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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
Diarrhea
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?
26
Melena
blood in the stool; may appear bright red, maroon or black and tarry
27
Constipation
fecal impaction; less than 2 times a week
28
Dysphagia occurs with disorders of the throat or esophagus, such as…
thrush (candida infection) neurologic changes (stroke) obstruction (solid mass or tumor)
29
Dysphasia
partial or complete impairment in the ability to speak
30
Pyrosis
burning as in heartburn
31
Hematemesis
vomiting of blood
32
Hemorrhoids
varicose veins in the rectal area due to straining, pregnancy, or obesity
33
Subjective Data
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
What does tarry black stool indicate?
upper GI bleed
35
What does non-tarry black stool indicate?
iron meds
36
What does bright red stool indicate?
lower GI bleed or hemorrhoids
37
What are some usual causes of hematemesis?
esophageal varices, stomach or duodenal ulcers
38
During OLDCARTS…
ask about associated symptoms regarding eating, pain getting worse or better association with other symptoms
39
Acute abdominal pain that require urgent diagnosis and referral are..
appendicitis, cholecystitis, bowel obstruction, diverticulitis, vascular occlusion, perforated organ
40
Chronic pain of gastric ulcers occur…
usually on an empty stomach, pain of duodenal ulcers occur 2-3 hours after a meal and is relieved with more food
41
Subjective Data: Additional History for Infants and Children
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
Subjective Data: Additional History for Adolescents
1. Diet and meals 2. Calories per day 3. Exercise and activity 4. Weight 5. Body image 6. Eating habits
43
Subjective Data: Additional History for the Aging Adult
1. Groceries and meal prep 2. Eat alone 3. Diet 4. Difficulty swallowing 5. Bowel habits 6. Constipation
44
IAPP
**I**nspectipn **AUSCULTATION** **P**ercussion **P**alpation
45
Objective Data: Preparation
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
Equipment for abdominal assessment
stethoscope small cm ruler skin-marking pen alcohol wipe to clean endpiece
47
Inspecting the abdomen for symmetry
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
Inspecting the Skin
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
Contour
determine the profile from the rib margin to the pubic bone; describes nutritional state! FLAT ROUNDED SCAPHOID PROTUBERANT (**DISTENTION**)
50
Objective Data: Inspection
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
Aortic pulsations are normal when…
seen in epigastric area, especially with smaller BMI pts
52
Bowel sounds originate from…
movement of air and fluid through small intestine
53
Auscultating bowel sounds
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
4 types of bowel sounds
1. Normoactive 2. Hypoactive 3. Hyperactive 4. Absent
55
Hypoactive bowel sound
less than 5 sounds per minute; peritonitis, ileus
56
Hyperactive bowel sounds
loud, high-pitched, rushing, tinkling sounds; gastroenteritis
57
Absent bowel sounds
no sounds for over 5 min.; UNCOMMON MUST LISTEN FOR 5 MIN. TO DECIDE
58
Auscultating vascular sounds
over aorta and renal arteries with bell of stethoscope (may be lower pitched); listen for bruits
59
Aorta location
slightly left of midline and bifurcates at about the navel
60
Percussion of abdomen
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
Why is tympany the prominent sound during percussion?
air in the intestines rises to the surface when the person is supine; stomach and intestine, heard over air-filled areas
62
Palpation: What to detect?
size of organs location shape tension presence of masses **IF POSSIBLE STAND ON RIGHT SIDE** *PT BENDS KNEES TO REDUCE MUSCLE TENSION*
63
Light palpation
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
Deep palpation
push down 5-8 cm (2-3in.) deep palpation helps evaluate organs and find masses
65
Mild tenderness is expected for what during deep palpation?
sigmoid colon in the LLQ **ANY OTHER TENDERNESS SHOULD BE INVESTIGATED**
66
Masses
physiologic (pregnancy) inflammatory (diverticulitis of the colon) vascular (aneurysm) neoplastic obstructive LEAVE AREA OF TENDERNESS FOR LAST
67
What to note when a mass is found?
location size shape consistency (soft, firm, hard) surface (smooth, nodular) mobility (including movement with respirations) pulsatility tenderness
68
Palpating the liver
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
Hooking technique
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
Normally, the spleen is..
not palpable and must be enlarged 3 times normal size to be felt
71
Palpating the spleen
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
What could spleen enlargement mean?
mononucleosis leukemia and lymphomas portal HTN or HIV infection
73
Costovertebral angle tenderness (ADVANCED PRACTICE)
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
Palpating the kidneys
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
Palpating the bladder
deep palpation in the hypogastric region, superior to suprapubic bone EMPTY BLADDER- *UNABLE TO PALPATE* FULL BLADDER- *ENLARGED* **IF TENDER, UTI??**
76
Developmental Competence: Infant
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
Developmental Competence: Child
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
Developmental Competence: Aging Adult
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
SUMMARY CHECKLIST: ABDOMEN
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
Ascites
fluid in the abdomen protuberant abdomen with bulging flanks can indicate ascites
81
Assessing ascites: Testing for shifting dullness
tympany to dullness ask pt to rest on side, dullness should shift to the more dependent side and tympany shifts to top

Health Assessment (19 decks)

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