Abdomen- Ch. 21

Question 1

Liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus are examples of?

Answer 1

Solid viscera

Question 2

Stomach, gall bladder, SI, colon, bladder are examples of?

Answer 2

Hollow viscera

Question 3

What are the divisions of the abdomen?

Answer 3

RUQ
LUQ
RLQ
LLQ

Question 4

What is the proper way to complete an abdominal assessment?

Answer 4

Systematic starting with RLQ and going clockwise

Question 5

Proper steps of abdominal assessment?

Answer 5

Inspect
Auscultation
Percussion
Palpation

Question 6

Why do we palpate and Percussion last?

Answer 6

Because we may activate/ disrupt bowel sounds

Question 7

Subjective data: health history questions

Answer 7

• change in appetite, anorexia nervosa
• dysphagia?
• abdominal pain? History of GI issues?
• N/V?
• bowel habits?
• medications?
• nutritional status?

Question 8

Objective Data: the physical exam

Answer 8

• enhance relaxation- easier to inspect abdominal muscles

- determine if there is any pain before beginning the exam

Question 9

The aging adult

Answer 9

• delayed esophageal emptying= ⬆️ risk for aspirations
• ⬇️ gastric secretions, pernicious anemia, CA+ absorption may be altered
• coughin while eating? Swallow test
• ⬆️incidence of gall stones
• ⬇️ liver size after 80

Question 10

👀Inspection: inspect the patient abdomen lying down with arms at their sides, relaxed position

Answer 10

Inspect contour (flat, rounded, scaphoid, protuberant)
Symmetrical both sides?
Umbilicus- midline (invented or everted-pregnant/acites)
Skin assessment- presence of striae
Pulsation or movement- peristalsis, aortic pulse can be normal but can also indicate and aneurysm- seen in pregnant women and very thin people

Question 11

What is striae?

Answer 11

Silvery white, elastic fibers break down causing stretch marks
Pregnancy
Acites
After large weight loss

Question 12

What are we assessing/inspecting for?

Answer 12

Abdominal distention
Buldges
Maas
Hernias
Obesity 
Air/gas
Acites 
Presence of feces

Question 13

👂🏻Auscultation: listening for bowel sounds, movement of air and fluid thru the small intestine

Answer 13

Use diaphragm and hold lightly

Note character and frequency of sounds

Question 14

Bowel sounds

Answer 14

Normal- high pitch, gurgling, cascading, irregular sounds, heard 5-30 times per minute
Hypoactive- <30 sounds per minute( diarrhea, bowel obstruction)
Absent- must listen for 5 minutes to make this determination (usually post surgery-NPO-ileocecal valve)

Question 15

Auscultate for vascular sounds

Answer 15

Use the bell of stethoscope to listen (low pitched sounds)

• aortic, renal, iliac (bilaterally)
• normal not to hear anything, may hear heart beat especially when listening for abdominal bruit.
• bruit- swooshing sound also heard in the heart of a murmur is present

Question 16

Aortic artery

Answer 16

Midline, above umbilicus

Question 17

Renal artery

Answer 17

Above umbilicus, lateral to midline

Question 18

Iliac artery

Answer 18

Below umbilicus, lateral to midline

Question 19

👆🏻Percussion- assessing for density, size, location of organs and any masses or fluid

Answer 19

*tympany- should be the dominant sound produced

Dull sound over organs (liver)
Flat sound over bone
*follow a system- RLQ, RUQ, LUQ, LLQ

Question 20

Palpation ✋🏻

Answer 20

Last step in abdominal assessment

• when palpating- palpate in each quadrant and go clockwise, it follows the patterns of the intestines, 4 fingers close together
• ask about pain or tender areas and palpate them last
• start with light palpation(1cm) and move to deep (5-8cm)
• to palpate liver have patient bend knees to relax

Question 21

Abdominal distention

-common reasons

Answer 21

Obesity 
Air/gas
Ascites
Ovarian cyst 
Pregnancy 
Feces 
Tumor

Question 22

3 types of hernias?

Answer 22

Umbilical
Epigastric
Incisional

Question 23

Umbilical hernia

Answer 23

Protrusion of omentum or intestine thru a weakness of closure of the umbilical ring “outie”

Question 24

Epigastric hernia

Answer 24

Protrusion of the abdominal structures presenting a small fatty nodule at epigastric in midline thru the linea Alba muscle

Question 25

Incisional hernia

Answer 25

A bulge near an old operative scar that may not show when a person is lying don but when they sit up and abdominal pressure increases and when standing it will Bulge

Question 26

Special procedures/advanced practice

Answer 26

• screening for acites: fluid wave test, shifting dullness test
• costovetebral tenderness: check for kidney infection, blunt blow to lower back
• rebound tenderness: “Blumbergs sign”- check for peritoneal inflammation associated with appendicitis (used to rule out appendicitis): push down and release and if it’s painful on releas then it’s a +Blumbergs sign
• inspiratory arrest: “Murphys sign”- test for inflamed galbladder, screen for cholecystitis

Question 27

Rebound tenderness is screening for what?

“Blumbergs Sign”

Answer 27

**to rule out appendicitis

Question 28

Inspiratory arrest we are checking for what?

“Murphys Sign”

Answer 28

Test for inflamed gallbladder

Screen for cholecystitis

Question 29

Costovetebral tenderness is checking for what?

Answer 29

Kidney infection

Question 30

Two tests to screen for ascites?

Answer 30

Fluid wave test

Shifting dullness test