Abdomen Flashcards
Abdomen
,
STRUCTURE AND FUNCTION
,
SURFACE LANDMARKS
,
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
A
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
________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
The abdomen is a large, oval cavity extending from the diaphragm down to the brim of the pelvis.
A)true
B)false
A
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
A
Four layers of large, flat muscles form the ventral abdominal wall.
A)true
B)false
A
___________ are joined at the midline by a tendinous seam, the linea alba..
Four layers of large, flat muscles form the ventral abdominal wall
Four layers of large, flat muscles form the________ abdominal wall. These are joined at the midline by a tendinous seam, the linea alba
ventral
INTERNAL ANATOMY
,
Inside the abdominal cavity, all the internal organs are called the viscera.
A)true
B)false
A
all the internal organs in the Inside the abdominal cavity,are called the viscera
A)true
B)false
A
The solid viscera are those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus).
A)true
B)false
A
solid viscera maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus).
A)true
B)false
A
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus. Area
The solid viscera those that maintain a characteristic shape.
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
A
The _______ fills most of the right upper quadrant (RUQ) and extends over to the left midclavicular line.
liver
The lower edge of the liver and the right kidney normally may be palpable
A)true
B)false
A
The ovaries normally are palpable only on bimanual examination during the pelvic examination.
A)true
B)false
A
The _________ normally are palpable only on bimanual examination during the pelvic examination.
ovaries
The shape of the hollow viscera (stomach, gallbladder, small intestine, colon, and bladder) depends on the contents.
A)true
B)false
A
The shape of the hollow viscera depends on the contents.
A) true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
You can palpate the aortic pulsations in the upper anterior abdominal wall.
A)true
B)false
A
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
A
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
A
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
A
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
A
The twelfth rib forms an angle with the vertebral column, the costovertebral angle.CVA
A)true
B)false
A
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
A
The left kidney lies at the eleventh and twelfth ribs.
A)true
B)false
A
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
A
sometimes the right kidney may be palpable.
It lies 1-2 cm lower than the left because of the liver
A)true
B)false
A
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
A
epigastric for the area between the costal margins.
A)true
B)false
A
Area above the costal margins is called epigastric
A)true
B)false
A
hypogastric or suprapubic for the area above the pubic bone.
A)true
B)false
A
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
A
umbilical cord on a newborn shows prominently, it contains two artifices and one vein.
A)true
B)false
A
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
A
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
A
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
A
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
A
during early childhood, abdominal wall is less muscular, so its easier to palpate the organs.
A)true
B)false
A
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
A
Nausea and vomiting, or “morning sickness” is an early sign of pregnancy, starting between the first and second missed periods.
A)true
B)false
A
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
A
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
A
The constipation, as well as increased venous pressure in the lower pelvis, may lead to hemorrhoids in an pregnant woman
A)true
B)false
A
The enlarging uterus displaces the intestines upward and posteriorly. Bowel sounds are diminished.
A)true pregnant woman
B)false
A
The intestines in an pregnant woman is located upward and posteriorly. And bowel sounds are diminished also
A)true
B)false
A
Traditional thinking was that the appendix was displaced upward and to the right. But the appendix does not move.
A)true
B)false
A
clinical evidence has have shown that pregnancy does not change the location of the appendix.
A)true
B)false
A
Any appendicitis-related pain during pregnancy would still be felt in the right lower quadrant.
A)true
B)false
A
skin changes on the abdomen, such as striae and linea nigra are present doing pregnancy
A)true
B)false
A
DEVELOPMENTAL COMPETENCE
The Aging Adult
,
Aging alters the appearance of the abdominal wall.
A)true
B)false
A
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
A
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
A
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
A
Aging adults with sedentary lifestyle. Males show some fat deposits in the abdominal area, resulting in the “big belly.”
A) true
B)false
A
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
A
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
A
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
A
No great changes occur in the GI in aging adults unless, disease is present
A)true
B)false
A
Salivation decreases in aging adult causing a dry mouth and a decreased sense of taste.
A)true
B)false
A
Esophageal emptying is delayed. If an aging person is fed in the supine position, this increases risk for aspiration.
A)true
B)false
A
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
A
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
A
Gastric acid secretion decreases with aging. This may cause pernicious anemia, iron deficiency anemia, and malabsorption of calcium.
A)true
B)false
A
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
A
gallstones increases with age, occurring in 10% -20% of middle-aged and older adults, being more common in females.
A) true
B)false
A
Liver size decreases by 25% between the ages of 20 and 70 years, although most liver function remains normal.
A)true
B)false
A
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
A
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
A
enzymatic oxidation, reduction, and hydrolysis of drugs is substantially decreased with an aging adult.
A)true
B)false
A
Aging persons frequently report constipation; most prevalence estimates are between 12% and 19%.
A)true, aging adult
B)false,aging adult
A
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
A
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
A
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
A
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
A
CULTURE AND GENETICS
,
Lactase is the digestive enzyme necessary for absorption of the carbohydrate lactose (milk sugar).
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.
A)true
B)fase
A
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
A
Lactose insolence is at risk for crucial nutrients because dairy foods meet crucial nutritional requirements including calcium, magnesium, and potassium.
A)true
B)false
A
Obesity is the accumulation of excess body fat.
A)true
B)false
A
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
A
Among children, Mexican-American boys had a greater prevalence of overweight than had white or Black boys.
A)true
B)false
A
Mexican-American and Black girls were significantly more likely to be overweight than white girls.
A)true
B)false
A
No differences were found in overweight rates in men of various racial groups.
A)true
B)false
A
in adult women, Mexican Americans and African Americans were significantly more likely to be obese than were whites.
A)true
B)false
A
Obesity in adults results in comorbidities of type 2 diabetes and cardiovascular disease.
A)true
B)false
A
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
A
SUBJECTIVE DATA
,
- Appetite
- Dysphagia
- Food intolerance
- Abdominal pain
- Nausea/vomiting
- Bowel habits
A)subjective data
B)objective data
A
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
A
________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
A
________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
A
Food intolerance can be lactase deficiency resulting in bloating or excessive gas after taking milk products.
A)true
B)false
A
Do you use antacids? How often?
A)Pyrosis (heartburn), a burning sensation in esophagus and stomach, from reflux of gastric acid.
B)false
A
__________(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
A
Abdominal pain may be visceral from an internal organ (dull, general, poorly localized);
A) true
B)false
A
parietal from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement);
A) true abdominal pain
B) false
A
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
A
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
A
Chronic pain of gastric ulcers occurs usually on an empty stomach;
A)true
B) false
A
pain of duodenal ulcers occurs 2 to 3 hours after a meal and is relieved by more food.
A)true
B)false
A
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
A
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
A
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
A
Nausea/vomiting is common with GI disease, many medications, and with early pregnancy.
A)true
B)false
A
Is it bloody?
A)Hematemesis occurs with stomach or duodenal ulcers and esophageal varices.
B)false
A
Hematemesis occurs with stomach or duodenal ulcers and esophageal varices.
A)true
B)false
A
Is the nausea and vomiting associated with colicky pain, diarrhea, fever, chills?
A)assessing for nausea and vomiting
B) false
A
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
A
Bowel Habits
M
Bowel habits. How often do you have a bowel movement?
A)Assess usual bowel habits
B)false
A
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
A
Black stools may be tarry due to occult blood (melena) from GI bleeding or nontarry from iron medications.
A)true
B)false
A
Gray stools occur with hepatitis.
A)true
B)false
A
Red blood in stools occurs with GI bleeding or localized bleeding around the anus.
A)true
B)false
A
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
A
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
A
Peptic ulcer disease occurs with frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, smoking, and Helicobacter pylori infection.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
Irregular eating patterns are common and a source of parental anxiety.
A)infants
B)adults
A
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
C
Pica: Although a toddler may attempt nonfoods at some time, he or she should recognize edibles by age 2 years.
A)true
B)false
A
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
A
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
C
Abdominal pain accompanies inflammation of the bowel, constipation, urinary tract infection, and anxiety.
A)true
B)false
A
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
A
Do any others in family have a similar problem?
A)assessing for Family history of obesity.
B)false
A
How does child feel about his or her own weight?
A)Assess body image
B)false
A
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
A
How many calories do you figure you consume?
A)You probably cannot change adolescent eating pattern, but you can supply nutritional facts.
B)false
A
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
A
Boys need an average 4000 cal/day to maintain weight; more calories if exercise is pursued.
A)true
B)false
A
Girls need 20% (3200) fewer calories and the same nutrients as boys.
A)true
B)false
A
Fast food is high in fat, calories, and salt and has no fiber.
A)true
B)false
A
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
A
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
A
What is your activity pattern?
A)The anorectic may have healthy activity and exercise but often is hyperactive.
B) false
A
Is the weight loss associated with any other body change, such as menstrual irregularity?
A)Amenorrhea is common with anorexia nervosa
B)false
A
Amenorrhea is common with anorexia nervosa
A)true
B)false
A
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
A
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
A
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
A
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
A
Do you have any trouble swallowing these foods? What do you do right after eating: walk, take a nap?
A)assessing
B)false
A
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
A
What medications do you take?
A)Consider GI side effects (e.g., nausea, upset stomach, anorexia, dry mouth).
B)false
A
OBJECTIVE DATA
,
PREPARATION
,
Expose the abdomen so that it is fully visible. Drape the genitalia and female breasts.
A)true
B) false
A
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
A
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
A
Scaphoid abdomen caves in. Protuberant abdomen and abdominal distention
A)abnormal findings of the contour of the abdomen
B)false
A
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
A
Bulges, masses in the abdomen are abnormal findings
A)true
B)false
A
Hernia-protrusion of abdominal viscera through abnormal opening in muscle wall.
A)abnormal finding
B)normal finding
A
________-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
C
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
A
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
A
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
A
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
A
The umbilicus is a common site for piercings in young women. The site should not be red or crusted.
A)true
B)false
A
An abnormal finding in the umbilicus would be Deeply sunken with obesity. Enlarged, everted with umbilical hernia.
A)true
B)false
A
Umbilicus that is deeply sunken mostly like means the person obese.
A)true
B)false
A
Umbilicus that is enlarge and everted most likely mean the person has a hernia.
A)true
B)false
A
Bluish periumbilical color occurs (though rarely) with intra-abdominal bleeding (Cullen sign).
A)true
B)false
A
Cullen sign shows Bluish periumbilical color occurs (though rarely) with intra-abdominal bleeding.
A)true
B)false
A
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
A
The skin appears as Redness with localized inflammation.
A)true
B)false
A
Jaundice (yellowing of skin and sclera) shows best in natural daylight.
A)abnormal finding of the skin
B)abnormal finding of the umbilicus
A
Skin that appears glistening and taut occurs with ascites.
A)true
B)false
A
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
A
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
A
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
A
________ 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
A
Pigmented nevi (moles)- circumscribed brown macular or papular areas, are common on the abdomen. A)true,skin B)false, skin
A
Abnormal finding would be that Unusual color or change in shape of mole occurs on the skin
A)true
B)false
A
Petechiae is a small red or purple spot caused by bleeding into skin.
A)true, abnormal
B)false, normal
Aa
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
A
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
A surgical scar alerts you to the possible presence of underlying adhesions and excess fibrous tissue.
A)true
B)false
A
Cutaneous angiomas (spider nevi) on the skin occur with portal hypertension or liver disease. A)true B)false
A
_________ (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
A
Underlying adhesions are inflammatory band that occur after trauma or surgery.
A)true
B)false
A
Veins usually are not seen, but a fine venous network may be visible in thin persons.
A)true
B)false
A
Prominent, dilated veins occur with portal hypertension, cirrhosis, ascites, or vena caval obstruction.
A)true
B)false
A
Veins are more visible with malnutrition as a result of thinned adipose tissue.
A)true
B)false
A
Veins are more visible with malnutrition.
A)true
B)false
A
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
A
Poor turgor occurs with dehydration, which often accompanies Gl disease.
A)true
B)false
A
Poor turgor occurs with dehydration.
A)true
B)false
A
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
A
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
A
Respiratory movement also shows in the abdomen, particularly in males.
A)true
B)false
A
Finally, waves of peristalsis sometimes are visible in very thin persons. They ripple slowly and obliquely across the abdomen.
A)true
B)false
A
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
A
Marked pulsation of aorta occurs with widened pulse pressure which is hypertension, aortic insufficiency, thyrotoxicosis and aortic aneurysm.
A)true
B)false
A
Marked visible peristalsis, together with a distended abdomen, indicates intestinal obstruction.
A)abnormal finding
B)normal finding
A
Hair Distribution
,
The pattern of pubic hair growth normally has a diamond shape in adult males.
A)true
B)false
A
pubic hair shape shows an inverted triangle shape in adult females
A)true
B)false
A
Patterns alter with endocrine or hormone abnormalities, chronic liver disease.
A)Hair Distribution, abnormal finding
B)false
A
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
A
Restlessness and constant turning to find comfort occur with the colicky pain of gastroenteritis or bowel obstruction.
A)abnormal finding of dmenour
B)false
A
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
A
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
A
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
A
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
A
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
A
Hold the stethoscope lightly -against the skin; pushing too hard may stimulate more bowel sounds
A)true
B)false
A
Begin in the RLQ at the ileocecal valve area because bowel sounds are normally always present here.
A)true
B)false
A
RLQ at the ileocecal valve area bowel sounds are normally always present here.
A)true
B)false
A
Bowel Sounds
,
Bowel sounds originate from the movement of air and fluid through the small intestine.
A)true
B)false
A
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
A
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
A
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
A perfectly “silent abdomen” is uncommon; you must listen for 5 minutes before deciding bowel sounds are completely absent.
A)true
B)false
A
Two distinct patterns of abnormal bowel sounds may occur. Hypoactive and hyperactive
A)true
B)false
A
Hyperactive sounds are loud, highpitched, rushing, tinkling sounds that signal increased motility.
A)true
B)false
A
_________ 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
A
______ 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
A
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
A
celiac artery.This is systolic, medium to low in pitch, and heard between the xiphoid process and the umbilicus.
A)true
B)false
A
Note location, pitch, and timing of a vascular sound.
A)true
B)false
A
A systolic bruit is a pulsatile blowing sound and occurs with stenosis or occlusion of an artery.
A)true
B)false
A
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
A
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
A
Move clockwise. When percussing.
A)true
B)false
A
Tympany should predominate because air in the intestines rises to the surface when the person is supine.
A)true
B)false
a
Dullness occurs over a distended bladder, adipose tissue, fluid, or a mass.
A)true
B)false
A
_________ 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
A
______ 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
A
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
A
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
A
Measure the distance between the two marks; the normal liver span in the adult ranges from 6 to 12 cm
A)true
B)false
A
6 to 12 cm for normal adult liver span
A)true
B)false
A
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
A
taller people have longer livers. Also males have a larger liver span than females of the same height.
A)true
B)false
A
An enlarged liver span indicates liver enlargement or hepatomegaly.
A)true
B)false
A
An enlarged liver span indicates hepatomegaly.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
the liver span usually is underestimated because of inaccurate detection of the upper border.
A)true
B)false
A
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
A
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
A
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
A dull note forward of the midaxillary line indicates enlargement of the spleen, as occurs with mononucleosis, trauma, and infection.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
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
A
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
A
Sharp pain on percussion of CVA occurs with inflammation of the kidney or paranephric area.
A)true
B)false
A
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
A
Ascites occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and cancer.
A)true
B)false
A
_________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
A
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
A
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
A positive fluid wave test occurs with large amounts of ascitic fluid.
A)true
B)false
A
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
A
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
A
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
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
A
Both tests, fluid wave and shifting dullness, are not completely reliable. Ultrasound study is the definitive tool.
A)true
B)false
A
PALPATE SURFACE AND DEEP AREAS
L
Because most people are naturally inclined to protect the abdomen, you need to use additional measures to enhance complete muscle relaxation.;
,
- Bend the person’s knees.
- 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
- Keep your own voice low and soothing. Conversation may relax the person.
- 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
- 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
A
- 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
A
Do not drag fingers when percussing
A)true
B)false
A
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
A
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
A
Muscle guarding. Rigidity. Large masses. Tenderness. Are all abnormal finding when palpating the abdomen light and deep surface.
A)true
B)false
A
As you circle the abdomen, discriminate between voluntary muscle guarding and involuntary rigidity.
A)true
B)false
A
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
A
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.
A)true
B)false
A
If the rigidity persists on the palpitation of the abdomen even with the respiration technique, it is probably involuntary.
A)true
B)false
A
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
A
____________ 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
A
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
A
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
A
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
A
Mild tenderness normally is present when palpating the sigmoid colon. Any other tenderness should be investigated.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
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
A
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
A
Spleen
,
Normally, the spleen is not palpable and must be enlarged three times its normal size to be felt.
A)true
B)false
A
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
A
The spleen enlarges with mononucleosis, trauma, leukemias, and lymphomas.
A)true
B)false
A
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
A
Describe the number of centimeters that the spleen extends below the left costal margin.
A)abnormal finding results
B)normal finding results
A
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
A
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
A
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
A
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
A
Enlarged kidney. Kidney mass. Are abnormal findings on palpating
A)true
B)false
A
The left kidney sits 1 cm higher than the right kidney and is not palpable normally.
A)true
B)false
A
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
A
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
A
Abnormal finding of the aorta is Widened with aneurysm.
A)true
B)false
A
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
A
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
A
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
A
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
A
Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation.
A)true
B)false
A
. Peritoneal inflammation accompanies appendicitis.
A)true
B)false
A
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
A
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
A
Cough tenderness that is localized to a specific spot also signals peritoneal irritation.
A)true
B)false
A
Refer the person with suspected appendicitis for computed tomography (CT) scanning.
A)true
B)false
A
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
A
Inspiratory Arrest (Murphy Sign). In a person with inflammation of the gallbladder (cholecystitis), pain occurs. A)true B)false
A
(Murphy Sign).is positive. In a person with inflammation of the gallbladder (cholecystitis), pain occurs
A)true
B)false
A
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
a
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
A
. 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
A
( Obturator Test, does not work to diagnose appendicitis)
A)true
B)false
A
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
A
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
A
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
A
Scaphoid shape of infant occurs with dehydration.
A)true
B)false
A
Dilated veins on the abdomen of the infant is an abnormal finding.
A)true
B)false
A
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
A
umbilical arteries and one vein are surrounded by mucoid connective tissue, called Wharton’s jelly.
A)true
B)false
A
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
A
The presence of only one artery in the umbilical signals the risk for congenital defects.
A)true
B)false
A
Inflammation. Drainage after cord falls off. Is abnormal finding of the infant umbilical cord
A)true
B)false
A
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
A
The abdomen should be symmetric, although two bulges are common. In an infant
A)true
B)false
A
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
A
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
A
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
A
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
A
Refer any umbilical hernia larger than 2.5 cm continuing to grow after 1 month;
A)abnormal finding
B)normal finding
A
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
A
Refer any umbilical hernia larger than 2.5 cm for more than 7 years in a Black child.
A)abnormal finding
B)normal finding
A
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
A
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
A
Marked peristalsis with pyloric stenosis in an abnormal finding of an infant
A)true
B) false
A
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
A
In an infant, Auscultation yields only bowel sounds, the metallic tinkling of peristalsis. No vascular sounds should be heard.
A)true
B)false
A
Bruit. Venous hum. On the abdomen of an infant is an abnormal finding.
A)true
B)false
A
. 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
A
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
A
Percussing the spleen is not done. On an infant.
A)true
B)false
A
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
A
Aid palpation of the abdomen by flexing the baby’s knees with one hand while palpating with the other.
A)true
B)false
A
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
A
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
A
Normally, you may palpate the spleen tip and both kidneys and the bladder.
A)true for infant
B)false for infant
A
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
A
Make note of the newborn’s first stool, a sticky, greenish black meconium stool within 24 hours of birth.
A)true
B)false
A
The infant first 24hrs stool should be meconium greenish black. For an infant
A)true
B)false
A
By the fourth day, stools of breastfed babies are golden yellow, pasty, and smell like sour milk,
A)true
B)false
A
Breast fed infant stools are golden yellow, pasty and smell like sour milk.
A)true
B)false
A
formula-fed babies are brown-yellow, firmer, and more fecal smelling.
A)true
B)false
A
DEVELOPMENTAL COMPETENCE
The Child
,
Younger than 4 years, the abdomen looks protuberant when the child is both supine and standing.
A)true
B)false
A
After age 4 years, the potbelly remains when standing because of lumbar lordosis but the abdomen looks flat when supine.
A)true
B)false
A
Normal movement on the abdomen includes respirations, which remain abdominal until 7 years of age.
A)true
B)false
A
Abdomen respirations are viewed until the age of 7
A)true
B)false
A
A scaphoid abdomen is associated with dehydration or malnutrition.
A)true
B)false
A
In the child a scaphoid abdomen is associated with dehydration or malnutrition.
A)true
B)false
A
Younger than 7 years, the absence of abdominal respirations occurs with inflammation of the peritoneum.
A)true
B)false
A
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
A
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
A
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
A
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
A
On the left, the spleen also is easily palpable with a soft, sharp, movable edge.
A)true for child
B)false
A
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
A
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
A
Percussion of the liver span measures about 3.5 cm at age 2 years,
A)true
B)false
A
Percussion of the liver span measures about, 5 cm at age 6 years.
A)true
B)false
A
Percussion of the liver span measures about 6 to 7 cm during adolescence.
A)true
B)false
A
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
A
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
A
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
A
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
A
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
A
Because of the thinner, softer abdominal wall, the organs may be easier to palpate (in the absence of obesity).
A)aging adult
B)false
A
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
A
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
A
The kidneys are easier to palpate. In the aging adult
A)true
B)false
A
Abdominal rigidity with acute abdominal conditions is less common in aging.
A)true
B)false
A
With an acute abdomen, the aging person often complains of less pain than a younger person would.
A)true
B)false
A
PROMOTING A HEAL THY LIFESTYLE
How’s Your Liver Doing?
,
The liver is the largest internal organ in the body.
A)true
B)false
A
It has an immense capacity to heal and regenerate, but that capacity is not infinite.
A)liver
B)kidney
A
There are many things an individual can do to protect the liver:
,
- Practice safe sex
- Do not share items that may have bodily fluids on them.
- Be aware of your environment.
- Watch your diet and weight
- Travel wisely
- Use medications wisely
- Do not mix medications without consulting a health care provider.
- Drink alcohol only in moderation
- Do not mix medications and alcohol
- Do not use illegal drugs.
- Get vaccinated.
- 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
A
ABNORMAL FINDINGS
,
Abdominal Distention
M
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
A
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
A
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
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
B
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
B
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
A
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
A
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
A
_________ 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
A
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
A
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
B
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
A
Liver-friction rub over lower right rib cage, from abscess or metastatic tumor.
A)true
B)false
A
Spleen-friction rub over lower left rib cage in left anterior axillary line, from abscess, infection, or tumor.
A)true
B)false
A
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
A
____________-murmur is harsh, systolic, or continuous and accentuated with systole. Note in person with hypertension..
A)aortic aneurysum
B)renal stenosis
C) partial occlusion
A
_____________-murmur is midline or toward flank, soft, low to medium pitch.
A)aortic aneurysum
B)renal artery stenosis
C) partial occlusion
B
Partial occlusion of femoral arteries. Can have a bruit
A)true
B)false
A
________-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
A
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
A
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
A
An enlarged and nodular liver occurs with late portal cirrhosis, metastatic cancer, or tertiary syphilis.
A)true
B)false
A
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
A
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
A
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
A
When splenomegaly occurs with acute infections (mononucleosis), it is moderately enlarged and soft, with rounded edges.
A)true
B)false
A
When the result of a chronic cause, the enlargement spleen is firm or hard, with sharp edges.
A)true
B)false
A
An enlarged spleen is usually not tender to palpation; it is tender only if the peritoneum is also inflamed.
A)true
B)false
A
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
A
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
A
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
,
- 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
A
EXTRA INFORMATION
,
pyloric stenosis is an congenital narrowing of the pyloric sphincter
A)true
B)false
A
moles on the abdomen are common
A)true
B)false
A
pyrosis is a burning sensations in the upper abdomen
A)true
B)false
A
a scaphoid abdomen abnormally caves in or is sunken
A)true
B)false
A
the abdomen normally moves when breathing until the age of 7 years
A)true
B)false
A
older adults have a decrease salivation leading to dry mouth
A)true
B)false
A
the symptoms occurring with lactose intolerance include bloating and flatulence
A)true
B)false
A
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
A
Severe dehydration from nausea and vomiting, fever, and acute abdominal pain are potentially life-threatening symptoms that require prompt attention.
A)true
B)false
A
He or she would assess for signs of hypovolemia including postural hypotension, poor skin turgor, thirst, sunken eyeballs, and weakness
A)true
B)false
A
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
B
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
A
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
A
Abdominal organs are more easily palpated in children because the abdominal muscles are underdeveloped.
Choose one of the following A True B False
A
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?
B
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
B
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
A
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
B
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
D
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
B
Increased bowel sounds occur with diarrhea and early intestinal obstruction.
A)true
B)false
A
Decreased bowel sounds occur with adynamic ileus and peritonitis
A)true
B)false
A
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
B
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
A
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
D
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
A
The abdomen is divided into six quadrants by imaginary vertical and horizontal lines.
Choose one of the following A True B False
B
the student nurse is studying the liver.the primary function of the liver is to metabolize nutrients
A)true
B)false
A
the umbilical cord turns black before it falls off, this is a normal finding
A)true
B)false
A
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
A
defect or sac formed by dilation in artery wall due to atherosclerosis trauma or congenital defect.
A)aneurysm
B)anorexia
A
loss of appetite for food is called anorexia
A)true
B)false
A
lower border of rib margin formed by the medial edges of the 8th,9th and 10th ribs.
A)costal margin
B)CVA
A
angle formed by the 12th rib and the vertebral column on the posterior thorax, overlying the kidney
A)CVA
B)hernia
A
abnormal protrusion of bowel through weakening in abdominal musculature
A)hernia
B)linea alba
A
midline tendinous seam joining the abdominal musccles
A)linea alba
B)hernia
A
complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction
A)paralytic ileus
B)false
A
midline abdominal muscles extending from rib cage to pubic bone is called rectus abdominal muscle
A)true
B)falsse
A
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
A
• Hyperactive bowel sounds—loud, high-pitched, rushing, tinkling sounds that signal increased motility.
A)true
B)false
A
• Hypoactive bowel sounds—diminished or absent sounds that signal decreased motility.
A)true
B)false
A
• 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
A
• 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
A
• Deep palpation—depressing the skin about 5 to 8 cm (2 to 3 inches), moving clockwise over the entire abdomen.
A)true
B)false
A
• Light palpation may reveal muscle guarding, rigidity, large masses, or tenderness.
A)true
B)false
A
• 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
A
• 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
A
• 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
A
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
a positive blumberg sign indicates peritoneal inflammation
A)true
B)false
A
an intra-abdominal mass is located within the abdominal cavity or attached to an organ.
A)true
B)false
A
______________, 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
A
