Abdomen, Nutrition and Elimination skills Flashcards
Organs in the 4 quadrants of abdomen
RLQ: - Right: ovary, fallopian tube, ureter, sprematic cord - Appendix - Cecum RUQ: - Right kidney and adrenal gland - Head of pancreas - Hepatic flexure of colon - Parts of ascending and transverse colon - Duodenum - Liver - Gallbladder LUQ: - Left kidney and adrenal gland - Spleen - Splenic flexure of colon - Parts of transverse and descending colon - Body of pancreas - Stomach LLQ: - Left: ovary, fallopian tube, ureter, spermatic cord - Parts of descending colon - Sigmoid colon MIDLINE: - Aorta - if enlarged: uterus, bladder
How is the stomach divided?
- RUQ, LUQ, RLQ, LLQ
- Epigastric, Umbilicus, Hypogastric/Suprapubic
Describe the layers of the abdominal cavity:
- Peritoneal cavity: abdomen and pelvic cavity
- Parietal Peritoneum: portion that lines the peritoneal cavity
- Visceral Peritoneum: covers the external surface of most abdominal organs
- Abdominal Aponeurosis: (rectal sheath) - fibrous sheaths that go from bottom of chest to top of pubic area
MUSCLES: - Transverse: stabilizes trunk, maintains internal abdominal pressure
- Internal and External oblique: allows trunk to twist. Internal contracts the way you twist, external the opposite
- Rectus Abdominis: between rips and pubic bone, moves the body between ribs and pelvis
What is solid and hollow viscera
Hollow: organ shape depends on content
(stomach, gallbladder, bladder, colon, small intestine)
Solid: organ shape remains constant
(liver, pancreas, kidneys, adrenal gland, spleen, ovaries, uterus, aorta)
What are abdominal considerations for infants and children?
- Larger liver: lower edge may be palpable below costal margin (in adults, it sits up under ribcage)
- Bladder is higher: sits by the umbilicus
- Abdominal wall is less muscular: less-developed muscle makes it easier for palpation
- Increased risk for GI illness: immune system not fully developed until age 5-6. At an age where they put a lot of objects in their mouths
Abdominal considerations for pregnancy?
- Nausea/vomiting
- Acid indigestion
- Constipation: elevated levels of progesterone relax smooth muscle, resulting in a delay in how things move through GI tract
- Diminished bowel sounds: intestines are displaced up and back, especially towards the end
- Skin changes on the abdomen
(Striae, Linea nigra)
Abdominal considerations in older adults?
- Adipose tissue redistribution to abdomen and hips
- Abdominal muscle relaxation (more lax appearance)
- Decreased salivation from salivary glands: more prone to dry mouth
- Decreased gastric acid secretion: implication in how some meds are absorbed
- Liver size decreased: especially after age 80, most drugs metabolize in the liver, so it has implications for uptake of drugs
- Decreased renal functioning: most drugs secreted through renal system, so implications for excretion of drugs (can lead to toxicity)
- Increased incidences of gallstones and colorectal cancer
Anorexia
loss of appetite that occurs with illness
Pyrosis
heart burn
Visceral, parietal, referred pain:
- Visceral pain: internal organ (dull, general, poorly localized)
- Parietal pain: from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement)
- Referred pain: from a disorder in another site, often structures that are at approx. the same spinal level
Hematemesis:
blood in vomit
Normal bowel habits?
3x a day to 2 x a week
- unexpected: 3+ days w/o BM
Melena stool
vs
Frank blood
Melena stool- black and tarry w/ characteristic odour. tells you there is an upper GI bleed
Frank blood - bright red obvious bleed, lower GI tract
Coffee ground vomit
blood originates in stomach and mixes with acid
Inflammed Bowel Disease
vs
Inflammatory Bowel Syndrome
IBD: inflammation of bowels causing cramping and diarrhea. higher risk of colon cancer
IBS: motility of GI tract issue often related to stress/diet, constipation, diarrhea. doesn’t cause lasting damage
Familial Adenomatous Polyposis (FAP)
inherited genetic mutation where large number of polyps in GI and colon. Risk of polyps turning into colon cancer is 87% by 45 yrs
Hernias:
protrusion in abdominal viscera through the abnormal wall opening in the muscle wall
1. UMBILICAL HERNIA: soft, skin-covered mass. Protrusion of intestine through a weakness or incomplete closure in the umbilical ring. In infants there may be an incomplete closure around the umbilicus, in adults, occurs with pregnancy, chronic ascites, or increase of abdominal pressure
2. INCISIONAL HERNIA:
bulge near an older operative scar that may not show when the patient is supine. Shows when sitting up because of increased intra-abdominal pressure
3. INGUINAL HERNIA: most common, spermatic cord can be an opening in the inguinal canal causing a protrusion through that hole
Paralytic ileus
paralysis of intestinal muscles which stops peristalsis (surgery)
Swallowing phases
- Oral: voluntary control. Propels the food bolus from the mouth to the pharynx
- Pharyngeal: involuntary control. Propels the food bolus from the pharynx to the esophagus
- Esophageal: involuntary control. Propels the food bolus from the esophagus to the stomach.
What can go wrong with swallowing?
- Dysphagia: impairment in any stage of the swallowing process (often neurological disease such as stroke, etc)
- Aspiration: food/fluid (or foreign substance) goes to the lungs rather than stomach
- Silent Aspiration: does not show signs/symptoms of aspiration
- Aspiration pneumonia: a lung infection that develops after aspirating food/liquid/etc. Can occur in one lobe and not affect the rest (left lower lobe pneumonia)
