Abdominal & GI Assessment Flashcards
Viscera means
Organs
Two categories of viscera
solid and hollow viscera
Solid viscera include
liver, spleen, pancreas, kidneys, adrenals, ovaries
Hollow viscera include
stomach, gallbladder, small intestine, colon, bladder
they will adjust their shape at different times
How many quadrants are in the abdomen?
Right Upper Quadrant
Right Lower Quadrant
left upper quadrant
left lower quadrant
Kidneys sit right up against the
peritoneum
Digestive organs begin to form at
4 weeks digestion
During pregnancy
abdominal muscles lose tone stomach displaced upwards peristaltic activity decreased and water reabsorption increased hemorrhoid formation occurs bladder compression
Elderly developmental considerations
Liver size decreases leading to significant altered metabolism of drugs
Subjective Data
appetite dysphagia food intolerance abdominal pain nausea or vomiting bowel habits past medical history past surgical history
Patient considerations for the physical exam
warm hands and warm stethoscope. letting them know what you are doing, having a conversation with them while doing assessment
Physical Exam inspection - Contour and symmetry
Contour - flat, rounded, protuberant or scaphoid (indented stoma
symmetry
Umbilicus
Color should be consistent with body’s color
Central without displacement
may be inverted or protruded slightly
free of inflammation, swelling, or bulges that indicate herniation
What is Cullen sign and Grey-Turners sign?
Cullen Sign: Intraperitoneal bleeding
Grey-Turner’s sign: retroperitoneal bleeding (behind the peritoneum)
Striae are what ?
stretch marks. this is a normal finding
potential causes of abdominal distension
obesity air or gas ascites ovarian cyst pregnancy feces tumor
hernia
an organ breaks through the lining and is displaced
Ascites
end up with fluid in the belly - very round. Much more free fluid in the interstitial space that pools in the flanks (sides)
Test with the fluid wave test
Striae
Stretchmarks - very common in those who have gained and lost a lot of weight
Rebound Tenderness
Test for Appendicitis
press deeply into abdomen, remote from area of discomfort
rapidly withdraw hand and fingers and assess for sharp stabbing pain
normal is no pain on release of pressure
In thin persons would it be abnormal to see pulsations of aorta and waves of peristalsis come over the abdomen ?
What about veins on the abdomen?
No, this would be a normal finding especially in thin people.
Veins normally would not show on the abdomen but in particularly thin people they may.
Hypoactive bowel sounds could be present when ?
Following abdominal surgery
Peritonitis (inflammation of the peritoneum)
What is borborygmus ?
The hyperactive bowel sounds one hears that occurs with the “stomach growling”
This is common finding.
A mechanical obstruction is within the abdomen - what kind of bowel sounds would you expect to hear?
Hypoactive either decreased or absent bowel sounds
Increased peristalsis and bowel sounds accordingly , are associated with which conditions and use of what kind of medications ?
Diarrhea, laxatives, gastroenteritis
What is the normal liver span?
6-12 cm in adults - liver span corresponds with height. Taller people have a greater liver span
What is hepatomegaly?
Enlargement of the liver
When would an aortic aneurysm be indicated ?
during palpation of aortic pulsation, the examiners thumb and forefinger are pushed wider apart during pulsation.
What could an enlarged spleen indicate ?
Possible lymphoma, trauma, leukemia or mononucleosis
What are two tests for Ascites specifically ?
Fluid Wave Test and the Shifting Dullness Test
If a patient has pain in a specific abdominal area, when would I palpate that area in the physical examination ?
Do this area last
What does the Rebound tenderness test assess for ?
A negative Rebound tenderness test would be when upon the release of pressure, there is no pain.
Positive would be if there is pain, which indicates inflammation of the peritoneum, which is part of appendicitis symptoms.
What organs and structures lie within the Left upper quadrant ?
Stomach Body of pancreas Spleen Part of transverse and descending colon left kidney left lobe of liver left adrenal gland
What does the Iliopsoas muscle test for ?
To test for appendicitis.
Have patient raise right leg and hold it as you push down on right upper thigh.
Increased abdominal pain occurs with appendicitis
What is Murphy’s test and what is it used for ?
It is used for cholecystitis (inflammation of the gallbladder)
Palpate just under the liver border and have patient take deep breath. Normally this should be done without pain. As patient takes deep breath, the gallbladder would be pushed by the descending liver into your palpating hand.
Abdominal pain assessment - parietal pain means ?
Sharp, precisely localized, and aggravated by movement that can occur with inflammation of the peritoneum
Abdominal pain assessment - visceral pain means ?
Pain may be visceral from an internal organ - pain characterized as poorly localized, dull and general
Abdominal pain assessment - referred pain means ?
Pain that occurs from a disorder in another site. In other words, pain is radiating to the abdominal area.
The space between the vertebrae and the 12th ribs is known as
the costovertebral angle (CVA)
What kind of percussive abdominal sounds sounds should one hear if a patient has bloating symptoms?
Potentially hyperresonance which occurs with gaseous distension
