Chapter 13: Abdomen and GI System Flashcards
Aneurysm
A ballooning out or abnormally widening of part of a weakened artery wall
Appendicitis
condition in which the appendix becomes inflamed, swollen, or infected
Bruit
sounds resembling heart murmurs
- swishing or washing machine-like sounds
Contour
smooth outline or shape of the abdomen
Costovertebral Angle
90 degree angle formed between the curve of the 12th rib located on the back at the bottom of rib cage and spine
Distention
an enlargement, dilation, or ballooning effect of the abdomen
Gastrostomy Tube
tube inserted through the abdomen that delivers nutrition directly to the stomach
Iliopsoas
two separate abdominal muscles (psoas and iliacus) merged in the thigh
Nasogastric Tube
thin tube that is passed through the nose and down through the nasopharynx and esophagus into the stomach to carry food and medicine
Obturator Muscle Test
physical test of inflammation in the region of the obturator internus muscle; usual cause is an inflamed appendix
Ostomy
a hole made by surgery to allow stool or urine to leave the body through the abdomen
Rebound Tenderness
deep palpation over the suspected inflamed appendix followed by sudden release of the pressure which causes the severe pain on the site
- indicates peritonitis (inflamed peritoneal)
Scaphoid
condition in which the anterior abdominal wall is sunken and presents a concave rather than a convex contour
Tympany
high pitched sound that indicates a hollow space filled by air or gas in the stomach or intestine
Umbilicus
belly button
Urinary Catheter
a hollow tube inserted into the bladder to drain or collect urine
What is important about the physical examination of the abdomen ?
order must be:
- inspection
- auscultation (must follow inspection)
- percussion
- palpation
(percussion and palpation can be flipped)
What are some important things to ensure for a abdominal assessment ?
- client must empty bladder before
- expose abdomen from xyphoid process to groin
- position in supine position with pillow under head and knees (if not pillow then have patient bend knees)
- avoid quick, unexpected movements
- watch facial expressions during exam
What is ascities and what are the symptoms (interstitial fluid) ?
it’s the buildup of fluid in the abdomen that is indicative of liver failure
- abdominal distension
- different from being fat because the belly is firm/hard
How do you measure abdominal distension ?
measuring tape around abdomen at the level of the superior iliac crests
What side of stethoscope do you use to listen for bowel sounds ?
diaphragm
- bell is for bruits
What are normal bowel sounds ?
high-pitched gurgling or clicking sounds
- usually occur 5 to 35 times per min
What types of sounds aren’t normal in the abdomen ?
vascular sounds
What are some reasons for abdominal distension ?
- obesity (fat)
- air or gas (flatulence)
- ascites (interstitial fluid)
- cyst or abscess (ovarian or intra-abdominal)
- pregnancy
- feces (constipation/fecal impaction)
- tumor (uterine fibroid, colon or other GI cancer, benign or malignant)
- hernia (bowel pushing through abdominal wall musculature)
What is the sequence you take to auscultate the bowel sounds ?
RUQ, LUQ, LLQ, RLQ
What are normoactive bowel sounds ?
- irregular
- high pitched gurgles or clicks (5-35 times per min)
What are hypoactive bowel sounds ?
- 1-4 sounds per min
- lower in pitch
What are hyperactive bowel sounds ?
- more than 35 sounds per min
- high-pitched sounds
- borborygmi (rumbling or gurgling sounds)
What are some reasons for hypoactive bowel sounds ?
- bowel/mechanical obstruction
- NPO (nothing per mouth)
- haven’t eaten anything in a while
- paralytic (paralysis)
What are some reasons for hyperactive bowel sounds ?
- diarrhea
- stomach bug
- Crohn’s
What are arterial vascular sounds ?
- heard in 4-20% of healthy people
- during systole
- continuous regardless of patient position
- swishing sound
- use bell of stethoscope over aorta, renal, iliac, and femoral arteries for bruits
What are venous vascular sounds ?
- soft sound
- continuous, louder diastolic component
- low pitched
- use bell of stethoscope over epigastric region and around umbilicus
- can be heard in some young, healthy individuals
- associated with portal hypertension & cirrhosis
How much should you depress for palpation ?
- about 1 cm
What are some organs you shouldn’t be able to palpate ?
kidneys, spleen, or gallbladder
When should you palpate the areas of reported pain ?
palpate these last
- it could cause them to tense up which could affect your findings
- observe for facial grimaces
When is percussion done ?
when you suspect distension, fluid or solid masses
When percussing where do you strike your finger ?
use indirect finger for percussion
- strike between cuticle and first joint (distal interphalangeal joint)
What are some signs/symptoms of visceral pain ?
arises from abdominal organ
- dull pain, poorly localized (intestinal obstruction, pancreatic tumor)
- can’t really locate where pain is
What are some signs/symptoms of parietal (somatic) pain ?
caused by inflammation of structure
- pain is sharp and well localized (peritonitis, ruptured appendix)
What is McBurney Point ?
point of specialized tenderness in acute appendicitis between the umbilicus and the right anterior superior iliac spine
What is a test that means acute appendicitis ?
- rebound tenderness: press firmly into the abdomen and release quickly which will cause pain (pain is felt when pressure is released and not when pressure is applied)
- pain= acute appendicitis
- worse when they cough
What is the iliopsoas muscle test ?
assessment for pain caused by inflammation
- performed if appendicitis is suspected
- press against raised, right leg or place patient on left side and have patient hyperextend the right leg at the hip
- iliopsoas muscle may be irritated indicating inflamed appendix
What is the obturator muscle test ?
assessment for pain caused by inflammation
- performed if ruptured appendix or pelvic abscess is suspected
- raise the patient’s right leg with the knee flexed
- pain in hypogastric region indicated irritation to obturator muscle
What is incontinence ?
lack of control of urination or defecation
What is stress incontinence ?
loss of urine (small) during physical experience, laughing, sneezing, exercising
What is urge incontinence ?
strong, sudden urge to void
- comes on really fast
- associated with diabetes, Parkinson’s, multiple sclerosis, stroke
What is overflow incontinence ?
when the bladder is already full and there is leaking of urine from the bladder
- associated with enlarged prostate
What is functional incontinence ?
don’t have any problems with bladder but can’t get to the bathroom quickly enough
- associated with mobility issues, like arthritis
What does dark urine signify?
kidney or liver disease
What are some pediatric consideration for newborns ?
- synchronous abdominal and chest wall movements
- diastasis rectus during crying
- visible pulsations (epigastric) are common
- edge of liver may be palpable (1-2 cm below right costal margin)
- both kidneys may be noted with deep palpation
What are some pediatric consideration for toddlers/children ?
- round (bot) belly present
- umbilical hernia can be present (most resolve spontaneously)
- belly breathers until age 7
What is expected palpation results ?
- no tenderness
- relaxed muscles throughout
- no masses
What is a common reason for tympany ?
- gas
What are common reasons for dullness ?
- distension
- fluid
- mass
- liver
- spleen (normally can’t be percussed)
- full stomach and stool may create dullness
What organs are found in the RUQ ?
- liver
- gallbladder
- duodenum
What organs are found in the LUQ ?
- spleen
- stomach
- heart
What organs are found in the RLQ ?
- cecum
- appendix
What organs are found in the LLQ ?
- sigmoid colon
What are some symptoms of a bladder infection ?
pain or burning with urination
What can frequent urinating in small amounts mean ?
- infection
- incontinence
- enlarged prostate
What are some symptoms of kidney infection (pyelonephritis) or kidney stone ?
fever, chills, and backpain
What can edema and low urine output mean ?
kidney failure causing fluid retention
- SOB, sudden weight gain
What are some normal inspection findings ?
- abdomen flat or rounded and symmetrical
- uniform in color and pigmentation
- striae, scars, faint vascular network may be present
- surface is smooth, with centrally located umbilicus
- no masses or nodules
- ripples of peristalsis not usually visible
- non-exaggerated pulsation of the abdominal aorta may be present
- no respiratory retractions
What is cirrhosis ?
degenerative disease that causes scarring and liver failure
What is Gastroesophageal Reflex Disease (GERD) ?
chronic digestive disease where the liquid content (acid and enzymes) of the stomach refluxes to the esophagus
How long do you listen to the bowel sounds before determining if they are absent ?
a total of 4 minutes
- 1 min in each quadrant
With what side of the stethoscope do you listen for bowel sounds ?
with the diaphragm
- bell is used for bruits
What is the order of quadrants when auscultating for bowel sounds ?
RUQ, LUQ, LLQ, RLQ
What is the range for normoactive bowel sounds ?
5-30 per min
What does dark urine usually mean ?
kidney or liver disease
