Abdomen Anatomy&Subjective

Question 1

Linea alba

Answer 1

The tendinous seam that joins the four layers of flat muscles that from the ventral abdominal wall.

Question 2

Rectus Abdominis

Answer 2

One set of the muscles that lines that abdominal wall. It forms a strip that extends the length of the midline, and its edge is often palpable.

Question 3

Function of the abdominal muscles

Answer 3

protect and hold the organs in place, and they flex the vertebral column

Question 4

Solid viscera

Answer 4

organs that maintain characteristic shape- liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus.
Liver-fills most of RUQ, and extends to mid clavicular line. Lower edge of liver is normally palpable.
Right kidney- normally palpable.
Ovaries- normally palpable only on bimanual manipulation during pelvic exam.

Question 5

Hollow viscera

Answer 5

Stomach, gall bladder, small intestine, colon, bladder.

• Shape depends on contents
• Not usually palpable, but may feel a colon distended with feces or bladder distended with urine.

Question 6

Spleen

Answer 6

soft mass of lymp tissue on posterolateral wall of abdominal cavity, immediately under diaphragm. Width extends from 9th-11th rib.

• not normally palpable
• if enlarged, its lower pole moves downward and toward midline.

Question 7

Aorta

Answer 7

left of midline in upper part of abdomen. Can be palpated easily in upper anterior abdominal wall

Question 8

RUQ contains…

Answer 8

Liver
gallbladder
duodenum
head of pancreas
R kidney and adrenal
Hepatic fixture of colon
Part of ascending and transverse colon

Question 9

LUQ contains..

Answer 9

Stomach
Spleen
Left lobe of liver
Body of pancreas
L kidney and adrenal
Splenic flexure of colon
Part of transverse and descending colon

Question 10

RLQ

Answer 10

Cecum
appendix
R ovary and tube
R ureter
R spermatic cord

Question 11

LLQ

Answer 11

Part of descending colon
Sigmoid colon
Left Ovary and tube
Left ureter
Left spermatic cord

Question 12

Midline contains..

Answer 12

Aorta
Uterus (if enlarged)
Bladder (if distended)

Question 13

The Aging Adult- Fat

Answer 13

• Fat accumulated in suprapubic area in females due to decreased estrogen
• Males: fat deposits in abdominal area
• With further aging, adipose tissue is redistributed away from the face and extremities, and moves to the abdomen and hips. Ab musculature also relaxes.

Question 14

The Aging Adult- GI system

Answer 14

Changes that dont affect fx as long as no disease is present:

• Decreased salivation (dry mouth, decreased taste)
• Delayed emptying of esophagus (is aging person is fed supine there is increased risk for aspiration)
• Gastir acid secretion decreases with aging –>pernicious anemia (because it interferes with B12 absorption), iron deficency anemia, and malabsorption of calcium.
• gallstones, more common in females
• decreased liver size between ages of 20-70.
• Decreased blood flow in liver impairs its drug metabolism. By age 65 there is decrease of blood flow in liver. Livers enzymes dont work, and its less effective at metabolizing drugs, so metabolism is prolonged. Leads to increased drug side effects
• Increased constipation–> Rome criteria

Question 15

What is the Rome criteria?

Answer 15

Rome criteria was developed to define constipation, and standardized symptom criteria. Symptoms are 1) reduced stool frequency (less than 3 BM/week), 2) troubling symptoms (straining, lumpy/hard stool, incomplete evacuation, anorectal blockage, manual maneuvers)… manual maneuvers???! Ew.

Question 16

Causes of constipation

Answer 16

decreased physical activity, low water intake, low fiber, meds (opiods, trycyclic antidepressants), IBS, bowel obstruction, hypothyroidism, inadequate toilet facilities (difficulty getting to a toilet)

Question 17

Subjective Categories for Abdominal exam

Answer 17

Appetite
Dysphagia
Food intolerance
Abdominal pain
Nausea/vom
Bowel habits
Past abdominal Hx
Medications
Nutritional Assessment

Question 18

Anorexia

Answer 18

Assessed when asking about changes in appetite.

Anorexia: loss of appetite from GI disease, as a side effect of some meds, pregnancy, or psychological disorders.

Question 19

Dysphagia

Answer 19

Any difficulty swallowing?

Dysphagia occurs with disorders of throat and esophagus

Question 20

Food intolerance

Answer 20

Are there any foods you cant eat?
Food Intolerance: could be allergy, heart burn, indigestion (example- lactase deficiency resulting in bloating or excessive gas after milk products
Pyrosis: Heartburn- a burning sensation in esophagus and stomach from reflux of gastirc acid.
Eructation: belching

Question 21

Abdominal Pain

Answer 21

Abdominal pain may be visceral from an internal organ (dull pain, general, poorly localized). May be parietal from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement), or referred pain from another disorder in another site.
Acute pain that requires urgent diagnosis occurs with appendicitis, cholecystitis, bowel obstruction, or perforated organ.

Question 22

Abdominal Pain- Chronic

Answer 22

Is the pain relieved by food or worse after eating?
Chronic pain of gastric ulcers occurs on an empty stomach. Pain of duodenal ulcers occurs 2-3 hours after a meal and is relieved by more food.

Question 23

Nausea/Vom

Answer 23

How often? How much comes up?
Nausea/Vomiting common with GI disease, many meds, and with early pregnancy
-Is there blood?–> Hematemesis= occurs with stomach or duodenal ulcers and esophageal varices
-What foods did you eat in the last 24 hrs and where? Anyone else in family with same symptoms?-> Consider food poisoning

Question 24

Bowel Habits

Answer 24

How often?- Assess usual bowel habits
Assess color and consistency- Black= if tarry might be from occult blood (melena) from GI bleeding or non-tarry from iron meds. Gray stools=with hepatits
Red blood in stool= GI bleeding or localized bleeding around anus

Question 25

Past abdominal Hx

Answer 25

Any Hx of GI problems? Any operations? Any problems after surgery? Any x-rays? results?

Question 26

Medications

Answer 26

What meds do you take? Alcohol consumption? Do you smoke?

peptic ulcer disease occurs with frequent use of NSAIDS, alcohol, smoking, and helicobactor pylori infection.

Question 27

Nutritional Assessment

Answer 27

Ask about diet- “Tell me all the food you ate yesterday, starting with breakfast” (use 24 hr. recall)
ask about fresh food markets in neighborhood- many inner-city lack markets and have a lot of fast food restaurants.

Question 28

Additional subjective HX for aging adult

Answer 28

1) How do you get groceries and prepare meals- asses risk for nutritional deficit due to access to store, disability)
2) Do you eat alone or share meals with others- If they live alone they may not bother prepare meals at all. Depression. Social isolation.
3) Please tell me all that you had to eat yesterday and start with breakfast- 24- hr recall may not be sufficient because daily pattern may vary. Do week long intake (food pattern may differ during the month due to income)
4) How often do you have BM? - if they report constipation, ask them what they mean by constipaton and inquire about their liquid and fiber intake. Also ask about Medications due to their GI effects.

Question 29

Abdominal pain described as dull, general pain, and poorly localized would most likely be what?

Answer 29

Visceral pain from an internal organ

Question 30

Abdominal pain described as sharp, well localized or precise, that is aggravated by movement, would most likely be what kind of pain?

Answer 30

Parietal abdominal pain from inflammation of overlying peritoneum

Question 31

What does acute pain occur with?

Answer 31

Appendicitis
Cholecystitis
Bowel Obstruction
Perforated Organ