Ch. 21 Abdominal Assessment Flashcards
What is defined in the abdominal area?
- from the diaphragm to the pelvis
What is located in the RUQ?
Liver Gallbladder Duodenum Right Kidney & Adrenal Gland Head of the Pancreas Part of Ascending & Transverse Colon
What is located in the LUQ?
Stomach Spleen Left lobe of Liver Pancreas Splenic Flexure of Colon Part of Transverse & Descending Colon Left Kidney & Adrenal Gland
What is located in the RLQ?
Right Ureter Right Ovary & Tube(female) Right Spermatic cord (male) Ascending colon Appendix Cecum
What is located in the LLQ?
Part of Descending colon Sigmoid colon Left Ureter Left Ovary & tube (female) Left spermatic cord (male)
What is located in the midline of the abdomen?
Aorta
Uterus (if enlarged)
Bladder (If distended)
Besides the 4 quadrants, how else is the abdomen sectioned?
Epigastric
Umbilical
Hypogastric or Suprapubic
What should we take into consideration when dealing with abdomens of babies?
- they don’t have abdominal musculature
- large livers
- urinary bladder is located higher
What should we take into consideration when assessing a pregnant woman’s abdomen?
- Morning sickness
- heartburn, esophageal reflux
- decreased gastric motility
- constipation due to decreased motility (increases water absorption)
- hemorrhoids from increased venous pressure in lower pelvis
- enlarging uterus displaces intestines
- striae (stretch marks)
- Linea Nigra (dark line)
What should we take into consideration when assessing an aging adult’s abdomen?
- fat redistribution to the abdomen
- abdominal musculature relaxes
- salivation decreases
- decreased sense of taste
- esophageal emptying is delayed which would lead to aspiration if eating in supine position
- increased gastric acid may cause pernicious anemia
- increased incidence of gallstones (more common in females)
- liver size decreases
- constipation
In which race is lactose intolerance commonly seen?
book says African americans and Mexican Americans although she says differently… see other question about lactose intolerance occurrence
What topic areas should we focus on when collecting subjective data for the abdominal assessment?
Appetite Dysphagia Food Intolerance Abdominal Pain Nausea/Vomiting Bowel Habits Past Abdominal History Medications Nutritional Assessment
what are some risk factors for liver problems?
alcohol consumption
medications (affect clotting factors like prothrombin)
Why is it important to note if a patient is taking aspirin or Advil?
can erode stomach lining and cause ulcers
Why is it important to note if a patient is taking Nexium over the counter for reflux?
alters pH
Why is it important to note if a patient is taking any herbal substances like ginseng ?
decreases clotting
What are some Addition History topics for infants and children?
- breastfeeding v. bottle feeding
- what formula do you use?
- how do you introduce new foods (how often, what kinds)?
- how often does the child eat?
- does the child eat non foods like grass, dirt or paint chips?
- constipation? how long?
What additional history should you take for adolescents?
Do you eat regularly? What is your exercise pattern? look for signs of eating disorders do they eat out a lot? Caloric intake
What additional history should you take for the aging adult?
do you eat alone?
diet recall
do they get enough fluids
encourage some activity to prevent constipation
Which race is sickle cell disease seen in most?
African Americans
Which race has a high prevalence of G6PD
African Americans
Which cultures are known for being lactose intolerant?
African Americans, Jewish Descent, Mediterranean Descent
Which race has a high occurrence of gastric and liver cancers?
Asian Americans
Which race has a high occurrence of alcoholism?
Native Americans
Which culture has a high occurrence of Crohn’s Disease?
Jewish Descent
What are some common abdominal symptoms?
indigestion anorexia nausea/vomiting hematemesis abdominal pain dysphagia change In bowel function (constipation/diarrhea) jaundice urinary/renal symptoms urinary incontinence kidney or flank pain ureteral colic
What do we inspect when assessing the abdomen?
abdomen: bloating, distention, look at contour
urine
Emesis (vomit)
Stool
What do we auscultate for when assessing the abdomen?
Bowel sounds Vascular sounds(i.e. "swish" sound seen with pulsating mass)
how long must we listen to the bowel without hearing any sounds at all before determining there really is no bowel activity?
5 mins
What do we palpate for when assessing the abdomen?
muscle guarding (light palpation) masses or enlarged organs (deep palpation)
Why do we auscultate before palpating the abdomen?
b/c palpation can stimulate gastrointestinal movement
What four words are used to describe the contour of an abdomen when the patient is supine?
Flat (normal)
Scaphoid ( caves in)
Rounded (normal)
Protuberant (extreme poking out)
How do we describe bowel sounds?
Hyperactive
Active
Hypoactive
Absent
What is Blumberg’s Sign?
“rebound tenderness”
pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation (appendicitis)
What is the Iliopsoas Muscle Test?
- performed when acute abdominal pain of appendicitis is suspected
1. Person supine, lift the right leg straight up flexing at the hip
2. push down over the lower part of the right thigh as the person tries to hold the leg up
What is the Obturator test?
another test for appendicitis that stretches the Obturator muscle. evidence shows however that this test does not work to diagnose appendicitis.
What are some abnormalities that are associated with the abdomen?
GERD (reflux) Hiatal Hernia (through diaphragm) Peptic Ulcer Disease (NSAIDs, medications) Crohn's Disease Ulcerative Colitis (bloody BM) Diverticulitis Viral Hepatitis (Hep. A & Hep. C) Cirrhosis Cholecystitis (inflammation of gallbladder) Cholelithiasis (gall stones )
What are some abnormal bowel sounds we listen for?
Hypoactive Bowel Sounds
Hyperactive Bowel Sounds
Arterial Bruit
Venous Hum
What is a venous hum and where would we be able to find it while auscultating the abdomen?
- Umbilicus Area
- comes from the inferior vena cava
- medium pitch, continuous sound, pressure on bell may obliterate it
- may be seen with palpable thrill
- occurs with Portal HTN and Cirrhotic Liver
When the patient reports that a certain spot in the abdomen in tender, it is best to….
palpate that spot last to prevent pain from interfering with the rest of the examination
Where is pain from appendicitis usually seen?
RLQ
