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Health Assessment > Abdomen (Exam 3) > Flashcards

Abdomen (Exam 3) Flashcards

1
Q

Linea alba

A

midline, tendinous seam joining the 4 layers of abdominal muscles

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2
Q

Muscles serve as protection of _______ and they flex the __________

A

internal organs; vertebral column

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3
Q

Peritoneum

A

envelope of serous membrane; parietal and visceral

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4
Q

Parietal peritoneum

A

lines the abdominal wall

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5
Q

Visceral peritoneum

A

covers the surface of most abdominal organs

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6
Q

Mesenteries

A

supporting networks to suspend and stabilize the abdominal organs (viscera); pathways for blood vessels, nerves and lymphatics

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7
Q

Greater omentum

A

specialized fatty mesentery overlies the ventral abdomen

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8
Q

Solid viscera

A

maintains characteristic shape; LIVER, PANCREAS, SPLEEN, ADRENAL GLANDS, KIDNEYS, OVARIES, UTERUS

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9
Q

Hollow viscera

A

shape depends on contents; STOMACH, GALLBLADDER, SMALL INTESTINE, COLON, BLADDER

USUALLY NOT PALPABLE

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10
Q

Spleen

A

mass of lymphatic tissue

ONLY PALPABLE IF ENLARGED

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11
Q

Aorta

A

able to palpate pulsations in the upper anterior abdominal wall

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12
Q

Costovertebral angle (kidneys)

A

angle formed with the 12th rib and the vertebral column, where the left kidney lies

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13
Q

Right Upper Quadrant (RUQ) organs

A

liver
gallbladder
duodenum
head of pancreas
right kidney and adrenal
part of ascending and transverse colon

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14
Q

Left Upper Quadrant (LUQ) organs

A

stomach
spleen
left lobe of liver
body of pancreas
left kidney and adrenal
splenic fixture of colon
part of transverse and descending colon

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15
Q

Right Lower Quadrant (RLQ) organs

A

cecum
appendix
right ovary and tube
right ureter
right spermatic cord

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16
Q

Left Lower Quadrant (LLQ) organs

A

part of descending colon
sigmoid colon
left ovary and tube
left ureter
left spermatic cord

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17
Q

Midline organs

A

aorta
uterus (if enlarged)
bladder (if enlarged)

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18
Q

What are the 9 regions of the abdomen?

A
  1. Epigastric
  2. Umbilical
  3. Hypogastric/Suprapubic
  4. Right epigastric (hypochondriac)
  5. Left epigastric (hypochondriac)
  6. Right umbilical/lumbar
  7. Left umbilical/lumbar
  8. Right hypogastric (inguinal)
  9. Left hypogastric (inguinal)
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19
Q

Developmental Considerations: Infants and Children

A

umbilical cord shows prominently on abdomen in newborns (contains 2 arteries and 1 vein)

abdominal wall less muscular, organs may be easier to palpate

urinary bladder is higher up in abdomen

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20
Q

Developmental Considerations: Pregnancy

A

morning sickness (nausea/vomiting, related to hormonal changes)

GI motility decreases (constipation which could lead to hemorrhoids)

heartburn, esophageal reflux

intestines are displaced upwards

bowel sounds diminished

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21
Q

Developmental Considerations: Aging Adult

A

motility and peristalsis slows (constipation increases)

fat becomes more pronounced in abdomen (weakening muscles makes a potbelly)

symptoms of acute disease may be diminished (less pain, fever less pronounced)

salivation decreases (dry mouth, decreased taste)

esophageal emptying slowed (feed in upright position)

liver size decreases with age (blood flow to liver decreased by 55%, metabolism of drugs is decreased with age)

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22
Q

Is constipation a physiological cause of aging?

A

NO!

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23
Q

What are 8 common causes of constipation?

A
  1. Decreased physical activity
  2. Inadequate intake of water
  3. Low-fiber diet
  4. Side effects of medications
  5. IBS
  6. Bowel obstruction
  7. Hypothyroidism
  8. Inadequate toilet facilities (difficulty ambulating to toilet can cause someone to hold it in until it becomes hard and difficult to pass)
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24
Q

Pica

A

eating non-nutritious food substances like grass, clay, stones, etc.

common in early childhood, pregnancy and psychologically impaired

DUE TO IRON DEFICIENCY? CAN RESULT IN EMERGENT SITUATIONS LIKE INTOXICATION AND INTESTINAL OBSTRUCTION

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25
Q

Diarrhea

A

ask about bowel routine (ask what is normal and how has it changed?)
use of OTC meds to promote or control bowels? regular or occasional usage?

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26
Q

Melena

A

blood in the stool; may appear bright red, maroon or black and tarry

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27
Q

Constipation

A

fecal impaction; less than 2 times a week

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28
Q

Dysphagia occurs with disorders of the throat or esophagus, such as…

A

thrush (candida infection)
neurologic changes (stroke)
obstruction (solid mass or tumor)

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29
Q

Dysphasia

A

partial or complete impairment in the ability to speak

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30
Q

Pyrosis

A

burning as in heartburn

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31
Q

Hematemesis

A

vomiting of blood

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32
Q

Hemorrhoids

A

varicose veins in the rectal area due to straining, pregnancy, or obesity

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33
Q

Subjective Data

A
  1. Appetite changes, anorexia?
  2. Dysphagia
  3. Food intolerance (type of reaction? any rx or OTC? heartburn?)
  4. Bowel habits (how often? consistency? color? diarrhea? constipation?)
  5. Meds (hep B vaccine-blood transfusions prior to 1980?)
  6. Hemorrhoids?
  7. Excessive gas, belching, regurgitating?
  8. Change in weight? planned?
  9. Nausea/Vomiting? (OLDCARTS! how much, recent travel?)
  10. Hematemesis (looks like coffee grounds)
  11. Past abdominal history (ulcers, gallbladder disease, hernia, IBD, IBS, surgeries, x-rays, CT?)
  12. Nutritional assessment (24 hr recall, “food deserts”)
34
Q

What does tarry black stool indicate?

A

upper GI bleed

35
Q

What does non-tarry black stool indicate?

A

iron meds

36
Q

What does bright red stool indicate?

A

lower GI bleed or hemorrhoids

37
Q

What are some usual causes of hematemesis?

A

esophageal varices, stomach or duodenal ulcers

38
Q

During OLDCARTS…

A

ask about associated symptoms regarding eating, pain getting worse or better association with other symptoms

39
Q

Acute abdominal pain that require urgent diagnosis and referral are..

A

appendicitis, cholecystitis, bowel obstruction, diverticulitis, vascular occlusion, perforated organ

40
Q

Chronic pain of gastric ulcers occur…

A

usually on an empty stomach, pain of duodenal ulcers occur 2-3 hours after a meal and is relieved with more food

41
Q

Subjective Data: Additional History for Infants and Children

A
  1. Breastfeeding or bottle fed
  2. Solid foods (tolerating well?)
  3. Eating habits and diet
  4. Eating nonfoods?
  5. Constipation
  6. Bowel habits
  7. Abdominal pain
  8. Weight issues
42
Q

Subjective Data: Additional History for Adolescents

A
  1. Diet and meals
  2. Calories per day
  3. Exercise and activity
  4. Weight
  5. Body image
  6. Eating habits
43
Q

Subjective Data: Additional History for the Aging Adult

A
  1. Groceries and meal prep
  2. Eat alone
  3. Diet
  4. Difficulty swallowing
  5. Bowel habits
  6. Constipation
44
Q

IAPP

A

Inspectipn
AUSCULTATION
Percussion
Palpation

45
Q

Objective Data: Preparation

A

adequate lighting
expose abdomen so it’s fully visible, drape genitalia and female breasts
position for comfort to enhance abdominal wall relaxation (knees bent)

empty bladder prior and save specimen if needed

warm stethoscope-examine areas identified as painful last to prevent guarding

use distraction to keep patient relaxed and facilitate muscle relaxation

46
Q

Equipment for abdominal assessment

A

stethoscope
small cm ruler
skin-marking pen
alcohol wipe to clean endpiece

47
Q

Inspecting the abdomen for symmetry

A

shine a light across abdomen
note any localized bulging, visible mass or asymmetry
have patient take a deep breath, abdomen should stay smooth and symmetrical OR ask pt to perform a sit up without pushing up with their hands
inspect umbilicus should be midline, inverted with no discoloration, inflammation, hernia. EXTROVERTED WITH PREGNANCY

48
Q

Inspecting the Skin

A

surface is smooth and even with homogeneous color
good area to judge pigment because it’s often protected from sun!
• pigmented nevi (moles)- brown macular or papular areas common on abdomen
• striae (lineae albicantes)-silvery white, linear, jagged marks 1-6cm long
veins visible with malnutrition
assess skin turgor
hair distribution (pubic hair; males are diamond shape and women are inverted triangle)
surgical scars common, note location

49
Q

Contour

A

determine the profile from the rib margin to the pubic bone; describes nutritional state!

FLAT
ROUNDED
SCAPHOID
PROTUBERANT (DISTENTION)

50
Q

Objective Data: Inspection

A

location of major abdominal organs
have client raise head to check for any abdominal bulges
are there any abdominal movements (aortic pulsations, peristalsis)
any abnormalities in umbilicus (observe for inflammation, hernia)

51
Q

Aortic pulsations are normal when…

A

seen in epigastric area, especially with smaller BMI pts

52
Q

Bowel sounds originate from…

A

movement of air and fluid through small intestine

53
Q

Auscultating bowel sounds

A

begin in the RLQ at the ileocecal valve area because bowel sounds are normally present here

HIGH PITCHED, GURGLING, CASCADING SOUNDS
REGULAR RATE IS EVERY 5-15 SEC. OR 5-30 TIMES A MIN.
ALTERED BS IN DIARRHEA, IBS, PERITONITIS

54
Q

4 types of bowel sounds

A
  1. Normoactive
  2. Hypoactive
  3. Hyperactive
  4. Absent
55
Q

Hypoactive bowel sound

A

less than 5 sounds per minute; peritonitis, ileus

56
Q

Hyperactive bowel sounds

A

loud, high-pitched, rushing, tinkling sounds; gastroenteritis

57
Q

Absent bowel sounds

A

no sounds for over 5 min.; UNCOMMON

MUST LISTEN FOR 5 MIN. TO DECIDE

58
Q

Auscultating vascular sounds

A

over aorta and renal arteries with bell of stethoscope (may be lower pitched); listen for bruits

59
Q

Aorta location

A

slightly left of midline and bifurcates at about the navel

60
Q

Percussion of abdomen

A

USED TO ASSESS SIZE AND DENSITY OF ORGANS, PRESENCE OF AIR OR FLUID

tympany is the primary sound
dullness heard over solid organs
systematic route of percussion
hyperresonance heard over gaseous distention
PERCUSS THE PAINFUL AREAS LAST

61
Q

Why is tympany the prominent sound during percussion?

A

air in the intestines rises to the surface when the person is supine; stomach and intestine, heard over air-filled areas

62
Q

Palpation: What to detect?

A

size of organs
location
shape
tension
presence of masses

IF POSSIBLE STAND ON RIGHT SIDE
PT BENDS KNEES TO REDUCE MUSCLE TENSION

63
Q

Light palpation

A

BEGIN WITH LIGHT PALPATION!!!

with first four fingers together depress skin about 1 cm
make gentle rotary motion, sliding the fingers and skin together
lift fingers and move clockwise to next location around abdomen

64
Q

Deep palpation

A

push down 5-8 cm (2-3in.)

deep palpation helps evaluate organs and find masses

65
Q

Mild tenderness is expected for what during deep palpation?

A

sigmoid colon in the LLQ

ANY OTHER TENDERNESS SHOULD BE INVESTIGATED

66
Q

Masses

A

physiologic (pregnancy)
inflammatory (diverticulitis of the colon)
vascular (aneurysm)
neoplastic
obstructive
LEAVE AREA OF TENDERNESS FOR LAST

67
Q

What to note when a mass is found?

A

location
size
shape
consistency (soft, firm, hard)
surface (smooth, nodular)
mobility (including movement with respirations)
pulsatility
tenderness

68
Q

Palpating the liver

A

place left hand under persons back parallel to 11th and 12th ribs and lift to support abdominal contents
place right hand on RUQ with fingers parallel to midline
push deeply down and under right costal margin
ask person to take a deep breath (normal to feel edge of liver bump fingertips as diaphragm pushes it down during inhalation, feels like a firm ridge…OFTEN NOT PALPABLE)

Hooking technique

69
Q

Hooking technique

A

alternative method to palpate liver

stand up to persons shoulder and swivel body to the right so that you face their feet
hook fingers over costal margin from above
ask person to take deep breath
try to feel liver edge

70
Q

Normally, the spleen is..

A

not palpable and must be enlarged 3 times normal size to be felt

71
Q

Palpating the spleen

A

reach left hand over abdomen and behind left side at the 11th and 12th ribs
lift up for support, place right hand obliquely on LUQ with fingers pointing toward left axilla and just inferior to rib margin
push hand deeply down and under left costal margin, ask person to take deep breath

YOU SHOULD FEEL NOTHING FIRM

72
Q

What could spleen enlargement mean?

A

mononucleosis
leukemia and lymphomas
portal HTN or HIV infection

73
Q

Costovertebral angle tenderness (ADVANCED PRACTICE)

A

indirect fist percussion
place one hand over 12th rib at costovertebral angle on the back, thump that hand with the ulnar edge of your other fist
SHOULD FEEL THUD BUT NO PAIN
PAIN PRESENT WITH KIDNEY INFLAMMATION

usually in sequence with thoracic exam since pt is sitting up

74
Q

Palpating the kidneys

A

NOT USUALLY PALPABLE

stand on left side of pt
place left hand to support posterior lower rib cage
pt takes deep breath and with right hand press down on kidney
repeat in the other side

75
Q

Palpating the bladder

A

deep palpation in the hypogastric region, superior to suprapubic bone

EMPTY BLADDER- UNABLE TO PALPATE
FULL BLADDER- ENLARGED

IF TENDER, UTI??

76
Q

Developmental Competence: Infant

A

contour (abdomen is protuberant because of immature musculature)
inspect umbilical cord
abdomen should be symmetric, but 2 bulges are common
abdomen shows respiratory movement
auscultate (no vascular sounds)
aid palpation by flexing knees

77
Q

Developmental Competence: Child

A

younger than 4, abdomen looks protuberant
older than 4, potbelly remains while standing
respirations visible in abdomen until 7
palpation (flex knees up and slightly elevate head)
liver easily palpable
for tenderness look for objective signs

78
Q

Developmental Competence: Aging Adult

A

may see increased deposits of subcutaneous fat on abdomen and hips
organs may be easier to palpate (liver, kidneys)
distended lungs (liver palpated lower)

79
Q

SUMMARY CHECKLIST: ABDOMEN

A
  1. INSPECTION CONTOUR, SYMMETRY, UMBILICUS, SKIN, PULSATION OR MOVEMENT, HAIR DISTRIBUTION AND DEMEANOR
  2. AUSCULTATION BOWEL SOUNDS, NOTE VASCULAR SOUNDS
  3. PERCUSSION ALL 4 QUADRANTS AND BORDERS OF LIVER AND SPLEEN
  4. PALPATION LIGHT AND DEEP IN ALL 4 Q’s, PALPATE FOR LIVER, SPLEEN, AND KIDNEYS
80
Q

Ascites

A

fluid in the abdomen

protuberant abdomen with bulging flanks can indicate ascites

81
Q

Assessing ascites: Testing for shifting dullness

A

tympany to dullness

ask pt to rest on side, dullness should shift to the more dependent side and tympany shifts to top

Health Assessment (14 decks)

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