ch 22 Jarvis Abdomen Flashcards
Tympany, hyperresonance, and dullness
abdominal assessment (normal findings)
notes normally heard during the abdominal assessment may include tympany, which should predominate because air in the intestines rises to the surface when the person is supine
Percussion (sound in abdomen)
which may be present with gaseous distention
hyperresonance
which may be found over a distended bladder, adipose tissue, fluid, or a mass.
dullness
Gastric acid secretion decreases with aging causing condition.because it interferes with vitamin B12 absorption, iron-deficiency anemia, and malabsorption of calcium.
pernicious anemia
inflammation of the kidney or paranephric area.
costovertebral angles
is free fluid in the peritoneal cavity
-occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and cancer..
Ascites
may be tarry as a result of occult blood (melena) from gastrointestinal bleeding
Black stools
occurs with localized bleeding around the anus.
Red blood in stools
iliopsoas muscle is inflamed
appendix (RLQ)
musculature is thinner and has less tone than that of the younger adult
- abdominal rigidity with an acute abdominal condition is less common in the aging person.
- The older adult with an acute abdominal condition often complains less about pain than the younger person.
older adult, the abdominal findings
Significant peristalsis, together with projectile vomiting, in the newborn
- After feeding, pronounced peristaltic waves cross from left to right, leading to projectile vomiting.
- One can also palpate an olive-sized mass in the right upper quadrant.
pyloric stenosis in infant
- palpable during routine examination and feel like a pulsating mass.
- A bruit will be audible
- femoral pulses are present but decreased
- aneurysms are located in the upper abdomen just to the left of midline.
aortic aneurysms
palpating the liver causes no pain.
- In a person with inflammation of the gallbladder, or cholecystitis, pain occurs as the descending liver pushes the inflamed gallbladder onto the examining hand during inspiration .
- The person feels sharp pain and abruptly stops midway during inspiration.
Murphy test
- is white
- contains two umbilical arteries and one vein inside the Wharton jelly.
- The umbilical stump dries within a week, hardens, and falls off in 10 to 14 days.
- Skin will cover the area in 3 to 4 weeks.
At birth, the umbilical cord
is a protrusion of the abdominal viscera through an abnormal opening in the muscle wall..
hernia
with the frequent use of nonsteroidal antiinflammatory drugs,
- alcohol use,
- smoking
- Helicobacter pylori infection.
Peptic ulcer disease occurs with
the mass is enlarged and everted
umbilical hernia
If ascites (fluid in the abdomen) is present, then the examiner will feel a fluid wave when assessing the abdomen
positive fluid wave test
Pain occurs 2 to 3 hours after a meal
- may relieved by more food
duodenal ulcers
Chronic pain usually occurs on an empty stomach.
gastric ulcers
Severe, acute pain would occur with
appendicitis and cholecystitis.
rebound tenderness ex appendix
Testing for the Blumberg sign
should be used when assessing for appendicitis
iliopsoas muscle test
is used when assessing for an inflamed gallbladder or cholecystitis
Murphy sign used for
assessing for ascites.
Testing for a fluid wave and shifting dullness is performed when
is a large, oval cavity extending from the diaphragm down to the brim of the pelvis. It is bordered in back by the vertebral column and paravertebral muscles, and at the sides and front by the lower rib cage and abdominal muscles
abdomen
the ventral abdominal wall
-joined at the midline by a tendinous seam, the linea alba
Four layers of large, flat muscles form
, forms a strip extending the length of the midline, and its edge is often palpable. The muscles protect and hold the organs in place, and they flex the vertebral column.
rectus abdominis
, a double envelope of serous membrane that lines the abdominal wall (parietal peritoneum) and covers the surface of most abdominal organs (visceral peritoneum)
Internal to the abdominal musculature lies the peritoneum
double layers of parietal peritoneum, extend from the abdominal wall as pathways for blood vessels, nerves, and lymphatics
Mesenteries
Mesenteries also serve as supporting networks to suspend and stabilize the abdominal organs, called
viscera
is a specialized fatty mesentery that overlies the ventral abdomen.
greater omentum
are those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus
solid viscera
fills most of the right upper quadrant (RUQ) and extends over to the left midclavicular line (MCL)
liver (size over abdomen)
on bimanual examination during the pelvic examination.
ovaries normally are palpable only on?
stomach, gallbladder, small intestine, colon, and bladder
-usually not palpable
shape hollow viscera
is just below the diaphragm, between the liver and spleen.
stomach location
rests under the posterior surface of the liver, just lateral to the right MCL.
gallbladder location
is located in all four quadrants
-extends from the pyloric valve of the stomach to the ileocecal valve in the right lower quadrant (RLQ), where it joins the colon.
small intestine (location)
is a soft mass of lymphatic tissue on the left posterolateral wall of the abdominal cavity, immediately under the diaphragm
- lies obliquely with its long axis behind and parallel to the 10th rib, lateral to the midaxillary line.
- width extends from the 9th to the 11th rib, about 7 cm. It is not palpable normally.
- If it becomes enlarged, its lower pole moves downward and toward the midline.
spleen (location)
is just to the left of midline in the upper part of the abdomen
-descends behind the peritoneum, and at 2 cm below the umbilicus it bifurcates into the right and left common iliac arteries opposite the 4th lumbar vertebra.
aorta
Their pulsations are easily palpated at a point halfway between the anterior superior iliac spine and the symphysis pubis.
right and left iliac arteries become the femoral arteries in the groin area
is a soft, lobulated gland located behind the stomach. It stretches obliquely across the posterior abdominal wall to the left upper quadrant.
pancreas
are retroperitoneal, or behind the peritoneal cavity along the posterior abdominal wall
bean-shaped kidneys
well protected by the posterior ribs and musculature. The 12th rib forms an angle with the vertebral column, the costovertebral angle.
bean-shaped kidneys
lies here at the 11th and 12th ribs. Because of the placement of the liver, the right kidney rests 1 to 2 cm lower than the left kidney and sometimes may be palpable.
left kidney (location)
epigastric for the area between the costal margins, umbilical for the area around the umbilicus, and hypogastric or suprapubic for the area above the pubic bone.)
abdominal wall is divided into four quadrants by a vertical and a horizontal line bisecting the umbilicus
Liver Gallbladder Duodenum Head of pancreas Right kidney and adrenal Hepatic flexure of colon Part of ascending and transverse colon
RUQ organs
Cecum Appendix Right ovary and tube Right ureter Right spermatic cord
RLQ organs
Stomach Spleen Left lobe of liver Body of pancreas Left kidney and adrenal Splenic flexure of colon Part of transverse and descending colon
LUQ organs
Part of descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord
LLQ organs
Aorta
Uterus (if enlarged)
Bladder (if distended)
Midline
- liver takes up proportionately more space in the abdomen at birth than in later life
- In a healthy term neonate the lower edge may be palpated 0.5 to 2.5 cm below the right costal margin.
- urinary bladder is located higher in the abdomen than in the adult. It lies between the symphysis and the umbilicus.
- during early childhood the abdominal wall is less muscular; therefore the organs may be easier to palpate.
infant organ development
- Nausea and vomiting, or “morning sickness,” is an early sign of pregnancy for most pregnant women, starting between the 1st and 2nd missed periods. = result of hormonal changes such as the production of human chorionic gonadotropin (hCG)
- another symptom acid indigestion” or heartburn (pyrosis) caused by esophageal reflux
- Gastrointestinal (GI) motility decreases, which prolongs gastric emptying time. The decreased motility causes more water to be resorbed from the colon, which leads to constipation. The constipation, in addition to increased venous pressure in the lower pelvis, may lead to hemorrhoids.
- enlarging uterus displaces the intestines upward and posteriorly.
- Bowel sounds are diminished.
- The appendix may be displaced upward and to the right, but any appendicitis-related pain during pregnancy would still be felt in the RLQ.
- skin changes on the abdomen such as striae and linea nigra
Pregnant woman (signs and symptoms)
- Aging alters the appearance of the abdominal wall.
- After middle age, some fat accumulates in the suprapubic area in females as a result of decreased estrogen levels.
- Males also show some fat deposits in the abdominal area, which accentuates with a more sedentary lifestyle
- further aging adipose tissue is redistributed away from the face and extremities and to the abdomen and hips. The abdominal musculature relaxes.
- Age-related changes occur in the GI system but do not significantly affect function as long as no disease is present.
Aging alterations in abdomen
have an increased risk of falling and thus of hip fracture).
older people taking benzodiazepines (caution)
symptoms include reduced stool frequency (less than 3 bowel movements per week) and other common and troubling associated symptoms (i.e., straining, lumpy or hard stool, feeling of incomplete evacuation, feeling of anorectal blockage, use of manual maneuvers).
Rome III standardizes symptom criteria for functional constipation.
include decreased physical activity, inadequate intake of water, a low-fiber diet, side effects of medications (opioids, tricyclic antidepressants), irritable bowel syndrome, bowel obstruction, hypothyroidism, and inadequate toilet facilities (i.e., difficulty ambulating to the toilet may cause the person to deliberately retain the stool until it becomes hard and difficult to pass).
Common causes of constipation
is the digestive enzyme necessary for absorption of the carbohydrate lactose (milk sugar)
-lactase activity is high at birth but declines to low levels by adulthood
Lactase
have abdominal pain, bloating, and flatulence when milk products are consumed.
lactose intolerant
