ASSESSMENT OF ABDOMEN Flashcards
System responsible for digesting the food that we eat
Gastrointestinal System or GI System
Components of the GI System
- Mouth
- Tongue
- Parotid, sublingual, and sub-mandibular glands
- Epiglottis
- Pharynx
- Esophagus
- Stomach
- Rugae
- Small Intestine
- Vermiform Appendix
- Large Intestine
Identify which component of GI System is being described
- this is where the first step of digestion occurs
- chewing, salivating, and swallowing
Mouth
Identify which component of GI System is being described
- Provides sense of taste
Tongue
Identify which component of GI System is being described
- they produce saliva
Parotid, Sublingual, and Submandibular glands
Identify which component of GI System is being described
- keeps food and fluid from being aspirated into the airway by closing over the larynx when food is swallowed
Epiglottis
Identify which component of GI System is being described
- consists of nasopharynx, oropharynx, and laryngopharynx
- allows passage of food from mouth to the esophagus
- assist in swallowing
- secretes mucus which aids in digestion
Pharynx
Identify which component of GI System is being described
- hollow, muscular tube that is approximately 10 in long
- moves food from the pharynx to the stomach using peristalsis
Esophagus
Identify which component of GI System is being described
- dilated sac like structure that lies obliquely in the left upper quadrant
- contains two important sphincters: the cardiac sphincter and the pyloric sphincter
- stores food and mixes it with gastric juices
- passes chyme into the small intestine for further digestion and absorbtion
Stomach
This sphincter protects the entrance to the stomach
Cardiac Sphincter
This Sphincter guards the exit of the stomach
pyloric sphincter
Identify which component of GI System is being described
- accordion like folds in the stomach lining
- allow stomach to expand
Rugae
Identify which component of GI System is being described
- consist of the duodenum, jejunum, and ileum
- location of carbohydrate, fat, and protein breakdown
- absorbs the end products of digestion
Small Intestine
Identify which component of GI System is being described
- finger like projection attached to the cecum
Vermiform Appendix
Identify which component of GI System is being described
- consists of the cecum; ascending, transverse, descending, and sigmoid colons; rectum; anus
- absorbs excess water and electrolytes
- stores food residue
- eliminates waste products in the form of feces
Large Intestine
This junction normally remains closed to prevent reflux of gastric contents and only opens during swallowing, belching, and vomiting
Esophagogastric Junction
Acessory GI organs and vessels
- Liver
- Gallbladder
- Pancreas
- Bile Ducts
Identify the Acessory GI organs or vessels being described
- metabolizes carbohydrates, fats, and proteins
- detoxifies blood
- converts ammonia to urea for excretion
- synthesizes plasma proteins, nonessential amino acids, vitamins, and essential nutrients
- secretes bile to digest fats and absorb fatty acids, cholesterol, and other lipids. It also gives stool their color
Liver
Identify the Acessory GI organs or vessels being described
- Stores bile from the liver until the bile empties into the duodenum
Gallbladder
Identify the Acessory GI organs or vessels being described
- measures 6 to 8 inches
- consist of a head, body, and tail
- releases insulin and glycogen into the bloodstream and produces enzymes that aid in digestion
Pancreas
Identify the Acessory GI organs or vessels being described
- has hepatic duct, cystic duct and common bile ducts
Bile Ducts
This duct drains bile from the liver
Hepatic Duct
This duct drains bile from the gallbladder
Cystic Duct
This duct receives bile from the hepatic and cystic ducts and empties bile into the duodenum
Common Bile Duct
Identify which of the abdominal quadrants is being described
- includes right lobe of the liver
- includes Gallbladder
- includes Pylorus
- includes Duodenum
- includes head of the pancreas
- includes hepatic flexure of the colon
- includes portion of the transverse and ascending colon
Right Upper Quadrant (RUQ)
Identify which of the abdominal quadrants is being described
- includes the Cecum and Appendix
- includes portion of the ascending colon
Right Lower Quadrant (RLQ)
Identify which of the abdominal quadrants is being described
- includes left lobe of the liver
- includes spleen
- includes stomach
- includes body and tail of the pancreas
- includes splenic flexure of the colon
- includes portions of the transverse and descending colon
Left Upper Quadrant (LUQ)
Identify which of the abdominal quadrants is being described
- includes the Sigmoid Colon
- includes portion of the descending colon
Left Lower Quadrant (LLQ)
Obtaining a health history
- Ask about past health
- Ask about current health
✓ Gnawing problems
✓ Travel plans - Family history: SSS Disorders with a familial link include:
✓ ulcerative colitis
✓ colorectal cancer
✓ peptic ulcers
✓ gastric cancer
✓ alcoholism
✓ Crohn’s disease - Asking about psychosocial health
Methods to assess the abdomen
Inspection, Auscultation, Percussion, and Palpation while mentally dividing it into 4 quadrants
EXAMINING THE ABDOMEN
To ensure an accurate assessment, take these actions before the examination:
✓ Ask the patient to empty his bladder.
✓ Drape the genitalia and, if the patient is female, her breasts.
✓ Place a small pillow under the patient’s knees to help relax the abdominal muscles.
✓ Ask the patient to keep his arms at his sides.
✓ Keep the room warm. Chilling can cause abdominal muscles to become tense.
✓ Warm your hands and the stethoscope head.
✓ Speak softly, and encourage the patient to perform breathing exercises or use imagery during uncomfortable procedures.
✓ Ask the patient to point to any areas of pain.
✓ Assess painful areas last to help prevent the patient from tensing his abdominal muscles.
Inspecting the Abdomen
- check for symmetry, bumps, bulges, or masses
- note patient’s abdominal shape and contour
- assess the umbilicus which should be inverted and located in abdominal midline
Auscultating Abdomen for Vascular Sounds
- using a bell of a stethoscope placing it on each quadrant clockwise
- note character and quality of bowel sounds in each quadrant
Percussion of the Abdomen
- use either direct or indirect to detect size and location of abnormal organs and detect air or fluid in the abdomen, stomach, or bowel
- begin at RLQ and proceed clockwise
- Note where percussed sounds change from tympany to dullness
- dont percuss if patient has abdominal aortic aneurysm or transplanted abdominal organ
Two sounds heard during percussion of the abdomen
Tympany - clear, hollow sound similar to a drum beating when percussing hollow organs
Dullness - heard when percussing solid organs
Degree of Tympany depends on what?
amount of air present and gastric dilations
Percussing the Liver Slide 24 to 25
- Identify upper border of liver dullness. Start in the right midclavicular line in area of lung resonance and go downward toward the liver using a pen to mark the spots where sound becomes dull
- Use a ruler to measure the distance between two marked spots. Normal liver of an adult ranges from 6.5 to 12 cm in the midclavicular line and 4 to 8 cm at the midsternal line
PERCUSSING THE SPLEEN Slide 26 to 27
Palpation of the abdomen slide 28 to 33
EXAMINING THE RECTUM AND ANUS Slide 34 to 36
Assessment Techniques for Ascites Slide 39 to 41
Assessing Tender parts in the Abdomen Slide 43 to 49
GASTROINTESTIONAL ABNORMALITIES
- probable causes of Burning pain
peptic ulcer, gastroesophageal reflux disease
GASTROINTESTIONAL ABNORMALITIES
- probable causes of Cramping
Biliary Colic, Irratable Bowel Syndrome, Diarrhea, Constipation, Flatulence
GASTROINTESTIONAL ABNORMALITIES
- probable causes of Severe Cramping
Appenidicitis, Crohn’s Disease, Diverticulitis
GASTROINTESTIONAL ABNORMALITIES
- probable causes of Stabbing
Pancreatitis and Cholecystitis
Abdominal Pain Origins Slide 52
Results from gas, a tumor, or a colon filled with feces. May also be caused by an incisional hernia which protude when patient lifts his head and shoulders
Distention
Skin Color Changes that signal a problem in the GI System
- Jaundice
- Spider Angiomas; signal liver disease
- Cullen’s Sign
- Grey Turner’s Sign
Identify the Skin Color Changes that signal a problem in the GI System
- a bluish periumbilical discoloration
- signals intra abdominal hemorrhage
- may be seen in acure hemorrhagic pancreatitis
- may be seen with massive hemorrhage after trauma
- usually appears gradually
- extent of discoloration depends on the extent of bleeding
- difficult to detect on dark skinned patients
Cullen’s Sign
Identify the Skin Color Changes that signal a problem in the GI System
- bruise like skin discoloration of the flank area
- appears 6 to 24 hours after onset of retroperitoneal hemorrhage associated with acute pancreatitis
Grey Turner’s Sign aka Turner’s Sign
It usually indicates GI bleeding
Bloody Stools or Hematochezia
it is caused by immobility, sedentary lifestyle, and medications. patient may complain of dull ache in abdomen and have a full feeling. Patient unable to pass flatus or stools and wont have bowel sounds below obstruction. Commonly occurs in older patients
Constipation
Caused by toxins, medications, or a GI condition such as Crohn’s disease. Accommodated with cramping, abdominal tenderness, anorexia, and hyperactive bowel sounds
Diarrhea
Its when the patient has difficulty swallowing which may be accompanied by weight loss. Can be caused by obstruction, achalasia of lower esophagogastric junction, or neurologic disease. Can lead to aspiration and pneumonia
Dysphagia
They both occur together. Caused by existing illness like:
- Myocardial Infraction
- Gastric and Peritoneal Irritation
- Appendicitis
- Bowel Obstruction
- Cholecystitis
- Acute Pancreatitis
- Bulimia Nervosa
- Neurologic Distrubances
- medications
Nausea and Vomiting
Commonly associated with hepatitis and other liver diseases
Hepatomegaly
its when the spleen is enlarged. caused by mononucleosis, trauma, and illnesses that destroy red blood cells like sickle cell anemia and some cancers
Splenomegaly
