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abdominal assessment Flashcards

1
Q

viscera

A

internal organs of the abdomen

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2
Q

peritoneum lines abdominal wall (______) and covers surface (_______) of most organs

A
  • parietal
  • visceral
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3
Q

solid viscera

A

organs that maintain a solid shape

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4
Q

solid viscera organs

A
  • liver
  • pancreas
  • spleen
  • adrenal glands
  • kidneys
  • ovaries
  • uterus
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5
Q

shape of ______ viscera depends on content

A

hollow

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6
Q

hollow viscera organs

A
  • stomach
  • gallbladder
  • small intestine
  • colon
  • bladder
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7
Q

4 quadrants of abdomen

A
  • right upper quadrant (RUQ)
  • left upper quadrant (LUQ)
  • right lower quadrant (RLQ)
  • left lower quadrant (LLQ)
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8
Q

midline organs

A
  • aorta
  • uterus (if enlarged)
  • bladder (if distended)
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9
Q

abdominal cavity protected by the _________, _______, and the _______.

A
  • rectus abdominis muscles
  • oblique muscles
  • linea alba
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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
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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
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12
Q

RLQ organs

A
  • cecum
  • appendix
  • R. ovary + tube
  • R. ureter
  • R. spermatic cord
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13
Q

LLQ

A
  • part of descending colon
  • sigmoid colon
  • L. ovary + tube
  • L. ureter
  • L. spermatic cord
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14
Q

liver is located in what quadrant? where in relation to diaphragm and kidney?

A
  • RUQ
  • below diaphragm + above R. kidney
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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
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16
Q

spleen is located in what quadrant? where in relation to diaphragm and kidney?

A
  • LUQ
  • just below diaphragm + above L. kidney
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17
Q

gallbladder is where and in what quadrant?

A
  • underneath posterior surface of liver
  • RUQ
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18
Q

kidneys is _____ to the abdominal contents

A

retroperitoneal

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19
Q

the left kidney is in what quadrant? between what ribs?

A
  • LUQ
  • btw 11th + 12th ribs
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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
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21
Q

L. adrenal gland is located in what quadrant?

A

LUQ

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22
Q

R. adrenal gland is located in what quadrant?

A

RUQ

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23
Q

the GI tract is a long tube (_____) w/in the abdomen that runs from the?

A
  • 27 ft
  • mouth to the anus
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24
Q

GI tract includes? what occurs in the GI tract?

A
  • esophagus
  • stomach
  • small intestine
  • large intestine (colon)
  • digestion
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25
Q

esophagus is a? where is it in relation to trachea? what does it connect?

A
  • 10 in collapsible tube
  • posterior to trachea
  • connects pharynx to stomach
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26
Q

the stomach is in what quadrant? location in relation to diaphragm?

A
  • LUQ
  • below the diaphragm
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27
Q

3 sections of the stomach

A
  • fundus
  • body
  • pylorus
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28
Q

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:____, ____, ____.

A
  • pylorus
  • stomach
  • large intestine
  • duodenum
  • jejunum
  • illeum
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29
Q

large intestine connects the _____ to the _____ and is made up of 4 sections: _____, ____, _____, ____.

A
  • small intestine
  • anus
  • cecum
  • ascending colon
  • transverse colon
  • descending colon
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30
Q

in aging adult: abdominal wall musculature?

A

relaxes

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31
Q

changes of the GI system occur w/ aging, but most do not significantly affect ____ as long as no _____ is present.

A
  • function
  • disease
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32
Q

salivation ____, leading to?

A
  • decreases
  • dry mouth + decreased sense of taste
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33
Q

esophageal emptying + gastric acid secretion are?

A

delayed

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34
Q

incidence of _____ increases w/ age.

A

gallstones

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35
Q

although liver size ______, most liver fxns ________; however, drug metabolism is ______.

A
  • decreases
  • remain normal
  • impaired
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36
Q

aging adults frequently report?

A

constipation

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37
Q

what standardizes symptoms criteria for fxnal constipation?

A

ROME III

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38
Q

common causes of constipation found in older adults

A
  • 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)
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39
Q

lactase

A

digestive enzyme necessary for absorption of carbohydrate lactose (milk sugar)

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40
Q

ppl who are lactose intolerant have what S/S when milk products are consumed?

A
  • abdominal pain
  • bloating
  • flatulence
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41
Q

celiac disease

A
  • autoimmune dz
  • gluten intolerant
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42
Q

subjective data

A
  • appetite
  • dysphagia
  • food intol
  • abdominal pain
  • N/V
  • bowel habits
  • past and hist
  • meds
  • nutritional assessment
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43
Q

appetite: ask about?

A
  • changes in appetite (time period + amt)
  • changes in wt (loss/gain [amt] + time period)
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44
Q

dysphagia: ask about?

A
  • any difficulty swallowing
  • onset + associated symptoms
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45
Q

food intolerance: ask about?

A
  • type of food rxn that occur
  • use of Rx/OTC med (amt + freq)
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46
Q

pain associated w/ duodenal ulcers occurs? how can it be relieved?

A
  • 2-3 hrs aft meal
  • relieved by eating more food
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47
Q

chronic pain associated w/ gastric ulcers usually occurs?

A
  • empty stomach
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48
Q

N/V: ask about?

A
  • onset, freq, type + amt
  • associated S and/or triggers
  • recent foods eaten and/or travel habits
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49
Q

bowel habits: ask about?

A
  • freq, color, consistency, D or constipation
  • any recent changes
  • laxative use: type, amt, freq
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50
Q

black stools

A
  • may be tarry bc occult blood (melena) from upper GI bleed or non-tarry from iron meds
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51
Q

localized bleeding around anus would cause?

A

bright red blood w/ localized anus bleeding (hemorrhoids)

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52
Q

past abd hist: ask about?

A
  • GI dz/pathology
  • GI diagnostic procedues
  • GI surgeries + clin response
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53
Q

meds: ask about?

A
  • Rx + OTC
  • alc: type, amt, freq
  • smoking hist
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54
Q

nutritional assessment: ask about?

A

dietary history

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55
Q

chronical alcohol use has been attributed to the development of _____. This is in part due to the __________________________.

A
  • malnutrition
  • inhibitory effect of ethanol on the absorption of vital nutrients (glucose, amino acids, lipids, H2O, vitamins, minerals) w/in the small intestine
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56
Q

primary malnutrition?

A

alcohol displaces food

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57
Q

secondary malnutrition?

A

alcohol interferes w/ digestion + absorption of nutrients

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58
Q

wernicke-korsakoff syndrome?

A
  • thiamin deficiency
  • memory disorder
  • require immediate tx
  • most often happens in ppl w/ alc use dz + malnutrition
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59
Q

what vitamins and other nutrients cannot be absorbed in the small intestine due to the inhibitory effect of ethanol?

A
  • vit. B1 (thiamine)
  • vit. B2 (riboflavin)
  • vit. B9 (folate)
  • vit. C (ascorbic acid)
  • selenium
  • iron
  • zinc
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60
Q

additional history of aging adults: ask about?

A
  • 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
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61
Q

preparation of assessment (objective data)

A
  • adequate light, expose abdomen so fully visible
  • drape genitalia + female breasts
  • position for comfort to enhance abdominal wall relaxation
  • AUSCULTATE PRIOR TO PALPATION + PERCUSSION
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62
Q

how to position for comfort to enhance abdominal wall relaxation

A
  • empty bladder prior to exam w/ specimen saved if needed
  • warm stethoscope + examine areas identified as painful last to prevent guarding
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63
Q

equipment for abdominal assessment

A
  • stethoscope
  • small cm ruler
  • skin-marking pen
  • alc wipe to clean endpiece
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64
Q

inspection of abdomen

A
  • surface structures
  • skin color + characteristics
  • venous return
  • lesions + scars
  • tautness + striae
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65
Q

dilated veins on the surface of the skin indicated? what is the indication found in?

A
  • portal HTN
  • liver cirrhosis or vena cava obstruction
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66
Q

caput medusa

A

distended/engorged superficial epigastric veins around umbilicius

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67
Q

why does caput medusa occur?

A

increased pressure in the portal system from portal HTN -> affects collateral flow btw portal + systemic systems

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68
Q

striae (_____) are ____ and usually not _____. often associated w/ wt ______ or -_____.

A
  • stretch marks
  • common
  • pathological
  • gain
  • pregnancy
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69
Q

an exorbitant amt of striae may be associated with certain diseases that have _______, such as _______.

A
  • abnormal collagen production
  • Ehlers-Danlos syndrome
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70
Q

inspection of the abdomen includes?

A
  • contour
  • symmetry
  • umbilicus
  • skin
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71
Q

inspection: contour

A
  • abdominal profile from rib margin to pubis
  • describes nutritional state + norm ranges from flat to rounded
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72
Q

inspection: symmetry

A

abdomen should be symmetric bilaterally (w/ pt first seated, then standing)

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73
Q

inspection: umbilicus

A
  • norm midline + inverted
  • no sign of discoloration, inflammation, or hernia
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74
Q

inspection: skin

A
  • surface smooth + even
  • homogeneous color
  • assess skin turgor
  • inspect for pigment change + presence of lesions or scars
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75
Q

scaphoid contour

A

scaphoid abdomen caves inward

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76
Q

rounded/convex contour

A

obese abdomen appears uniformly rounded w/ sunken umbilicus

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77
Q

protuberant contour

A

protuberant abdomen is rounded, bulging, and stretched

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78
Q

hernia

A

protrusion of the abdominal viscera through an abdominal opening in the abdominal muscle wall

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79
Q

inspection: pulsation/movement NORM

A
  • see pulsations from aorta beneath skin in epigastric area
  • see particularly in thin persons w/ good muscle wall relaxation
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80
Q

pulsations of the renal arteries are/are not visable?

A

ARE NOT

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81
Q

the vena cava is a ? with/with no pulsation?

A
  • vein, not an artery
  • WITH NO
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82
Q

waves of peristalsis are sometimes visible in ______ and appear as a ?

A
  • very thin people
  • slow ripple moving obliquely across the abdomen
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83
Q

inspection: hair distribution

A

pattern of pubic growth norm has diamond shape in adult males and inverted triangle shape in adult females

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84
Q

inspection: demeanor

A

a comfortable person relaxed quietly on examining table + has a benign facial expression + slow, even respiration

85
Q

four steps to performing a visual inspection of the abdomen

A

(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
Q

visual inspection of the abdomen: (1) examine the contour of the abd wall

A
  • distension
  • masses
  • bulging at the flanks
87
Q

visual inspection of the abdomen: (2) notice any skin changes

A
  • discoloration
  • sinus or fistula
  • striae
  • dilated veins
  • scars
  • stoma
88
Q

visual inspection of the abdomen: (3) inspect for visible masses

A
  • changes w/ Valsalva maneuver
  • presence of Fothergill’s sign
89
Q

Valsalva maneuver

A
  • 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
Q

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.

A
  • bulges
  • hernias
  • umbilical, epigastric, incisional, spigelian (lateral hernia btw rectus + lateral oblique muscles)
  • pain, skin discoloration
  • hernia
91
Q

Fothergill’s sign

A

rectus sheath hematoma also presents as an abdominal wall mass

92
Q

(+) Fothergill’s sign

A
  • flexion of the rectus muscles does not cause the mass to change/cross the midline
  • mass may be a rectus sheath hematoma
93
Q

(-) Fothergill’s sign

A
  • mass changes w/ flexion + becomes more prominent (hernia)
94
Q

intraabdominal masses can also be caused by?

A
  • tumors
  • malignancies
  • organomegaly
95
Q

visual inspection of the abdomen: (4) observe for motion w/ respiration

A
  • rigidity
  • fluid waves
96
Q

auscultation is done after inspection because?

A

percussion + palpation can increase peristalsis, which would give a false interpretation of bowel sounds

97
Q

use a _____ endpiece for auscultation because?

A
  • diaphragm
  • bowel sounds are relatively high pitched
98
Q

auscultation: begin in ____ at _____ are because?

A
  • RLQ
  • ileocecal valve
  • bowel sounds are norm always present here
99
Q

bowel sounds originate from?

A

air + fluid movement thru the small intestine

100
Q

bowel sounds are?

A
  • high-pitched, gurgling, cascading sounds
  • occur irregularly anywhere from 5-30 times per min
101
Q

abnorm hypoactive bowel sound

A

decreased, can follow abdominal surgery or w/ inflammation

102
Q

abnorm hyperactive bowel sound

A

loud, high-pitched signal increased motility

103
Q

borborygmus

A

sound of hyperperistalsis

104
Q

diminished/absent bowel sounds signal _____ GI motility, which is caused by?

A
  • decreased
  • inflammation from peritonitis, a paralytic ileus aft abdomen surgery, or bowel obstruction
105
Q

what can cause hyperactive bowel sounds?

A
  • diarrhea
  • laxative use
  • gastroenteritis
106
Q

absent bowel sounds are _____. the nurse must listen for ______ before deciding bowel sounds are completely absent.

A
  • rare
  • 5 mins
107
Q

____ percentage of healthy people may have a bruit.

A

small

108
Q

what kind of bruits are there?

A
  • abdominal
  • aortic
  • renal
  • iliac
  • femoral
109
Q

most _________ are palpable during routine exam and feel like a pulsating mass.

A

aortic aneurysms

110
Q

a ___ will be audible, and _____ pulses present, but decreased.

A
  • bruit
  • femoral
111
Q

aortic aneurysms are located?

A

upper abdomen just to the left of the midline

112
Q

using ____ pressure, check over _______, esp in ppl w/ HTN

A
  • firmer
  • aorta
  • renal arteries
  • iliac
  • femoral arteries
113
Q

do not use auscultation for?

A

initial placement of NG tube insertion

114
Q

where to auscultate for abdominal vascular sounds/bruits?

A

(1) aorta (costal angle)
(2) renal (2-3 cm superior + lateral to umbilicus)
(3) iliac (below umbilicus)

115
Q

percuss general _______ & _____, and ________

A
  • tympany
  • liver
  • splenic dullness
116
Q

percuss lightly in all _____ to determine ______ and ______ in clockwise manner

A
  • 4 quadrants
  • prevailing amt of tympany
  • dullness
117
Q

indirect _____ percussion causes tissues to _____ instead of producing a sound.

A
  • fist
  • vibrate
118
Q

to assess kidney, place one hand over _______ at _____ on back. thump that hand w/ ____ of your other fist

A
  • 12th rib
  • costovertebral angle
  • ulnar edge
119
Q

percussing costovertebral angle tenderness: a person normally feels?

A
  • thud, but no pain
120
Q

positive finding when percussing costovertebral angle tenderness indicates?

A

inflammation of the kidney

121
Q

begin w/ ____ palpation then proceed to ___ palpation

A
  • light
  • deep
122
Q

palpation: judge __________ of certain organs and screen for ______?

A
  • size, location, and consistency
  • abnormal mass or tenderness
123
Q

most people are naturally inclined to ______, need to use additional measures to _______.

A
  • protect abdomen
  • enhance complete muscle relaxation
124
Q

light + deep palpation: note?

A
  • location, size, consistency, mobility of any palpable organs
  • presence of any abnorm enlargement, tenderness, or masses
125
Q

_______ tenderness is norm present when palpating sigmoid colon. what about tenderness anywhere else?

A
  • mild
  • any other tenderness should be investigated
126
Q

if you identify a mass though palpation, first?

A

distinguish it from a normally palpable structure or an enlarged organ

127
Q

beginning w/ ___ palpation, depress the abdomen in each qradrant approx ______ in depth using ________.

A
  • light
  • 1 cm
  • gentle, circular motion
128
Q

if the pt is experiencing any abdominal pain, you should do what with that area?

A

palpate that area last

129
Q

being palpating in what quadrant?

A

right lower quadrant + move clockwise

130
Q

during light palpation, assessing for any ____ close to the abdominal surface like ______ and the qualities of the underlying structures.

A
  • abnormalities
  • hernias
131
Q

proceed w/ ___ palpation by compressing the abdomen about __________ using the same ______ hand motion.

A
  • deep
  • 4-5 cm
  • circular
132
Q

a potential abnorm finding is abdominal mass which can indicate?

A

constipation or even malignancy

133
Q

percussion abnorm: ____ predominant

A

dullness

134
Q

percussion abnorm: liver

A
  • 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
Q

percussion abnorm: spleen

A
  • large area of dullness (not associated w/ full stomach)
  • tone change from tympany to dullness w/ inspiration
136
Q

percussion abnorm: stomach

A

dullness

137
Q

a palpable gallbladder or spleen is a?

A

abnormal palpation finding

138
Q

palpation abnormalities

A
  • muscular tension/resistance
  • tenderness
  • masses/bulges
  • nodules
139
Q

if resistance is present, feel for ____ of the abdominal muscles w/ a pillow beneath pt’s knees. continued tension indicates?

A
  • relaxation
  • involuntary response to localized/generalized rigidity
140
Q

abnorm palpation: umbilical ring + umbilicus

A
  • bulges, nodules, granulation
  • protruding umbilicus
141
Q

abnorm palpation: liver + gallbladder

A
  • tenderness
  • nodules
  • irregularity
  • palpable gallbladder w/ pain + tenderness
142
Q

abnorm palpation: spleen

A

palpable spleen

143
Q

abnorm palpation: kidneys + bladder

A
  • tenderness
  • bladder palpable when not distended w/ urine
144
Q

abnorm palpation: aorta

A
  • prominent lateral pulsation (aortic aneurysm)
145
Q

what to note when identify a mass

A
  • location
  • size
  • shape
  • consistency: soft, hard, firm
  • surface: smooth, nodular
  • mobility (movement w/ respirations)
  • pulsatility
  • tenderness
146
Q

how to palpate liver (left hand)

A

place your left hand under a person’s back parallel to 11th + 12th ribs and lift to support abdominal contents

147
Q

how to palpate liver (right hand)

A
  • 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
Q

alternative method to palpating liver

A

hooking technique

149
Q

normally, spleen is _______ and must be enlarged ______ its normal size to be felt.

A
  • not palpable
  • 3x
150
Q

the spleen is located within the ________ and is well protected under the _________. its long axis is roughly parallel to the _____.

A
  • intraperitoneal space
  • left costal margin
  • 10th rib
151
Q

to search for the spleen….

A

reach left hand over abdomen and behind left side at the 11th + 12th ribs

152
Q

spleen palpation: lift up for support: place your ______ hand obliquely on ____ w/ fingers pointing toward left _____ and just inferior to _____ margin.

A
  • right
  • LUQ
  • axilla
  • rib
153
Q

a pathologically enlarged spleen is palpated?

A

under the left costal margin during inspiration as the inferior edge descends to the examiner’s fingertips

154
Q

if an enlarged spleen is suspected?

A
  • palpation should begin further down
  • examination may be facilitated by gently lifting pt’s left flank ventrally
155
Q

enlargement of the spleen is seen w/

A
  • mononucleosis
  • leukemia and lymphomas
  • portal HTN
  • HIV infection
156
Q

an alternative position to palpate the spleen is?

A

roll a person onto his/her right side to displace spleen more forward + downward

157
Q

if the spleen is palpable…

A

do not continue to palpate as it is friable and can rupture

158
Q

the kidneys are a _______ structure, protected by both ______ and _____ of the back.

A
  • retro-peritoneal
  • ribs
  • musculature
159
Q

kidney palpation: pt must take ________ before examination

A

deep breath

160
Q

right kidney palpation

A
  • feel no change or feel smooth muscle mass
  • either is norm
161
Q

left kidney palpation

A
  • feel no change w/ inhalation
  • not normally palpable
  • 1.5 - 2.0 cm higher than right kidney
162
Q

percussion of the _____ in the ________ can help discern pathological processes involving the kidneys, such as _______ or _______.

A
  • flanks
  • lower rib cage
  • pyelonephritis
  • urolithiasis
163
Q

palpation of the aorta

A
  • 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
Q

widened pulse during palpation of the aorta is?

A

abdominal aortic aneurysm

165
Q

percussion notes norm heard during the abdominal assessment may include?

A
  • tympany
  • should predominate bc air in the intestines rises to surface when person is supine
166
Q

hyperresonance may be present w/?

A

gaseous distention

167
Q

dullness may be found over a?

A
  • distended bladder
  • adipose tissue
  • fluid
  • mass
168
Q

may suspect that a person has ascites (which is?) because of?

A
  • free fluid in the peritoneal cavity
  • distended abdomen
  • bulging flanks
  • umbilicus that is protruding and displaced downward
169
Q

can differentiate ascites from gaseous distention by performing?

A
  • fluid wave test
  • shifting dullness test
170
Q

first test for a fluid wave by standing on the person’s?

A

right side

171
Q

fluid wave test: place the _____ of another examiner’s hand or pt’s own hand firmly on the ___________. this stops __________>

A
  • ulnar edge
  • abdomen in the midline
  • transmission across the skin of the upcoming tap
172
Q

fluid wave: place your left hand on the person’s ______. with your right hand, reach across the abdomen and give the left flank ______.

A
  • right flank
  • firm strike
173
Q

fluid wave: if ascites is present, the blow will generate?

A
  • a fluid wave through the abdomen
  • will feel a distinct tap on your left hand
174
Q

fluid wave: if the abdomen is distended from gas/adipose tissue?

A

no change

175
Q

shifting dullness test: in a supine person, ascitic fluid settles by ____________, displacing the ___________.

A
  • gravity into the flanks
  • air-filled bowel to the periumbilical space
176
Q

shifting dullness is a sign elicited on physical examination for?

A

ascites (fluid in the peritoneal cavity).

177
Q

percussion shifts from ____ to ______ after the pt changes from _____ to _______ position.

A
  • dull
  • tympanic
  • supine
  • lateral decubitus
178
Q

murphy’s sign

A

inspiratory arrest for cholecystitis (inflammation of gallbladder)

179
Q

murphy’s sign test

A

abrupt interruption of deep inspiration by palpation of the gallbladder area

180
Q

Blumberg’s sign

A
  • rebound tenderness
  • pain upon removing pressure rather than applying pressure to the abdomen
  • indicative of peritonitis
181
Q

McBurney’s sign

A
  • appendicitis test
  • deep tenderness at McBurney’s point
  • sign of acute appendicitis
182
Q

Rovsing sign

A
  • appendicitis test
  • RLQ pain w/ palpation of LLQ
  • suggests peritoneal irritation in the RLQ precipitated by palpation at a remote location
183
Q

Obturator sign

A
  • appendicitis test
  • performed by flexing pt’s right thigh at hep w/ knee flexed + rotating internally
  • increased pain at RLQ (appendicitis)
184
Q

Psoas sign

A
  • 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
Q

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.

A
  • thigh
  • lift their leg
  • RLQ
186
Q

guarding

A

pt involuntarily tenses their abdominal muscles when palpated

187
Q

aging adult: on inspection, may note ____ deposits of _____ on abdomen + hips bc it is redistributed away from _______.

A
  • increased
  • subcutaneous fat
  • extremities
188
Q

aging adult: abdominal musculature is _____ and has ____ tone than that of younger adult, so in absence of ______. may note ______.

A
  • thinner
  • less
  • obsesity
  • peristalsis
189
Q

aging adult: bc of ___, ____ abdominal wall, organs may be ____ to palpate, in the absence of ______.

A
  • thinner
  • softer
  • easier
  • obesity
190
Q

aging adult: ____ and ____ are easier to palpate

A
  • liver
  • kidneys
191
Q

aging adult: w/ ___ lungs + ____ diaphragm, liver can be palpated ____, ______ below costal margin w/ inhalation.

A
  • distended
  • depressed
  • lower
  • descending 1-2 cm
192
Q

abnormal findings: abdominal distention

A
  • obesity
  • air/gas
  • ascites
  • ovarian cyst
  • pregnancy
  • feces
  • tumor
193
Q

common sites of referred abdominal pain: liver

A

RUQ

194
Q

common sites of referred abdominal pain: esophagus

A

behind lower sternum

195
Q

common sites of referred abdominal pain: ulcer

A

shoulder

196
Q

common sites of referred abdominal pain: gallbladder

A

RUQ

197
Q

common sites of referred abdominal pain: cholecystitis referred pain

A
  • upper right abdominal pain radiating to right shoulder/back
  • pain aft eating fatty meal
198
Q

common sites of referred abdominal pain: appendix

A

RLQ

199
Q

common sites of referred abdominal pain: pancreas

A

midscapular

200
Q

common sites of referred abdominal pain: kidney

A

flank pain

201
Q

common sites of referred abdominal pain: small intestine

A

diffuse

202
Q

common sites of referred abdominal pain: colon

A

colicky pain + bloating

203
Q

abnormal findings upon inspection

A
  • umbilical hernia
  • epigastric hernia
  • incisional hernia
  • diastasis recti
204
Q

abnormal bowel sounds

A
  • succussion splash
  • marked peristalsis
  • hypoactive bowel sounds
  • hyperactive bowel sounds
205
Q

succussion splash

A
  • heard on percussion
  • auscultation of the abdomen due to excessive fluid or gas in the stomach
206
Q

abnormal findings: friction rubs + vascular sounds

A
  • peritoneal friction rub
  • arterial bruit
  • venous hum
207
Q

venous hum

A
  • epigastric/umbilical area
  • soft humming noises w/ both systolic/diastolic component
  • indicates increased collateral circulation btw portal + venous systems as in hepatic cirrhosis
208
Q

abnormal findings on palpation of enlarged organs

A
  • liver
  • nodular liver
  • gallbladder
  • spleen
  • kidney
  • aortic aneurysm

health assess (3 decks)

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