Chapter 21: Abdomen Flashcards
What are the functions of the abdominal muscles?
- to flex and hold organs in place and 2. to flex the vertebral column.
What is the viscera?
All the internal organs inside the abdominal cavity.
What is the solid viscera
Those visceral organs that maintain a shape: kidneys, liver, pancreas, spleen, adrenal glands, ovaries, and uterus
What is the hollow viscera?
Stomach, gallbladder, small intestine, colon, and bladder
Where can you palpate aortic pulsations?
In the upper anterior abdominal wall.
Where are the kidneys located within the abdomen?
retroperitoneal: posterior to abdominal contents
What is the costovertebral angle?
The angle that is formed by the 12th rib and vertebral column,
What organs are located in the RUQ?
liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal, hepatic flexure of colon, and part of ascending and transverse colon.
What organs are located in the LUQ?
Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal, splenic flexure of colon, part of transverse and descending colon.
What organs are located in the RLQ?
Cecum, appendix, right ovary and tube, right ureter, right spermatic cord.
What organs are located in the LLQ?
Part of descending colon, sigmoid colon, left ovary and tube, left ureter, and left spermatic cord.
What organs are located in the midline of the abdomen?
Aorta, Uterus ( if enlarged) and Bladder ( if distended)
How are infants’ abdomens different from children and adults?
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.
What are some changes that occur in the abdominal cavity of a pregnant woman?
There is decreased motility of the GI tract and intestines are displaced upward and posterior by the enlarging uterus.
What are some changes that occur with the aging adult in regard to the abdomen and its organs?
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.
What is the Rome III
This is a standardized symptom criterion for functional constipation.
What are the criteria used in the Rome III?
Decrease in stool frequency (less than 3X a week), straining, hard stool, and feel of incomplete evacuation and anorectal blockage.
While constipation is NOT a physiologic consequence of aging, what are some reasons that an aging adult might be constipated?
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.
What happens to the sensation of thirst in the aging adult? What consequence might occur as a result of this?
Thirst sensation is diminished, thereby increasing risk of dehydration.
What subjective data should be asked during an abdominal assessment?
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.
What are three types of abdominal pain and what you ask the patient?
Visceral: pain dull, general, poorly localized
Parietal: pain inflammatory, sharp, localized, aggravated by movement.
Referred pain: pain referred from another site.
Ask: PQRSTU
What kind of subjective data would you ask with an infant?
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.
What kind of subjective data would you collect on an overweight child?
Ask about diet pattern, family’s eating pattern, body image
What subjective data would you collect for an adolescent?
Ask if they eat breakfast, eating patterns/habits, exercise pattern. If weight loss: ask about amount, body image, menstrual irregularities.
What subjective data would you want to collect on an aging adult?
Ask about acquiring groceries, meal preparation, 24hr diet recall, bowel problems (constipation) and any medications that may cause dry mouth (anticholinergics)
What is the order for performing a physical exam on the abdomen?
Inspection, auscultation, percussion, and palpitation
What things should an examiner look for when inspecting the abdomen?
Contour: flat, rounded, scaphoid, protuberant
Symmetry, umbilicus, skin, pulsation or movement, hair distribution, and demeanor.
why is auscultation performed before percussion and palpation?
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.
What are descriptions of bowel sounds?
character, frequency, Normal: high-pitched, gurgling, and cascading.
What do you hear with hyperactive bowel sounds?
loud, high-pitched, rushing, tinkling
What do you hear with hypoactive bowel sounds?
infrequent bowel sounds
What types of vascular sounds might you hear? using what part of the stethoscope? What do you need to note?
Use diaphragm of the stethoscope to listen for bruits over aorta, renal arteries, iliac arteries, and femoral arteries. Note: location, pitch, and timing.
What is the purpose of performing percussion?
Percussion is used to assess relative density of abdominal contents, locate organs, and to screen for fluid or masses.
What are the four areas to percuss, what are you noting?
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
What is the purpose of palpation?
Used to judge size, location, and consistency of certain organs, to screen for abnormal mass or tenderness.
What are the two types of palpation, what is the depth for each?
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.
If a patient c/o pain or tenderness when should you palpate that area?
You palpate any areas of tenderness last
If you note a mass, what should you indicate?
location, size, shape, consistency (soft, firm, hard), surface (smooth, nodular), mobility (including movement with respirations), pulsatility, and tenderness
With protuberency what are the 7 Fs?
fat, fluid, flatus, feces, fetus, fatal growth, fibroid tumor.
Hyperactive bowel sounds might indicate?
early phase bowel obstruction
hypoactive bowel sounds might indicate
late phase complete bowel obstruction
What is the Blumberg Sign
Rebound tenderness
What is the Murphy Sign
Inspiratory arrest. used to detect inflammation of the GB
What is iliopsoas muscle test
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
