infant B)false for infant

Also easily palpated are the cecum in the RLQ, and the sigmoid colon, which feels like a sausage in the left inguinal area. A)infant B)adult

Make note of the newborn's first stool, a sticky, greenish black meconium stool within 24 hours of birth. A)true B)false

The infant first 24hrs stool should be meconium greenish black. For an infant A)true B)false

By the fourth day, stools of breastfed babies are golden yellow, pasty, and smell like sour milk, A)true B)false

Breast fed infant stools are golden yellow, pasty and smell like sour milk. A)true B)false

formula-fed babies are brown-yellow, firmer, and more fecal smelling. A)true B)false

DEVELOPMENTAL COMPETENCE | The Child

Younger than 4 years, the abdomen looks protuberant when the child is both supine and standing. A)true B)false

After age 4 years, the potbelly remains when standing because of lumbar lordosis but the abdomen looks flat when supine. A)true B)false

Normal movement on the abdomen includes respirations, which remain abdominal until 7 years of age. A)true B)false

Abdomen respirations are viewed until the age of 7 A)true B)false

A scaphoid abdomen is associated with dehydration or malnutrition. A)true B)false

In the child a scaphoid abdomen is associated with dehydration or malnutrition. A)true B)false

Younger than 7 years, the absence of abdominal respirations occurs with inflammation of the peritoneum. A)true B)false

In a child that is younger than 7 years old, the absence of abdominal respirations occurs with inflammation of the peritoneum. A)true B)false

To palpate the abdomen, position the young child on the parent's lap as you sit knee-to-knee with the parent. Flex the knees up, and elevate the head slightly. The child can "pant like a dog" to further relax abdominal muscles. A)true B)false

Hold your entire palm flat on the abdominal surface for a moment before starting palpation. This accustoms the child to being touched. If the child is very ticklish, hold his or her hand under your own as you palpate, or apply the stethoscope and palpate around it. A)true B)false

The liver remains easily palpable 1 to 2 cm below the right costal margin. The edge is soft and sharp and moves easily. A)child B)false

On the left, the spleen also is easily palpable with a soft, sharp, movable edge. A)true for child B)false

Usually you can feel 1 to 2 cm of the right kidney and the tip of the left kidney. A)true for child B)false for child

Percussion of the liver span measures about 3.5 cm at age 2 years, 5 cm at age 6 years, and 6 to 7 cm during adolescence. A)true B)false

Percussion of the liver span measures about 3.5 cm at age 2 years, A)true B)false

Percussion of the liver span measures about, 5 cm at age 6 years. A)true B)false

Percussion of the liver span measures about 6 to 7 cm during adolescence. A)true B)false

In assessing abdominal tenderness, remember that the young child often answers this question affirmatively no matter how the abdomen actually feels. Use objective signs to aid assessment, such as a cry changing in pitch as you palpate, facial grimacing, moving away from you, and guarding. A)true B)false

The school-age child has a slim abdominal shape as he or she loses the potbelly. This slimming trend continues into adolescence. The adolescent easily is embarrassed with exposure of the abdomen, and adequate draping is necessary. The physical findings are the same as those listed for the adult. A)true B)false

The adolescent easily is embarrassed with exposure of the abdomen, and adequate draping is necessary. The physical findings are the same as those listed for the adult. A)true B)false

DEVELOPMENTAL COMPETENCE | The Aging Adult

On inspection, you may note increased deposits of subcutaneous fat on the abdomen and hips because it is redistributed away from the extremities. A)true for aging adult B)false for aging adult

The abdominal musculature is thinner and has less tone than that of the younger adult; thus, in the absence of obesity, you may note peristalsis. A)aging adult B)false

Because of the thinner, softer abdominal wall, the organs may be easier to palpate (in the absence of obesity). A)aging adult B)false

The liver is easier to palpate. Normally, you will feel the liver edge at or just below the costal margin. A)aging adult B)false

With distended lungs and a depressed diaphragm, the liver is palpated lower, descending 1 to 2 cm below the costal margin with inhalation. A)true for aging adult B)false for aging adult

The kidneys are easier to palpate. In the aging adult A)true B)false

Abdominal rigidity with acute abdominal conditions is less common in aging. A)true B)false

With an acute abdomen, the aging person often complains of less pain than a younger person would. A)true B)false

PROMOTING A HEAL THY LIFESTYLE | How's Your Liver Doing?

The liver is the largest internal organ in the body. A)true B)false

It has an immense capacity to heal and regenerate, but that capacity is not infinite. A)liver B)kidney

There are many things an individual can do to protect the liver:

1. Practice safe sex 2. Do not share items that may have bodily fluids on them. 3. Be aware of your environment. 4. Watch your diet and weight 5. Travel wisely 6. Use medications wisely 7. Do not mix medications without consulting a health care provider. 8. Drink alcohol only in moderation 9. Do not mix medications and alcohol 10. Do not use illegal drugs. 11. Get vaccinated. 12. Be aware of your risk for hepatitis.

The three leading causes of hepatitis are hepatitis A (HAV), hepatitis B (HBV), and hepatitis C (HCV) infection. A)true B)false

ABNORMAL FINDINGS

Abdominal Distention

Inspection. Uniformly rounded. Umbilicus sunken (it adheres to peritoneum, and layers of fat are superficial to it). Auscultation. Normal bowel sounds. Percussion. Tympany. Scattered dullness over adipose tissue. Palpation. Normal. May be hard to feel through thick abdominal wall. This condition is

Obesity

Inspection. Single round curve. Auscultation. Depends on cause of gas, e.g., decreased or absent bowel sounds with ileus; hyperactive with early intestinal obstruction. Percussion. Tympany over large area. Palpation. May have muscle spasm of abdominal wall. This condition is

Air or Gas

Inspection. Single curve. Everted umbilicus. Bulging flanks when supine. Taut, glistening skin; recent weight gain; increase in abdominal girth. Auscultation. Normal bowel sounds over intestines. Diminished over ascitic fluid. Percussion. Tympany at top where intestines float. Dull over fluid. Produces fluid wave and shifting dullness. Palpation. Taut skin and increased intra-abdominal pressure Limit palpation. This condition is

Ascites

Inspection. Curve in lower half of abdomen, midline. Everted umbilicus. Auscultation. Normal bowel sounds over upper abdomen where intestines pushed superiorly. Percussion. Top dull over fluid. Intestines pushed superiorly. Large cyst produces fluid wave and shifting dullness. Palpation. Transmits aortic pulsation, whereas ascites does not. This condition is

Ovarian Cyst (large)

Inspection. Single curve. Umbilicus protruding. Breasts engorged. Auscultation. Fetal heart tones. Bowel sounds diminished. Percussion. Tympany over intestines. Dull over enlarging uterus. Palpation. Fetal parts. Fetal movements. This is

Pregnancy

Inspection. Localized distention. Auscultation. Normal bowel sounds. Percussion. Tympany predominates. Scattered dullness over fecal mass. Palpation. Plastic-like or rope-like mass with feces in intestines. This is

Feces

Inspection. Localized distention. Auscultation. Normal bowel sounds. Percussion. Dull over mass if reaches up to skin surface. Palpation. Define borders. Distinguish from enlarged organ or normally palpable structure. This is a

Tumor

ABNORMAL FINDINGS FOR ADVANCED PRACTICE

Common Sites of Referred Abdominal Pain

___________ may have mild to moderate, dull pain in right upper quadrant or epigastrium, along with anorexia, nausea, malaise, low-grade fever.

Liver. Hepatitis

___________is a complex of symptoms of esophagitis, including burning pain in midepigastrium or behind lower sternum that radiates upward, or "heartburn." Occurs 30 to 60 minutes after eating; aggravated by lying down or bending over

Gastroesophageal reflux disease (GERD)

____________ is biliary colic, sudden pain in right upper quadrant that may radiate to right or left scapula, and which builds over time, lasting 2 to 4 hours, after ingestion of fatty foods, alcohol, or caffeine. Associated with nausea and vomiting and with positive Murphy sign or sudden stop in inspiration with RUQ palpation.

Gallbladder. Cholecystitis

__________ has acute, boring midepigastric pain radiating to the back and sometimes to the left scapula or flank, severe nausea, and vomiting.

Pancreas. Pancreatitis

____________ typically has dull, aching, gnawing pain, does not radiate, may be relieved by food, and may awaken the person from sleep.

Duodenum. Duodenal ulcer

_________ pain is dull, aching, gnawing epigastric pain, usually brought on by food, radiates to back or substernal area. Pain of perforated ulcer is burning epigastric pain of sudden onset that refers to one or both shoulders.

Stomach. Gastric ulcer

_________ typically starts as dull, diffuse pain in periumbilical region that later shifts to severe, sharp, persistent pain and tenderness localized in RLQ (McBurney point). Pain is aggravated by movement, coughing, deep breathing; associated with anorexia, then nausea and vomiting, fever.

Appendix. Appendicitis

________ prompt a sudden onset of severe, colicky flank or lower abdominal pain

Kidney. Kidney stones

__________ has diffuse, generalized abdominal pain, with nausea, diarrhea.

Small intestine. Gastroenteritis

_________ has moderate, colicky pain of gradual onset in lower abdomen, bloating. Irritable bowel syndrome (IBS) has sharp or burning, cramping pain over a wide area; does not radiate. Brought on by meals, relieved by bowel movement.

Colon. Large bowel obstruction

Abnormalities on Inspection

is a soft, skin-covered mass, which is the protrusion of the omentum or intestine through a weakness or incomplete closure in the umbilical ring. It is accentuated by increased intra-abdominal pressure as with crying, coughing, vomiting, or straining, but the bowel rarely incarcerates or strangulates. It is more common in premature infants. A)Umbilical hernia B)ulcer

Most ___________ resolve spontaneously by 1 year; parents should avoid affixing a belt or coin at the hernia because this will not help closure and may cause contact dermatitis A)Umbilical hernia B)ulcer

In an adult, it occurs with pregnancy, with chronic ascites, or with chronic intrathoracic pressure (e.g., asthma, chronic bronchitis). A)umbilical hernia B)ulcer

A small, fatty nodule at epigastrium in midline, through the linea alba. Usually one can feel it rather than observe it. May be palpable only when standing. A) umbilical hernia B)Epigastric Hernia

A bulge near an old operative scar that may not show when person is supine but is apparent when the person increases intraabdominal pressure by a sit-up, by standing, or by the Valsalva maneuver. A)umbilical hernia B)lncisional Hernia

a midline longitudinal ridge, is a separation of the abdominal rectus muscles. Ridge is revealed when intraabdominal pressure is increased by raising head while supine. Occurs congenitally and as a result of pregnancy or marked obesity in which prolonged distention or a decrease in muscle tone has occurred. It is not clinically significant. A)Diastasis recti B)umbilical hernia

Abnormal Bowel Sounds

Unrelated to peristalsis, this is a very loud splash auscultated over the upper abdomen when the infant is rocked side to side. It indicates increased air and fluid in the stomach, as seen with pyloric obstruction or large hiatus hernia. A)Succussion Splash B)hernia splash

Marked peristalsis together with projectile vomiting in the newborn suggests pyloric stenosis, an obstruction of the stomach's pyloric valve. A)Succussion Splash B)hernia

_________ is a congenital defect and appears in the second or third week. After feeding, pronounced peristaltic waves cross from left to right, leading to projectile vomiting. Then one can palpate an olive-sized mass in the RUQ midway between the right costal margin and umbilicus. Refer promptly because of the risk for weight loss. A)Pyloric stenosis B)hernia

Diminished or absent bowel sounds signal decreased motility as a result of inflammation as seen with peritonitis; from paralytic ileus as following abdominal surgery; or from late bowel obstruction. Occurs also with pneumonia. A)Hypoactive Bowel Sounds B)hyperactive bowel sounds

Loud, gurgling sounds, "borborygmi," signal increased motility. They occur with early mechanical bowel obstruction (high-pitched), gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus. A)hypoactive bowel sounds B)Hyperactive Bowel Sounds

Friction Rubs and Vascular Sounds

A rough, grating sound, like two pieces of leather rubbed together, indicates peritoneal inflammation. Occurs rarely. Usually occurs over organs with a large surface area in contact with the peritoneum A)Peritoneal Friction Rub B)liver rub

Liver-friction rub over lower right rib cage, from abscess or metastatic tumor. A)true B)false

Spleen-friction rub over lower left rib cage in left anterior axillary line, from abscess, infection, or tumor. A)true B)false

Vascular Sounds abnormal findings

Arterial-a bruit indicates turbulent blood flow, as found in constricted, abnormally dilated, or tortuous vessels. Listen with the bell. A)true B)false

____________-murmur is harsh, systolic, or continuous and accentuated with systole. Note in person with hypertension.. A)aortic aneurysum B)renal stenosis C) partial occlusion

_____________-murmur is midline or toward flank, soft, low to medium pitch. A)aortic aneurysum B)renal artery stenosis C) partial occlusion

Partial occlusion of femoral arteries. Can have a bruit A)true B)false

________-occurs rarely. Heard in periumbilical region. Originates from inferior vena cava. Medium pitch, continuous sound, pressure on bell may obliterate it. May have palpable thrill. Occurs with portal hypertension and cirrhotic liver. A)Venous hum B)aortic obstruction

Palpation of Enlarged Organs

An enlarged, smooth, and nontender liver occurs with fatty infiltration, portal obstruction or cirrhosis, high obstruction of inferior vena cava, and lymphocytic leukemia. A)Enlarged Liver B)enlarged spleen

The liver feels enlarged and smooth but is tender to palpation with early heart failure, acute hepatitis, or hepatic abscess. A)enlarged liver B)enlarged spleen

An enlarged and nodular liver occurs with late portal cirrhosis, metastatic cancer, or tertiary syphilis. A)true B)false

An enlarged, tender gallbladder suggests acute cholecystitis. Feel it behind the liver border as a smooth and firm mass like a sausage, although it may be difficult to palpate because of involuntary rigidity of abdominal muscles. The area is exquisitely painful to fist percussion, and inspiratory arrest (Murphy sign) is present. A)Enlarged Gallbladder true B)Enlarged Gallbladder false

An enlarged, non tender gallbladder also feels like a smooth, sausagelike mass. It occurs when the gallbladder is filled with stones, as with common bile duct obstruction. A)true B)false

Because any enlargement superiorly is stopped by the diaphragm, the spleen enlarges down and to the midline. When extreme, it can extend down to the left pelvis. It retains the splenic notch on the medial edge. A)true Enlarged Spleen B)false

When splenomegaly occurs with acute infections (mononucleosis), it is moderately enlarged and soft, with rounded edges. A)true B)false

When the result of a chronic cause, the enlargement spleen is firm or hard, with sharp edges. A)true B)false

An enlarged spleen is usually not tender to palpation; it is tender only if the peritoneum is also inflamed. A)true B)false

Enlarged with hydronephrosis, cyst, or neoplasm. May be difficult to distinguish an enlarged kidney from an enlarged spleen because they have a similar shape. Both extend forward and down. However, the spleen may have a sharp edge, whereas the kidney never does. The spleen retains the splenic notch, whereas the kidney has no palpable notch. Percussion over the spleen is dull, whereas over the kidney it is tympanitic because of the overriding bowel. A)Enlarged Kidney true B)false

Most aortic aneurysms (>95%) are located below the renal arteries and extend to the umbilicus. A focal bulging >5 cm is palpable in about 80% of cases during routine physical examination and feels Like a pulsating mass in the upper abdomen just to the left of midline. You will hear a bruit. Femoral pulses are present but decreased. A)true Aortic Aneurysm B)false Aortic Aneurysm

Summary Checklist: Abdomen Examination

``` 1. Inspection Contour Symmetry Umbilicus Skin Pulsation or movement Hair distribution Demeanor ```

``` 2. Auscultation Bowel sounds Note a ny vascular sounds 3. Percussion Percuss all four quadrants Percuss borders of liver, spleen ```

4. Palpation Light palpation in all four quadrants Deeper palpation in all four quad rants Palpate for liver, spleen, kidneys

diastasis recti are common in infants and more common in black infants. A)true B)false

EXTRA INFORMATION

pyloric stenosis is an congenital narrowing of the pyloric sphincter A)true B)false

moles on the abdomen are common A)true B)false

pyrosis is a burning sensations in the upper abdomen A)true B)false

a scaphoid abdomen abnormally caves in or is sunken A)true B)false

the abdomen normally moves when breathing until the age of 7 years A)true B)false

older adults have a decrease salivation leading to dry mouth A)true B)false

the symptoms occurring with lactose intolerance include bloating and flatulence A)true B)false

``` The nurse's role relative to subjective data collection is to gather information to improve the patient's health status and to help determine the cause of the patient's current symptoms. Choose one of the following A True B False ```

Severe dehydration from nausea and vomiting, fever, and acute abdominal pain are potentially life-threatening symptoms that require prompt attention. A)true B)false

He or she would assess for signs of hypovolemia including postural hypotension, poor skin turgor, thirst, sunken eyeballs, and weakness A)true B)false

The nurse assigns a nursing diagnosis of fluid volume deficit to an elderly female diagnosed with severe dehydration. Her vital signs are P 120, BP 84/52, respirations 24, and temperature 37.4°C. Which of the following interventions is appropriate for this patient? ``` Choose one of the following A Get a physical therapy consult B Monitor P and BP every 15 minutes until stable C Assess for signs of hypervolemia D Monitor intake and output and weights once a week ```

Which of the following people need to be vaccinated for Hepatitis A and B? ``` Choose one of the following A Food-service workers B Truck drivers C Office personnel D Animal care workers ```

Hepatitis A and B immunizations are recommended for all infants; people whose work may expose them to blood, body fluids, or unsanitary conditions (ie, health care, food services, sex workers); and those traveling to parts of the world where these illnesses are prevalent. A)true B)false

Abdominal organs are more easily palpated in children because the abdominal muscles are underdeveloped. ``` Choose one of the following A True B False ```

Which additional health history question related to the abdominal system is appropriate for people of African American descent? Choose one of the following A Do you have heartburn, indigestion, anorexia, or unplanned weight loss? B Do you or your parents have sickle cell disease or trait? C Is there any family history of gastric cancer? D Is there any personal or family history of ulcerative colitis or Crohn's disease?

The nurse is assessing a 36-year-old woman with right lower quadrant abdominal pain. The patient has no history of prior surgeries, has no allergies, and is physically fit. Which of the following should the nurse do during the abdominal examination? Choose one of the following A Do not distract the patient with questions while performing the examination B Observe the patient's face for signs of discomfort C Place the patient supine with arms extended up D Examine the abdomen with the patient's bladder full

Which organ that resides in the abdominal cavity stores red blood cells and platelets, produces new red blood cells and macrophages, and activates B and T lymphocytes? ``` Choose one of the following A Spleen B Liver C Pancreas D Gallbladder ```

Why is the appearance of urine important to evaluation during an abdominal examination? ``` Choose one of the following A Cloudy urine rules out UTI B Dark urine may be from dehydration C Sediment in the urine could indicate malnutrition D Blood could indicate cholecystitis ```

A woman brings her 18-month-old son into the clinic. He is diagnosed with lead poisoning. Which assessment finding supports this diagnosis? ``` Choose one of the following A The child has been eating play dough B The child has been eating glue C The child has been eating paper D The child has been eating paint chips ```

A patient has a history of multiple abdominal surgeries from a gunshot wound 3 years ago. He is currently reporting severe abdominal pain. Auscultation reveals high-pitched, rushing sounds. These sounds could be a sign of what? ``` Choose one of the following A Peritonitis B Partial bowel obstruction C Air under tension in a dilated bowel D Intestinal fluid in a dilated bowel ```

Increased bowel sounds occur with diarrhea and early intestinal obstruction. A)true B)false

Decreased bowel sounds occur with adynamic ileus and peritonitis A)true B)false

Some changes that appear on the skin of the abdomen as a result of pregnancy are what? Select all that apply. ``` Select all that apply: A Hemorrhoids B Linea nigra C Everted umbilicus D Striae E Inverted umbilicus ```

B C D

Absorption of nutrients takes place almost exclusively in the __________.

Small intestine

Which assessment questions are appropriate for people of Native American descent? Select all that apply. Select all that apply: A Do you drink alcohol? If so, how much and how often? B Is there any family history of gastric cancer? C Have you ever had yellow skin or yellow eyes? D Have you had liver disease, gallbladder disease, or pancreatitis? E Do you have diabetes?

A C D E

The easiest way to prevent hepatitis C is early vaccination. ``` Choose one of the following A True B False ```

Hepatitis C is the most common blood-borne viral infection in the United States. To date, no vaccine is available to prevent it. A)true B)false

The nurse is assessing an elderly woman for severe malnutrition. Which of the following factors increases this patient's risk for malnutrition? ``` Choose one of the following A She was recently diagnosed with a urinary tract infection (UTI) B She only eats 2,000 calories per day C Daughter shops for her only once a week D Limited access to a grocery store ```

The nurse is assessing a 50-year-old woman with severe abdominal pain and asks the patient if she has had any prior surgeries. The patient states that she had a hysterectomy 20 years ago. Why is this information relevant? Select all that apply. ``` Select all that apply: A It rules out infection B It shows increased risk for adhesions C It shows increased risk for obstructions D It shows increased risk for malabsorption E It rules out appendicitis ```

B C D

A mother is worried about her 14-year-old daughter's weight. The daughter weighs 80 kg. What can the nurse teach the mother about her daughter's eating habits? Select all that apply. Select all that apply: A Educate the family about the poor nutritional value of fast food B Supply nutritional information to her daughter C Teach the mother that adolescents rarely have diet-related problems such as iron deficiency and anemia D Tell the mother that girls require 3,500 calories per day E Supply only healthy foods in the house

A B E

Girls require 2,200 calories per day A)true B)false

The abdomen is divided into six quadrants by imaginary vertical and horizontal lines. ``` Choose one of the following A True B False ```

the student nurse is studying the liver.the primary function of the liver is to metabolize nutrients A)true B)false

the umbilical cord turns black before it falls off, this is a normal finding A)true B)false

the nurse includes questions about chest pain as part of an abdominal history because myocardial pain can be perceived as esophageal and stomach pain A)true B)false

defect or sac formed by dilation in artery wall due to atherosclerosis trauma or congenital defect. A)aneurysm B)anorexia

loss of appetite for food is called anorexia A)true B)false

lower border of rib margin formed by the medial edges of the 8th,9th and 10th ribs. A)costal margin B)CVA

angle formed by the 12th rib and the vertebral column on the posterior thorax, overlying the kidney A)CVA B)hernia

abnormal protrusion of bowel through weakening in abdominal musculature A)hernia B)linea alba

midline tendinous seam joining the abdominal musccles A)linea alba B)hernia

complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction A)paralytic ileus B)false

midline abdominal muscles extending from rib cage to pubic bone is called rectus abdominal muscle A)true B)falsse

``` liver right kidney ascending colon cecum uterus full bladder are all organs that are normally palpable ```

true

• Normal bowel sounds—high-pitched, gurgling, cascading sounds that occur irregularly from 5 to 30 times per minute. A)true B)False

• Hyperactive bowel sounds—loud, high-pitched, rushing, tinkling sounds that signal increased motility. A)true B)false

• Hypoactive bowel sounds—diminished or absent sounds that signal decreased motility. A)true B)false

• Succession splash—a very loud splash, not related to peristalsis, that is ausculated over the upper abdomen when the infant is rocked side to side; it indicates increased air and fluid in the stomach. A)true B)false

• Light palpation—depressing the skin about 1 cm, and, using a gentle rotary motion, move over the surface of the abdomen. A)true B)false

• Deep palpation—depressing the skin about 5 to 8 cm (2 to 3 inches), moving clockwise over the entire abdomen. A)true B)false

• Light palpation may reveal muscle guarding, rigidity, large masses, or tenderness. A)true B)false

• Deep palpation reveals the location, size, consistency, and mobility of any palpable organ, and the presence of any abnormal enlargement, tenderness, or masses. A)true B)False

• Involuntary rigidity is a constant boardlike hardness of the muscles; it is a protective measure that accompanies inflammation of the peritoneum, and can be unilateral. A)true B)false

• Voluntary guarding occurs when the person is cold, tense, or ticklish; it is bilateral, and you will feel the muscles relax slightly during exhalation. A)true B)false

straie,which occur when the elastic fibers in the reticular layer of the skin are broken after rapid or prolong stretching, have a distinct color when of a long duration. this color is A)silvery white B)purple blue

a positive blumberg sign indicates peritoneal inflammation A)true B)false

an intra-abdominal mass is located within the abdominal cavity or attached to an organ. A)true B)false

______________, forms a strip extending the length of the midline, and its edge is often palpable

rectus abdominis

rectus abdominis, forms a strip extending the length of the midline, and its edge is often palpable. A)true B)false