Ch 22. Abdomen Flashcards
Solid viscera examples
Liver Pancreas Spleen Adrenal glands Kidneys Ovaries Uterus
Hollow viscera examples
Stomach Gallbladder Small intestine Colon Bladder
Organs in the right upper quadrant
RUQ: liver, gallbladder, duodenum, head of pancrease, R. kidney, r. adrenal gland, hepatic flecture of colon and portions of ascending and transverse colon
Organs in the left upper quadrant
LUQ: l. liver, spleen, stomach, bodt of pancrease, L.adrenal glnad, L.kidney, spenic flecture of colon, trasverse/descing colon
Organs in the right lower quadrant
RLQ: r. kidney, cecum, appendix, ascending colon, r. uterer, r. ovary/fallopian tube, r. spermaticord
Organs in the left lower quadrant
LLQ: l. kidney, sigmoid colon, descending colon, l. ureter, l. ovary/fallopian tube, l. spermaticord
Developmental Considerations: Pregnant women
Morning sickness
Heartburn
Constipation and decreased bowel sounds (More water absorbed so constipatipon)
Appendicitis: Appendix can move in pregnancy
Skin: Straie, linea nigra
Developmental Considerations: Older Adults
Salivation decreases Delayed esophageal emptying Decrease in gastric acid secretion Dehydration susceptibility Liver size decreases Renal function decreases Increased gall stone formation Constipation Increased risk for colorectal cancer
Women have deposits on fat in superpubic area, men have buldging belly look
Adipose tissue is redistributed (away from face)
Decrease in gastric astric delays medications/absorptions of nutrients
Decrease ability to absorb water/respond in temperature changes
Developmental Considerations: Infants and Children
Umbilical Cord Gastroenteritis Unbiblical cord = 2 arteries 1 vein Large liver in infant Children have increased risk of dehydration
Cultural and Social Considerations
- Prevalence of lactose intolerance
- Rates of celiac disease
- GERD and modifiable risk factors
- Peptic ulcer disease (Canada has highest incidence in world)
- Inflammatory bowel disease (Canada has one of the highest rates)
- Relationship of hepatitis A and GI illnesses to socioeconomic factors
Subjective Data: Health History
- older adults
- adolescence
Appetite Dysphagia Food intolerance Abdominal pain Nausea/vomiting Bowel habits Past abdominal history Medications Alcohol and tobacco Nutritional assessment
Adolescents:
Schedule and content
Exercise
Underweight
Older adults: Food access Emotional characteristics Recall Bowel movements
Precations against Hepatitis Risk
- 6 hepatitis viruses have been identified,
- 3 (hep A, B, C) cause 90% of acute hepatitis cases in Canada
- Practise safe sex
- Don’t share items that may have bodily fluids on them
- Be aware of environment
- Watch diet and weight
- Travel wisely
- Use medications wisely
- Do not mix medications without consulting a health care provider
- Drink alcohol in moderation
- Measures an individual can follow to protect his or her liver (cont’d)
- Do not mix alcohol and medications
- Do not use illegal drugs
- Get vaccinated
Why do we do auscultation first?
Do palpation/percussion last because it can increase peristalisis so false bowl sounds might cause discomfort or move things
Inspection of Abdomen
Contour: flat, scaphoid, rounded, protuberant
-sitting down and gaze across the abdomen look for shadows/masses/buldges, get them to take a big breath
Symmetry Umbilicus Skin Pulsation or movement Hair distribution Demeanor
Auscultate of Abdomen
Bowl Sounds:
Start listening in 4Q’s in RLQ in ‘ileocecal’ area. Note type of sound you’re hearing
Bowl sounds is the movement of air through the GI tract.
Stomach growling = hyper peristalsis (~fancy word~)
-5-35 per min = normal
-must listen for 5 min to say there’s none
Vasular Sounds:
- (bruits)
- aorta, renal, iliac, femoral
- Use bell
Percussion of Abdomen
Assess the relative density of abdominal contents, locate organs and to screen for abnormal fluid or masses
All 4 quadrants, clockwise
Tympany
Dullness- solid structures (liver), a distended bladder, adipose, fluid, mass
Hyper-resonance- gaseous distention
- General tympany
- density of the abdominal contents.
- Because air in the intestines, tympany is the predominant sound.
- Dullness may be heard over a distended bladder, adipose tissue, fluid or a mass.
- A change in tone may be noted over the descending colon if there is a need for evacuation.
- A change from lung resonance to dullness will identify the borders of the liver, which ranges from 6 – 12 cm in width and in some individuals an area of splenic dullness 7 cm or less in width may be noted between the ninth and the eleventh intercostal space behind the left midaxillary lien.
Palpation of abdomen
- light/deep
- organs you can palpate?
Light palpation: moisture, pain, temperature, ridgitiy 1cm depression, rotary motion in clockwise manner
Deep palpation: distinguish normal organs, large masses. Same start point. Depress 5-8cm, may need to use bimanual technique on large or obese person
Bimanual palpation: palpation with both hands
Get patient to relax, stick a pillow under their knees, breathe slowly
Ticklish patient use their hand with your fingers curled over them
Palpation of the Liver
Liver: non dom hand under patients back under 11-12 rib, other hand under ribds under right costal margin. Take a deep breath and push. Hoocking: both hands hook under the ribs and hook hands under the right side of the ribs, deep breath and palpate the edge
Palpation of the Spleen
Slpeen: not palpable and must be 3x the normal size to be felt. Non dominate hand under back, other hand on rib edge, breathe and push
Palpation of the Kidneys
Kidneys: duck bill hand on right side. Round and smooth if you do feel it. L.Kidney about 1cm higher than R and normally not palpable
Palpation of the Aorta
Aorta: upper abdomen. Pulse about 2.5-4cm wide
Old version of the 4 quadrants
epigastric (above umbilical)
umbilical region
hypogastic/suprapubic
