Abdominal Ch. 22 Flashcards
Test for appendicitis: iliopsoas muscle test
have the pt. lift right leg, pain is a positive result
Burning sensation in the esophagus or stomach
Pyrosis, heartburn
organs in the RUQ
Liver Gallbladder Duodenum Head of pancreas Right kidney and adrenal Hepatic flexure of colon Part of ascending and transverse colon
organs in the LUQ
Stomach Spleen Left lobe of liver Body of pancreas Left kidney and adrenal Splenic flexure of colon Part of transverse and descending colon
organs in the RLQ
Cecum Appendix Right ovary and tube Right ureter Right spermatic cord
organs in the LLQ
Part of descending colon
Sigmoid colon
Left ovary and tube
Left ureter
Solid viscera are those that maintain a characteristic shape (8):
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus
The shape of the hollow viscera depends on the contents (5):
stomach, gallbladder, small intestine, colon, and bladder
name for the upper central quadrant (directly over the stomach)
epigastrum
the 2 names for the lower central quadrant
hypogastrium or supra-pubic
what can clay, yellow stool signify?
Jaundice, liver disfunction
what can gray stool signify?
hepatitis
what is black tarry stool called and what does it signify?
Melena
Upper GI bleed
what is bright bloody stool called and what does it signify?
Hematochezia (he·ma·to·che·zia)
Lower GI bleed- colon, rectum
Dyschezia
excessive straining with stools, specifically referring to a very common problem of newborns, and perhaps more subtle difficulties with toddlers being toilet trained
Dysphagia Dyslopia Dyspnea Dysarthria Dysphasia
DysphaGia: difficulty swallowing (G, think “gag”)
Dyslopia: double vison
Dyspnea: shallow breathing (“pnea” =breathing)
DySARthria: slurred speech (saarr, sounds slurred)
DysphaSia: trouble generating speech (s, think speech)
burp
eructation (ee·ruhk·tei·shn)
what is frothy stool called and what does it signify?
steatorrhea (stee·ree·uh)
excessive fat in stool: malabsorption as in celiac disease, cystic fibrosis, chronic pancreatitis, Crohn disease.
what is stool called that looks like it has coffee grounds in it and what does it signify?
hematemesis (hee·muh·teh·muh·suhs)
occurs with stomach or duodenal ulcers and esophageal varices.
what is the term for eating uneatable things
pica
The accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
Ascites
What are the causes of Ascites, the symptoms, and the assessment to support it
Cause: cirrhosis of the liver (most common), recurrent cancer, infection, ruptured gallbladder
Symptoms: dullness over hypogastrium region when standing, shifting dullness, jaundice, bulging flanks, taught glistening skin over abd.
Assessment: routine measurement of abd. girth (BEST method for early ditection)
Fluid wave test: pt. supine, tap flak and will feel the fluid wave on the opposite flank
cirrhosis
scarring (fibrosis) of the liver.
Protrusion of abdominal viscera through abnormal opening in muscle wall
Hernia
Omentum
a large flat adipose tissue layer nestling on the surface of the intra-peritoneal organs
Umbilical Hernias are caused by what?
Infants
Adults
- increased intra-abdominal pressure as with crying, coughing, vomiting, or straining (the bowel rarely incarcerates or strangulates).
- More common in premature infants (most resolve spontaneously by 1 year)
- Occurs in adults during pregnancy
- Chronic ascites, or chronic asthma or chronic bronchitis
Difference in pain Gastric Ulcer vs Duodenum Ulcer
Gastric: pain is worse after eating
Duodenum: pain is worse w/o food (eg: at night when the pt. has not eaten for awhile) b/c of the release of HCO3
Abdominal pain questions:
- point to where it hurts
- better/ worse with food (ulcer)
- foods that make it worse (intolerance)
- vaginal/ penile bleeding (UTI)
- LMP (pregnant)
- fatigue, fever, flatulence
- last BM, how often you pee at night (obstruction, prostate)
- N/V, onset (food poisoning)
- new medication
In what order for APPI is abd. assesment done?
why?
Inspection, auscultation, percussion, palpation
Percussion and palpation can increase peristalsis which would give a false interpretation of bowel sounds.
Peristalsis
the involuntary constriction and relaxation of the muscles of the intestine creating wave-like movements that push the contents
what done a positive Cullen sign mean?
hemorrhagic discoloration od the periumbilical region. Occurs (though rarely) with intraperitoneal bleeding; more often it is acute hemorrhagic panniculitis.
inspection of the abdomen
Contour: Stand on the person’s right side and look down on the abdomen. Then stoop or sit to gaze across the abdomen. Determine the profile from the rib margin to the pubic bone.
Symmetry: Shine a light across the abdomen toward you or lengthwise across the person. Step to the foot of the examination table to recheck symmetry.
describe the different Contour findings
The contour describes the nutritional state.
flat, concave (scaphoid), rounded, protuberant (only normal in pregnancy)
Describe abnormalities in Symmetry
Note any localized bulging, visible mass, or asymmetric shape. Even small bulges are highlighted by shadow.
what does a positive Turner sign mean?
discoloration of the left flank associated with acute hemorrhagic pancreatitis.
Visible waves of peristalsis is a sign of what?
bowl obstruction
Describe the process of auscultation of the abd. for bowel sounds
use the diaphragm, start in RLQ (because iileocecal valve is very active), move clockwise (follow the path of digestion), do not count sounds (move on as soon as you hear a sound)
Bowel sounds:
Normative
Hypoactive
Hyperactive
Normative: high-pitched, irreg., gurgling, should hear sound within a few seconds
Hypoactive: less frequent than normative. Due to surgery, peritonitis, opioids, late obstruction
Hyperactive: loud, rushing, tinkling, constant. due to hunger, diarrhea, laxatives, gastroenteritis, early obstruction
Gastroenteritis
what it is
symptoms
inflammation of the lining of the intestines caused by a virus, bacteria, or parasites (stomach flu).
Symptoms: diarrhea, cramps, nausea, vomiting, and fever.
A rumbling or gurgling noise made by the movement of fluid and gas in the intestines.
borborygmus (bor·br·ig·muhs)
Describe the process of auscultation of the abd. for vascular sounds
use the bell
aorta (central above the umbilicus), right and left renal artery, right and left iliac artery, and right and left femoral artery.
it is normal to not hear anything, you are listening for artery bruits due to stenosis
stenosis
the abnormal narrowing of a passage in the body.
Describe the process of percussion of the abd.
percuss in each quadrant. Should hear tympany over hallow viscera and dullness over liver, fecal matter, adipose tissue.
Describe the process of Fist percussion, and the rationale for determining costovertebral angle (CVA) tenderness.
Examples of what could cause pain
To assess kidney: place non dominant hand over the 12th rib at the costovertebral angle on the back. Thump that hand with the ulnar edge of your dominant fist.
Sharp pain occurs with inflammation of the kidney.
eg: kidney stones, UTI (moved to infection of the kidney), tumor, blockage in the ureter backs up into the sac around the kidney
Describe the process of palpation of the abd.
Light: 1-2cm- surface characteristics (hernias, masses, lumps, distention), tenderness. Overall assessment
Deep: 4-5cm- feel internal organs shape and consistency; advanced technique. Localized assessment
Test for appendicitis: Blumberg Sign
palpation of the area opposite from the site of pain. Rebound tenderness it is a positive result
Diactesis recti
normal midline abd. bulge in infants
Meconium
sticky, greenish-black stool within 24 hours of birth.
Normal finding during pregnancy relating to venous compression
Inferior vena cava compression: decreased GI motility leading to constipation
Varicose veins in rectum leading to hemorrhoids
Normal finding for the aging adult’s abd.
abd. fat accumulation
Salvation decreases
Decreased gastric acid absorption
Constipation
What does decreased gastric acid absorption result in?
decreased bioavailability for med. breakdown
decreased vit. A absorption
increased risk of gallstones
liver size decreases by 25% (effects the metabolization of meds)
What changes in the older adult results in constipation
decreased mobility
decreased appetite (due to dentition and decreased sense of taste)
Decreased water consumption
usually on a number of medications
GERD
what it is
clinical findings
Gastroesophageal reflux disease: gastric secreations flows back into the esophagus. Due to a weaken lower esophageal pressure or increased intra-abdominal pressure
Findings: regurgitation, burning retrosternal pain after eating, pain worse when lying down
Peptic ulcer disease:
what is it
what causes it
clinical findings
Ulcer occuring in the lower esophagus, stomach, or duodenum (most common)
Cause: Occurs with frequent use of nonsteroidal antiinflammatory drugs (NSAIDs), asprin, alcohol, smoking, stress, and Helicobacter pylori infection.
Findings: Pain relieved with food. Dull aching, gnawing epigastric pain.
If the ulcer is bleeding pt. may have melena or hematemesis.
If it perforates: rigid abd., severe radiating pain, fever
Appendicitis
what it is
clinical findings
inflammation of the Appendix
findings: RLQ pain (McBurney’s point), N/V, fever, bloating, + iliopsoas muscle test, + Blumberg sign
Proactive measure taken when pt. presents with abd. pain
NPO
Cholecystitis
what it is
clinical findings
Inflammation of the gallbladder. Bile duct becomes obstructed by inflammation or gallstones
Findings: RUQ pain that may radiate, worse with food, mild jaundice, fever, + Murphy’s sign,
Murphy’s sign
Deep palpation of the liver. Pt. breathes in, push fingers under right rib cage; pt. will involuntarily tense if gallbladder is inflamed.
Diverticulitis
what it is
clinical findings
Inflammation of Diverticula creating Diverticulitis. Small, bulging pouches develop in the digestive tract.
Findings: Asymptomatic, unless the diverticula become inflamed or infected (diverticulitis) which can result in:
fever, crampy, abd pain in LLQ, constipation, distended abd and tenderness
UC
what it is
clinical findings
Ulcerative Colitis: A chronic, IBD that causes inflammation in the digestive tract. Usually only in the innermost lining of the rectum and moves up.
Findings: profuse bloody, mucousy diarrhea. Abd pain, wt loss
Crohn’s
what it is
clinical findings
A chronic, IBD that causes inflammation in the digestive tract. More severe than UC. Fissures/ fistula/ ulcer anywhere from the mouth to the anus.
Findings: typically in sm intestine leading to melena. diarrhea, wt loss
IBD
inflammatory bowel disease
autoimmune
Peritonitis
what it is
cause
clinical findings
Inflammation of the peritoneum membrane due to infection.
Cause: Peritoneal dialysis, ruptured appendix, pancreatitis, diverticulitis, trauma, perforated peptic ulcer, perforated bowl.
Findings: fever, bloating, abd pain and rigidity
Peritoneal dialysis
a type of dialysis which uses the peritoneum in a person’s abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood. It is used to remove excess fluid, correct electrolyte problems, and remove toxins in those with kidney failure
AAA
what it is
cause
clinical findings
Abd Aortic Aneurysm: Dilation of the abd aorta caused by alterations in the integrity of its walls
Cause: atherosclerosis, HTN, high LDL
Findings: Asymptomatic, bruit over abd aorta, abd or lower back pain, strong palpable abd pulse. Sudden severe pain and hypotension may indicate rupture or dissection and may lead to shock and death
