Ch. 22 (Abdomen) Flashcards
What region classifies all the internal organs?
viscera
What kind of organs change shape depending on whatever is in it?
hollow organs
What organ is located behind the stomach?
pancreas
what organ is located in the posterior wall of the abdominal cavity underneath the stomach?
spleen
What is known as the angle between the spine and ribs, where the kidneys are?
costovertebral angle
What are the famous hollow organs?
- stomach
- gallbladder
- small intestine
- bladder
- colon
- aorta
What happens to the abdomenal organs with aging?
- increased fat disposits
- galbladder: sluggish, drainage slows down
- liver: shrinks
- bowels: constipation - movements slow down
What is located in the right upper quadrant?
- liver
- gallbladder
- head of pancreas
- stomach
- right kidney/adrenal
- colon (hepatic flexure)
- duodenum
What is located in the right lower quadrant?
- colon (ascending)
- cecum
- appendix
- right ovary/tube OR right spermatic cord
- right ureter
What is located in the left upper quadrant?
- stomach
- spleen
- left lobe liver
- body of pancreas
- left kidney/adrenal
- colon (splenic flexure, parts of transverse, descending)
What is located in the left lower quadrant?
- colon (descending, sigmoid)
- rectum
- left ovary/tube OR left spermatic cord
- left ureter
When performing an abdomen exam, how should the pt be positioned?
- on their back
- hands at side
- head on pillow
Where should you be positioned during an abdomen exam?
pts right side
When looking at the side profile of the abdomen, what different kinds of profiles could they have?
- flat (flat)
- scaphoid (deep depression)
- rounded (round)
- protuberant (pregnant, bulging)
What are the seven f’s that cause protuberance in the abdomen?
- fat
- fetus
- flatuence
- fluid
- fibroid tumor
- feces
- fatal growth
Abdomen breaks the order of what you should be performing second during the physical exam. What do you do first in the physical exam for the abdomen?
auscultation
Abdomen breaks the order of what you should be performing second during the physical exam. Why do we auscultate before palpating and percussing?
alters baseline sounds
Where do we start during auscultation of the abdomen?
- right lower quadrant
What do bowel sounds like?
- bubbling
- gurgling
What do hyperactive bowel sound like?
- loud
- gurgling
- going crazy
What usually causes hyperactive bowel sounds?
- diarrhea
- stomach bug
What do hypoactive bowel sound like?
- diminished
- related to decreased mobility
- small
What usually causes hypoactive bowel sounds?
- after surgery
- bowel obstruction
- inflammation in the perioteal cavity
- constipation
If bowel sounds are absent, then how long can you clarify that they are absent when auscultating?
5 minutes
What vascular locations do you listen to during the abdomen physical auscultation exam?
- aorta
- left renal artery
- iliac artery
- femoral artery
What are we listening for in the abdomen arteries during the physical auscultation exam?
- bruit - opening is blocked
During the abdomen physical exam, what is percussion used for?
- done to locate organs
- screen for abnormal fluids and masses
During the abdomen physical exam, what is the normal percussion sound heard?
tympany
How hard do we percuss during an abdomen physical exam?
light percussion - percuss lightly in all four quadrants
Why do we perform costoverbral angle tenderness (CVAT)?
- check for kidney infection
How do you perform a costoverbral angle tenderness (CVAT) test?
- left hand on the posterior abdomen cavity where kidneys would be
- banging right hand on back of left hand over kidneys
Why do we palpate the abdomen?
- judges size, location and consistency of certain organs
- screen for abdominal masses and/or tenderness
How do you palpate the abdomen during light palpation?
- four fingers together, in gentle circular motion
- 1cm deep
What kind of palpation do we perform first during the abdomen physical exam?
light before deep
How do you palpate the abdomen during deep palpation?
- 5cm
- same technique just deeper
What should you note when feeling a mass in the abdomen?
- location
- size
- hard or soft
- tenderness
How do you palpate the liver in a physical exam when assessing the abdomen?
- left hand under back
- right hand on RUQ, fingers parallel to midline
- push down deeply upon inhalation
nml to feel edge of liver bump your fingers during inhalation
Is the spleen normally palpable? Should you palpate it repeatedly if it is palpable?
- no - palpable = enlarged
- no - risk for rupture
How do you palpate the spleen in a physical exam when assessing the abdomen?
- reaches left hand over abdomen, behind left side
- right hand obliquely on LUQ w/fingers pointing toward left axilla & inferior to rib margin
- push down and ask pt to take deep breath
What do you do when performing rebound?
press down firmly and quickly let go
typically for appendicitis, inflammation in belly
What are you looking for when performing rebound on the abdomen?
rebound tenderness - pain upon immediate letting go (not when you press down)
testing appendix
What do you do when performing the iliopsoas test on the abdomen?
- pt lies on back, lifts right leg straight up
- put pressure on thigh and ask pt to keep leg up
if pain occurs - likely from inflammation
testing appendix
What do you do when performing the obturator test on the abdomen?
- pt lies on back
- rotate left hip with leg
record for pain
testing appendix
What describes the Murphy sign or inspiratory arrest?
pt cannot take a full deep breath when palpating RUQ
test for inflamed galbladder or liver
What abdomen abnormality causes the digestive enzymes are attacking the pancreas causing inflammation?
pancreatitis
What abdomen abnormality causes pain in the abdomen that spreads to the back, severe nausea, vomiting, and the pain worsens when eating, drinking or laying flat?
pancreatitis
How do we treatment pancreatitis?
- rest
- IV fluids
- pain medication
- encourage cessation of alcohol
not much we can do
What abdomen abnormality causes heartburn, dysphagia, nausea and burning and can be aggrevated by pregnancy?
GERD
What abdomen abnormality causes stomach acid to backflow into the esophagus?
GERD
How do we treat GERD?
- elevate your head in bed
- stop smoking
- don’t lie down after a meal
- avoid alcohol, choocoalte, caffeine, fatty foods and peppermint
What abdomen abnormality causes inflammation of the galbladder from a blocked duct?
Cholecystitis
What abdomen abnormality causes abdomen pain that spreads into the shoulder or upper right abdomen, bloating, nausea and vomiting?
Cholecystitis
How do we treat cholecystitis?
- positive murphy sign
- avoid fatty foods & alcohol
usually galbladder is removed
What abdomen abnormality causes a bacterial infection with inflammation in the kidneys?
Pyelonephritis
What abdomen abnormality causes aching back or suprapubic pain, dysuria and a fever?
pyelonephritis
What do we treat pyelonephritis?
- assess for CVAT
- increase fluids
- antibotics
- rest
What abdomen abnormality is caused by a virus obtained by fecal contamination in foods?
Hepatitis A
What abdomen abnormality causes jaundice, RUQ pain, lose of appetitie, vomiting, fever and diarrhea?
hepatitis A
How do we treat hepatitis A?
- blood test - enzyme, bilirubin, antibodies check
- rest
- perform hand hygiene
goes away on its own
What abdomen abnormality causes a gap in the muscular wall that allows contents in the abdomen to protrude outwards?
Hernia
What abdomen abnormality causes bulging in either side of the pubic bone that is more noticeable when sitting upright or coughing, burning or aching sensation at bulge and discomfort?
hernia
usually overweight males that lift heavy objects
How do we treat a hernia?
- cold compress
- medication
- light stretch & movement
usually resolved with surgery
What abdomen abnormality causes the appendix to become swollen and inflamed from a build up of bacteria?
Appendicitis
What abdomen abnormality causes diarrhea or constipation which can decrease the pain, RLQ pain, nausea, and an internal pressure such as a cough that can make the pain worse?
appendicitis
What tests will prompt pain in someone with appendicitis?
- rebound
- obturator
- iliopsoas
How do we treat appendicitis?
- blood test for WBC count
- pain relievers
- surgery
