abdominal assessment Flashcards
1
Q
viscera
A
internal organs of the abdomen
2
Q
peritoneum lines abdominal wall (______) and covers surface (_______) of most organs
A
- parietal
- visceral
3
Q
solid viscera
A
organs that maintain a solid shape
4
Q
solid viscera organs
A
- liver
- pancreas
- spleen
- adrenal glands
- kidneys
- ovaries
- uterus
5
Q
shape of ______ viscera depends on content
A
hollow
6
Q
hollow viscera organs
A
- stomach
- gallbladder
- small intestine
- colon
- bladder
7
Q
4 quadrants of abdomen
A
- right upper quadrant (RUQ)
- left upper quadrant (LUQ)
- right lower quadrant (RLQ)
- left lower quadrant (LLQ)
8
Q
midline organs
A
- aorta
- uterus (if enlarged)
- bladder (if distended)
9
Q
abdominal cavity protected by the _________, _______, and the _______.
A
- rectus abdominis muscles
- oblique muscles
- linea alba
10
Q
RUQ organs
A
- liver
- gallbladder
- duodenum
- head of the pancreas
- R. kidney + adrenal gland
- hepatic flexure of colon
- part of ascending + transverse colon
11
Q
LUQ organs
A
- stomach
- spleen
- left lobe of liver
- body of pancreas
- L. kidney + adrenal gland
- splenic flexure of colon
- part of transverse + descending colon
12
Q
RLQ organs
A
- cecum
- appendix
- R. ovary + tube
- R. ureter
- R. spermatic cord
13
Q
LLQ
A
- part of descending colon
- sigmoid colon
- L. ovary + tube
- L. ureter
- L. spermatic cord
14
Q
liver is located in what quadrant? where in relation to diaphragm and kidney?
A
- RUQ
- below diaphragm + above R. kidney
15
Q
pancreas is located where? the body of the pancreas and head of pancreas is in what quadrant?
A
- behind the stomach
- body = LUQ
- head = RUQ
16
Q
spleen is located in what quadrant? where in relation to diaphragm and kidney?
A
- LUQ
- just below diaphragm + above L. kidney
17
Q
gallbladder is where and in what quadrant?
A
- underneath posterior surface of liver
- RUQ
18
Q
kidneys is _____ to the abdominal contents
A
retroperitoneal
19
Q
the left kidney is in what quadrant? between what ribs?
A
- LUQ
- btw 11th + 12th ribs
20
Q
the right kidney is in what quadrant? where in relation to left kidney and why?
A
- RUQ
- 1.5-2 cm lower than L. kidney due to size of liver
21
Q
L. adrenal gland is located in what quadrant?
A
LUQ
22
Q
R. adrenal gland is located in what quadrant?
A
RUQ
23
Q
the GI tract is a long tube (_____) w/in the abdomen that runs from the?
A
- 27 ft
- mouth to the anus
24
Q
GI tract includes? what occurs in the GI tract?
A
- esophagus
- stomach
- small intestine
- large intestine (colon)
- digestion
25
esophagus is a? where is it in relation to trachea? what does it connect?
- 10 in collapsible tube
- posterior to trachea
- connects pharynx to stomach
26
the stomach is in what quadrant? location in relation to diaphragm?
- LUQ
- below the diaphragm
27
3 sections of the stomach
- fundus
- body
- pylorus
28
small intestine begins at the _____ and is approx. 21 ft long. the small intestine connects the ______ to the _____ and is made up of three sections:____, ____, ____.
- pylorus
- stomach
- large intestine
- duodenum
- jejunum
- illeum
29
large intestine connects the _____ to the _____ and is made up of 4 sections: _____, ____, _____, ____.
- small intestine
- anus
- cecum
- ascending colon
- transverse colon
- descending colon
30
in aging adult: abdominal wall musculature?
relaxes
31
changes of the GI system occur w/ aging, but most do not significantly affect ____ as long as no _____ is present.
- function
- disease
32
salivation ____, leading to?
- decreases
- dry mouth + decreased sense of taste
33
esophageal emptying + gastric acid secretion are?
delayed
34
incidence of _____ increases w/ age.
gallstones
35
although liver size ______, most liver fxns ________; however, drug metabolism is ______.
- decreases
- remain normal
- impaired
36
aging adults frequently report?
constipation
37
what standardizes symptoms criteria for fxnal constipation?
ROME III
38
common causes of constipation found in older adults
- decreased physical activity
- inadequate intake of water
- low-fiber diet
- SE meds
- IBS
- bowel obstruction
- hyperthyroidism
- inadequate toilet facilities (difficulty ambulating to toilet may cause person to deliberately retains tool until it becomes hard + difficult to pass)
39
lactase
digestive enzyme necessary for absorption of carbohydrate lactose (milk sugar)
40
ppl who are lactose intolerant have what S/S when milk products are consumed?
- abdominal pain
- bloating
- flatulence
41
celiac disease
- autoimmune dz
- gluten intolerant
42
subjective data
- appetite
- dysphagia
- food intol
- abdominal pain
- N/V
- bowel habits
- past and hist
- meds
- nutritional assessment
43
appetite: ask about?
- changes in appetite (time period + amt)
- changes in wt (loss/gain [amt] + time period)
44
dysphagia: ask about?
- any difficulty swallowing
- onset + associated symptoms
45
food intolerance: ask about?
- type of food rxn that occur
- use of Rx/OTC med (amt + freq)
46
pain associated w/ duodenal ulcers occurs? how can it be relieved?
- 2-3 hrs aft meal
- relieved by eating more food
47
chronic pain associated w/ gastric ulcers usually occurs?
- empty stomach
48
N/V: ask about?
- onset, freq, type + amt
- associated S and/or triggers
- recent foods eaten and/or travel habits
49
bowel habits: ask about?
- freq, color, consistency, D or constipation
- any recent changes
- laxative use: type, amt, freq
50
black stools
- may be tarry bc occult blood (melena) from upper GI bleed or non-tarry from iron meds
51
localized bleeding around anus would cause?
bright red blood w/ localized anus bleeding (hemorrhoids)
52
past abd hist: ask about?
- GI dz/pathology
- GI diagnostic procedues
- GI surgeries + clin response
53
meds: ask about?
- Rx + OTC
- alc: type, amt, freq
- smoking hist
54
nutritional assessment: ask about?
dietary history
55
chronical alcohol use has been attributed to the development of _____. This is in part due to the __________________________.
- malnutrition
- inhibitory effect of ethanol on the absorption of vital nutrients (glucose, amino acids, lipids, H2O, vitamins, minerals) w/in the small intestine
56
primary malnutrition?
alcohol displaces food
57
secondary malnutrition?
alcohol interferes w/ digestion + absorption of nutrients
58
wernicke-korsakoff syndrome?
- thiamin deficiency
- memory disorder
- require immediate tx
- most often happens in ppl w/ alc use dz + malnutrition
59
what vitamins and other nutrients cannot be absorbed in the small intestine due to the inhibitory effect of ethanol?
- vit. B1 (thiamine)
- vit. B2 (riboflavin)
- vit. B9 (folate)
- vit. C (ascorbic acid)
- selenium
- iron
- zinc
60
additional history of aging adults: ask about?
- access to groceries + food prep
- shared meals/eat alone
- 24 hr dietary recall
- swallowing/feeding difficulties
- activities done following mealtimes
- bowel health: freq, constipation, fiber in diet, use of laxatives
- meds: Rx + OTC
61
preparation of assessment (objective data)
- adequate light, expose abdomen so fully visible
- drape genitalia + female breasts
- position for comfort to enhance abdominal wall relaxation
- AUSCULTATE PRIOR TO PALPATION + PERCUSSION
62
how to position for comfort to enhance abdominal wall relaxation
- empty bladder prior to exam w/ specimen saved if needed
- warm stethoscope + examine areas identified as painful last to prevent guarding
63
equipment for abdominal assessment
- stethoscope
- small cm ruler
- skin-marking pen
- alc wipe to clean endpiece
64
inspection of abdomen
- surface structures
- skin color + characteristics
- venous return
- lesions + scars
- tautness + striae
65
dilated veins on the surface of the skin indicated? what is the indication found in?
- portal HTN
- liver cirrhosis or vena cava obstruction
66
caput medusa
distended/engorged superficial epigastric veins around umbilicius
67
why does caput medusa occur?
increased pressure in the portal system from portal HTN -> affects collateral flow btw portal + systemic systems
68
striae (_____) are ____ and usually not _____. often associated w/ wt ______ or -_____.
- stretch marks
- common
- pathological
- gain
- pregnancy
69
an exorbitant amt of striae may be associated with certain diseases that have _______, such as _______.
- abnormal collagen production
- Ehlers-Danlos syndrome
70
inspection of the abdomen includes?
- contour
- symmetry
- umbilicus
- skin
71
inspection: contour
- abdominal profile from rib margin to pubis
- describes nutritional state + norm ranges from flat to rounded
72
inspection: symmetry
abdomen should be symmetric bilaterally (w/ pt first seated, then standing)
73
inspection: umbilicus
- norm midline + inverted
- no sign of discoloration, inflammation, or hernia
74
inspection: skin
- surface smooth + even
- homogeneous color
- assess skin turgor
- inspect for pigment change + presence of lesions or scars
75
scaphoid contour
scaphoid abdomen caves inward
76
rounded/convex contour
obese abdomen appears uniformly rounded w/ sunken umbilicus
77
protuberant contour
protuberant abdomen is rounded, bulging, and stretched
78
hernia
protrusion of the abdominal viscera through an abdominal opening in the abdominal muscle wall
79
inspection: pulsation/movement NORM
- see pulsations from aorta beneath skin in epigastric area
- see particularly in thin persons w/ good muscle wall relaxation
80
pulsations of the renal arteries are/are not visable?
ARE NOT
81
the vena cava is a ? with/with no pulsation?
- vein, not an artery
- WITH NO
82
waves of peristalsis are sometimes visible in ______ and appear as a ?
- very thin people
- slow ripple moving obliquely across the abdomen
83
inspection: hair distribution
pattern of pubic growth norm has diamond shape in adult males and inverted triangle shape in adult females
84
inspection: demeanor
a comfortable person relaxed quietly on examining table + has a benign facial expression + slow, even respiration
85
four steps to performing a visual inspection of the abdomen
(1) examine the contour of the abdominal wall
(2) notice any skin changes
(3) inspect for visible masses
(4) observe for motion w/ respiration
86
visual inspection of the abdomen: (1) examine the contour of the abd wall
- distension
- masses
- bulging at the flanks
87
visual inspection of the abdomen: (2) notice any skin changes
- discoloration
- sinus or fistula
- striae
- dilated veins
- scars
- stoma
88
visual inspection of the abdomen: (3) inspect for visible masses
- changes w/ Valsalva maneuver
- presence of Fothergill's sign
89
Valsalva maneuver
- pt tense up abdominal wall + bear down OR perform partial sit-up by lifting their head & feet up off the table
- abdominal wall mass usually become more prominent
- intraabdominal mass become less prominent
90
abdominal wall masses usually present as ___ and are commonly ____ (a defect/weakness in the abdominal wall). can be ____, ____, ____, or _____. can be associated w/ ____ and sometimes ______ over the bulge if the ___ is incarcerated or strangulated.
- bulges
- hernias
- umbilical, epigastric, incisional, spigelian (lateral hernia btw rectus + lateral oblique muscles)
- pain, skin discoloration
- hernia
91
Fothergill's sign
rectus sheath hematoma also presents as an abdominal wall mass
92
(+) Fothergill's sign
- flexion of the rectus muscles does not cause the mass to change/cross the midline
- mass may be a rectus sheath hematoma
93
(-) Fothergill's sign
- mass changes w/ flexion + becomes more prominent (hernia)
94
intraabdominal masses can also be caused by?
- tumors
- malignancies
- organomegaly
95
visual inspection of the abdomen: (4) observe for motion w/ respiration
- rigidity
- fluid waves
96
auscultation is done after inspection because?
percussion + palpation can increase peristalsis, which would give a false interpretation of bowel sounds
97
use a _____ endpiece for auscultation because?
- diaphragm
- bowel sounds are relatively high pitched
98
auscultation: begin in ____ at _____ are because?
- RLQ
- ileocecal valve
- bowel sounds are norm always present here
99
bowel sounds originate from?
air + fluid movement thru the small intestine
100
bowel sounds are?
- high-pitched, gurgling, cascading sounds
- occur irregularly anywhere from 5-30 times per min
101
abnorm hypoactive bowel sound
decreased, can follow abdominal surgery or w/ inflammation
102
abnorm hyperactive bowel sound
loud, high-pitched signal increased motility
103
borborygmus
sound of hyperperistalsis
104
diminished/absent bowel sounds signal _____ GI motility, which is caused by?
- decreased
- inflammation from peritonitis, a paralytic ileus aft abdomen surgery, or bowel obstruction
105
what can cause hyperactive bowel sounds?
- diarrhea
- laxative use
- gastroenteritis
106
absent bowel sounds are _____. the nurse must listen for ______ before deciding bowel sounds are completely absent.
- rare
- 5 mins
107
____ percentage of healthy people may have a bruit.
small
108
what kind of bruits are there?
- abdominal
- aortic
- renal
- iliac
- femoral
109
most _________ are palpable during routine exam and feel like a pulsating mass.
aortic aneurysms
110
a ___ will be audible, and _____ pulses present, but decreased.
- bruit
- femoral
111
aortic aneurysms are located?
upper abdomen just to the left of the midline
112
using ____ pressure, check over _______, esp in ppl w/ HTN
- firmer
- aorta
- renal arteries
- iliac
- femoral arteries
113
do not use auscultation for?
initial placement of NG tube insertion
114
where to auscultate for abdominal vascular sounds/bruits?
(1) aorta (costal angle)
(2) renal (2-3 cm superior + lateral to umbilicus)
(3) iliac (below umbilicus)
115
percuss general _______ & _____, and ________
- tympany
- liver
- splenic dullness
116
percuss lightly in all _____ to determine ______ and ______ in clockwise manner
- 4 quadrants
- prevailing amt of tympany
- dullness
117
indirect _____ percussion causes tissues to _____ instead of producing a sound.
- fist
- vibrate
118
to assess kidney, place one hand over _______ at _____ on back. thump that hand w/ ____ of your other fist
- 12th rib
- costovertebral angle
- ulnar edge
119
percussing costovertebral angle tenderness: a person normally feels?
- thud, but no pain
120
positive finding when percussing costovertebral angle tenderness indicates?
inflammation of the kidney
121
begin w/ ____ palpation then proceed to ___ palpation
- light
- deep
122
palpation: judge __________ of certain organs and screen for ______?
- size, location, and consistency
- abnormal mass or tenderness
123
most people are naturally inclined to ______, need to use additional measures to _______.
- protect abdomen
- enhance complete muscle relaxation
124
light + deep palpation: note?
- location, size, consistency, mobility of any palpable organs
- presence of any abnorm enlargement, tenderness, or masses
125
_______ tenderness is norm present when palpating sigmoid colon. what about tenderness anywhere else?
- mild
- any other tenderness should be investigated
126
if you identify a mass though palpation, first?
distinguish it from a normally palpable structure or an enlarged organ
127
beginning w/ ___ palpation, depress the abdomen in each qradrant approx ______ in depth using ________.
- light
- 1 cm
- gentle, circular motion
128
if the pt is experiencing any abdominal pain, you should do what with that area?
palpate that area last
129
being palpating in what quadrant?
right lower quadrant + move clockwise
130
during light palpation, assessing for any ____ close to the abdominal surface like ______ and the qualities of the underlying structures.
- abnormalities
- hernias
131
proceed w/ ___ palpation by compressing the abdomen about __________ using the same ______ hand motion.
- deep
- 4-5 cm
- circular
132
a potential abnorm finding is abdominal mass which can indicate?
constipation or even malignancy
133
percussion abnorm: ____ predominant
dullness
134
percussion abnorm: liver
- lower liver border > 2-3 cm below costal margin
- upper liver border above 5th or below 7th ICS
- liver span < 6 cm or >12 cm
135
percussion abnorm: spleen
- large area of dullness (not associated w/ full stomach)
- tone change from tympany to dullness w/ inspiration
136
percussion abnorm: stomach
dullness
137
a palpable gallbladder or spleen is a?
abnormal palpation finding
138
palpation abnormalities
- muscular tension/resistance
- tenderness
- masses/bulges
- nodules
139
if resistance is present, feel for ____ of the abdominal muscles w/ a pillow beneath pt's knees. continued tension indicates?
- relaxation
- involuntary response to localized/generalized rigidity
140
abnorm palpation: umbilical ring + umbilicus
- bulges, nodules, granulation
- protruding umbilicus
141
abnorm palpation: liver + gallbladder
- tenderness
- nodules
- irregularity
- palpable gallbladder w/ pain + tenderness
142
abnorm palpation: spleen
palpable spleen
143
abnorm palpation: kidneys + bladder
- tenderness
- bladder palpable when not distended w/ urine
144
abnorm palpation: aorta
- prominent lateral pulsation (aortic aneurysm)
145
what to note when identify a mass
- location
- size
- shape
- consistency: soft, hard, firm
- surface: smooth, nodular
- mobility (movement w/ respirations)
- pulsatility
- tenderness
146
how to palpate liver (left hand)
place your left hand under a person's back parallel to 11th + 12th ribs and lift to support abdominal contents
147
how to palpate liver (right hand)
- place right hand on RUQ, fingers parallel to midline
- push deeply down + under R. costal margin
- ask person take deep breath (norm to feel edge of liver bump fingertips as diaphragm pushes it down during inhalation)
- liver feels like firm regular ridge: liver usually not palpable
148
alternative method to palpating liver
hooking technique
149
normally, spleen is _______ and must be enlarged ______ its normal size to be felt.
- not palpable
- 3x
150
the spleen is located within the ________ and is well protected under the _________. its long axis is roughly parallel to the _____.
- intraperitoneal space
- left costal margin
- 10th rib
151
to search for the spleen....
reach left hand over abdomen and behind left side at the 11th + 12th ribs
152
spleen palpation: lift up for support: place your ______ hand obliquely on ____ w/ fingers pointing toward left _____ and just inferior to _____ margin.
- right
- LUQ
- axilla
- rib
153
a pathologically enlarged spleen is palpated?
under the left costal margin during inspiration as the inferior edge descends to the examiner's fingertips
154
if an enlarged spleen is suspected?
- palpation should begin further down
- examination may be facilitated by gently lifting pt's left flank ventrally
155
enlargement of the spleen is seen w/
- mononucleosis
- leukemia and lymphomas
- portal HTN
- HIV infection
156
an alternative position to palpate the spleen is?
roll a person onto his/her right side to displace spleen more forward + downward
157
if the spleen is palpable...
do not continue to palpate as it is friable and can rupture
158
the kidneys are a _______ structure, protected by both ______ and _____ of the back.
- retro-peritoneal
- ribs
- musculature
159
kidney palpation: pt must take ________ before examination
deep breath
160
right kidney palpation
- feel no change or feel smooth muscle mass
- either is norm
161
left kidney palpation
- feel no change w/ inhalation
- not normally palpable
- 1.5 - 2.0 cm higher than right kidney
162
percussion of the _____ in the ________ can help discern pathological processes involving the kidneys, such as _______ or _______.
- flanks
- lower rib cage
- pyelonephritis
- urolithiasis
163
palpation of the aorta
- using the opposing thumb + fingers, palpate aortic pulsation in upper abdomen slightly to left of midline
- norm 2.5-4 cm wide in adult + pulsates in an anterior direction
164
widened pulse during palpation of the aorta is?
abdominal aortic aneurysm
165
percussion notes norm heard during the abdominal assessment may include?
- tympany
- should predominate bc air in the intestines rises to surface when person is supine
166
hyperresonance may be present w/?
gaseous distention
167
dullness may be found over a?
- distended bladder
- adipose tissue
- fluid
- mass
168
may suspect that a person has ascites (which is?) because of?
- free fluid in the peritoneal cavity
- distended abdomen
- bulging flanks
- umbilicus that is protruding and displaced downward
169
can differentiate ascites from gaseous distention by performing?
- fluid wave test
- shifting dullness test
170
first test for a fluid wave by standing on the person's?
right side
171
fluid wave test: place the _____ of another examiner's hand or pt's own hand firmly on the ___________. this stops __________>
- ulnar edge
- abdomen in the midline
- transmission across the skin of the upcoming tap
172
fluid wave: place your left hand on the person's ______. with your right hand, reach across the abdomen and give the left flank ______.
- right flank
- firm strike
173
fluid wave: if ascites is present, the blow will generate?
- a fluid wave through the abdomen
- will feel a distinct tap on your left hand
174
fluid wave: if the abdomen is distended from gas/adipose tissue?
no change
175
shifting dullness test: in a supine person, ascitic fluid settles by ____________, displacing the ___________.
- gravity into the flanks
- air-filled bowel to the periumbilical space
176
shifting dullness is a sign elicited on physical examination for?
ascites (fluid in the peritoneal cavity).
177
percussion shifts from ____ to ______ after the pt changes from _____ to _______ position.
- dull
- tympanic
- supine
- lateral decubitus
178
murphy's sign
inspiratory arrest for cholecystitis (inflammation of gallbladder)
179
murphy's sign test
abrupt interruption of deep inspiration by palpation of the gallbladder area
180
Blumberg's sign
- rebound tenderness
- pain upon removing pressure rather than applying pressure to the abdomen
- indicative of peritonitis
181
McBurney's sign
- appendicitis test
- deep tenderness at McBurney's point
- sign of acute appendicitis
182
Rovsing sign
- appendicitis test
- RLQ pain w/ palpation of LLQ
- suggests peritoneal irritation in the RLQ precipitated by palpation at a remote location
183
Obturator sign
- appendicitis test
- performed by flexing pt's right thigh at hep w/ knee flexed + rotating internally
- increased pain at RLQ (appendicitis)
184
Psoas sign
- appendicitis test
- RLQ pain w/ extension of right hip or w/ flexion of right hip against resistance
- inflamed appendix located along course of right psoas muscle
185
when the pt lies supine + attempts to flex their hip against resistance, place hand on their ______ and ask them to ______. if they have pain in _______, (+) Psoas sign.
- thigh
- lift their leg
- RLQ
186
guarding
pt involuntarily tenses their abdominal muscles when palpated
187
aging adult: on inspection, may note ____ deposits of _____ on abdomen + hips bc it is redistributed away from _______.
- increased
- subcutaneous fat
- extremities
188
aging adult: abdominal musculature is _____ and has ____ tone than that of younger adult, so in absence of ______. may note ______.
- thinner
- less
- obsesity
- peristalsis
189
aging adult: bc of ___, ____ abdominal wall, organs may be ____ to palpate, in the absence of ______.
- thinner
- softer
- easier
- obesity
190
aging adult: ____ and ____ are easier to palpate
- liver
- kidneys
191
aging adult: w/ ___ lungs + ____ diaphragm, liver can be palpated ____, ______ below costal margin w/ inhalation.
- distended
- depressed
- lower
- descending 1-2 cm
192
abnormal findings: abdominal distention
- obesity
- air/gas
- ascites
- ovarian cyst
- pregnancy
- feces
- tumor
193
common sites of referred abdominal pain: liver
RUQ
194
common sites of referred abdominal pain: esophagus
behind lower sternum
195
common sites of referred abdominal pain: ulcer
shoulder
196
common sites of referred abdominal pain: gallbladder
RUQ
197
common sites of referred abdominal pain: cholecystitis referred pain
- upper right abdominal pain radiating to right shoulder/back
- pain aft eating fatty meal
198
common sites of referred abdominal pain: appendix
RLQ
199
common sites of referred abdominal pain: pancreas
midscapular
200
common sites of referred abdominal pain: kidney
flank pain
201
common sites of referred abdominal pain: small intestine
diffuse
202
common sites of referred abdominal pain: colon
colicky pain + bloating
203
abnormal findings upon inspection
- umbilical hernia
- epigastric hernia
- incisional hernia
- diastasis recti
204
abnormal bowel sounds
- succussion splash
- marked peristalsis
- hypoactive bowel sounds
- hyperactive bowel sounds
205
succussion splash
- heard on percussion
- auscultation of the abdomen due to excessive fluid or gas in the stomach
206
abnormal findings: friction rubs + vascular sounds
- peritoneal friction rub
- arterial bruit
- venous hum
207
venous hum
- epigastric/umbilical area
- soft humming noises w/ both systolic/diastolic component
- indicates increased collateral circulation btw portal + venous systems as in hepatic cirrhosis
208
abnormal findings on palpation of enlarged organs
- liver
- nodular liver
- gallbladder
- spleen
- kidney
- aortic aneurysm
