Chapter 21: Abdomen

Question 1

What are the functions of the abdominal muscles?

Answer 1

1. to flex and hold organs in place and 2. to flex the vertebral column.

Question 2

What is the viscera?

Answer 2

All the internal organs inside the abdominal cavity.

Question 3

What is the solid viscera

Answer 3

Those visceral organs that maintain a shape: kidneys, liver, pancreas, spleen, adrenal glands, ovaries, and uterus

Question 4

What is the hollow viscera?

Answer 4

Stomach, gallbladder, small intestine, colon, and bladder

Question 5

Where can you palpate aortic pulsations?

Answer 5

In the upper anterior abdominal wall.

Question 6

Where are the kidneys located within the abdomen?

Answer 6

retroperitoneal: posterior to abdominal contents

Question 7

What is the costovertebral angle?

Answer 7

The angle that is formed by the 12th rib and vertebral column,

Question 8

What organs are located in the RUQ?

Answer 8

liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal, hepatic flexure of colon, and part of ascending and transverse colon.

Question 9

What organs are located in the LUQ?

Answer 9

Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal, splenic flexure of colon, part of transverse and descending colon.

Question 10

What organs are located in the RLQ?

Answer 10

Cecum, appendix, right ovary and tube, right ureter, right spermatic cord.

Question 11

What organs are located in the LLQ?

Answer 11

Part of descending colon, sigmoid colon, left ovary and tube, left ureter, and left spermatic cord.

Question 12

What organs are located in the midline of the abdomen?

Answer 12

Aorta, Uterus ( if enlarged) and Bladder ( if distended)

Question 13

How are infants’ abdomens different from children and adults?

Answer 13

Infants have a thinner abdominal wall, making it easier to palpate organs, the liver takes up more abdominal space, and the bladder is higher in the abdomen.

Question 14

What are some changes that occur in the abdominal cavity of a pregnant woman?

Answer 14

There is decreased motility of the GI tract and intestines are displaced upward and posterior by the enlarging uterus.

Question 15

What are some changes that occur with the aging adult in regard to the abdomen and its organs?

Answer 15

Increased adipose tissue, decreased salivary secretions, decreased taste and smell, delayed esophageal emptying, decreased gastric acid secretions, increase in an incidence of gallstones, decreased drug metabolism by the liver, and constipation symptoms.

Question 16

What is the Rome III

Answer 16

This is a standardized symptom criterion for functional constipation.

Question 17

What are the criteria used in the Rome III?

Answer 17

Decrease in stool frequency (less than 3X a week), straining, hard stool, and feel of incomplete evacuation and anorectal blockage.

Question 18

While constipation is NOT a physiologic consequence of aging, what are some reasons that an aging adult might be constipated?

Answer 18

Lack of physical activity, inadequate intake of water, low-fiber diet, side effects of medications, irritable bowel syndrome, bowel obstruction, hypothyroidism, and inadequate toilet facilities.

Question 19

What happens to the sensation of thirst in the aging adult? What consequence might occur as a result of this?

Answer 19

Thirst sensation is diminished, thereby increasing risk of dehydration.

Question 20

What subjective data should be asked during an abdominal assessment?

Answer 20

Appetite: changes; weight loss/gain, Dysphagia,
Food intolerance: heartburn, acid reflux, indigestion, use of antacids,
Abd. pain,
N/V: how often, contents, odor, fever, chills, diarrhea, pain, eating, and travel within last 24hrs,
Bowel habits: frequency, color, consistency, diarrhea/constipation, laxative use
Past abd. hx: ulcer, GB disease, hepatitis/jaundice, appendicitis, colitis, hernia, past surgeries, xrays
Medication use, alcohol consumption, tobacco use
Nutritional assessment: 24hr recall.

Question 21

What are three types of abdominal pain and what you ask the patient?

Answer 21

Visceral: pain dull, general, poorly localized
Parietal: pain inflammatory, sharp, localized, aggravated by movement.
Referred pain: pain referred from another site.

Ask: PQRSTU

Question 22

What kind of subjective data would you ask with an infant?

Answer 22

Ask about bottle/breast feeding, how are they tolerating the feedings, are they eating table food, what are their eating habits, bowel habits, and water intake.

Question 23

What kind of subjective data would you collect on an overweight child?

Answer 23

Ask about diet pattern, family’s eating pattern, body image

Question 24

What subjective data would you collect for an adolescent?

Answer 24

Ask if they eat breakfast, eating patterns/habits, exercise pattern. If weight loss: ask about amount, body image, menstrual irregularities.

Question 25

What subjective data would you want to collect on an aging adult?

Answer 25

Ask about acquiring groceries, meal preparation, 24hr diet recall, bowel problems (constipation) and any medications that may cause dry mouth (anticholinergics)

Question 26

What is the order for performing a physical exam on the abdomen?

Answer 26

Inspection, auscultation, percussion, and palpitation

Question 27

What things should an examiner look for when inspecting the abdomen?

Answer 27

Contour: flat, rounded, scaphoid, protuberant | Symmetry, umbilicus, skin, pulsation or movement, hair distribution, and demeanor.

Question 28

why is auscultation performed before percussion and palpation?

Answer 28

Auscultation is done prior to both percussion and palpation as these things can promote peristalsis which can lead to an erroneous interpretation of bowel sounds.

Question 29

What are descriptions of bowel sounds?

Answer 29

character, frequency, Normal: high-pitched, gurgling, and cascading.

Question 30

What do you hear with hyperactive bowel sounds?

Answer 30

loud, high-pitched, rushing, tinkling

Question 31

What do you hear with hypoactive bowel sounds?

Answer 31

infrequent bowel sounds

Question 32

What types of vascular sounds might you hear? using what part of the stethoscope? What do you need to note?

Answer 32

Use diaphragm of the stethoscope to listen for bruits over aorta, renal arteries, iliac arteries, and femoral arteries. Note: location, pitch, and timing.

Question 33

What is the purpose of performing percussion?

Answer 33

Percussion is used to assess relative density of abdominal contents, locate organs, and to screen for fluid or masses.

Question 34

What are the four areas to percuss, what are you noting?

Answer 34

General tympany: move clockwise; tympany should predominate. Liver span: will note change from tympany to dull sound. Splenic Dullness: percussing for dull note from 9th -11th ICS just behind the left midaxillary line. CVAT: indirect fist percussion over 12th rib at the CVA. Note: tenderness, change of tympany

Question 35

What is the purpose of palpation?

Answer 35

Used to judge size, location, and consistency of certain organs, to screen for abnormal mass or tenderness.

Question 36

What are the two types of palpation, what is the depth for each?

Answer 36

Light palpation: 1st four fingers, gentle rotary motion, sliding fingers and skin together; depress 1 cm. Deep palpation: Using same technique as light except depress 5-8cm.

Question 37

If a patient c/o pain or tenderness when should you palpate that area?

Answer 37

You palpate any areas of tenderness last

Question 38

If you note a mass, what should you indicate?

Answer 38

location, size, shape, consistency (soft, firm, hard), surface (smooth, nodular), mobility (including movement with respirations), pulsatility, and tenderness

Question 39

With protuberency what are the 7 Fs?

Answer 39

fat, fluid, flatus, feces, fetus, fatal growth, fibroid tumor.

Question 40

Hyperactive bowel sounds might indicate?

Answer 40

early phase bowel obstruction

Question 41

hypoactive bowel sounds might indicate

Answer 41

late phase complete bowel obstruction

Question 42

What is the Blumberg Sign

Answer 42

Rebound tenderness

Question 43

What is the Murphy Sign

Answer 43

Inspiratory arrest. used to detect inflammation of the GB

Question 44

What is iliopsoas muscle test

Answer 44

test used to indicate possible appendicitis. Raise right leg, flex at hip, push down over lower part of the lower thigh as person tries to hold leg up. RLQ pain is a positive result