Chapter 21: Abdomen Flashcards
abdomen
large oval cavity extending from diaphragm down to the brim of the pelvis
Viscera
includes all internal organs.
Two types: hollow viscera and solid viscera.
solid viscera
includes liver, pancreas, spleen, adrenal glands, kidneys, ovaries and uterus
hollow viscera
stomach, gallbladder, small intestine, colon and bladder
Abdomen is divided into four quadrants
RUQ, LUQ, RLQ, LLQ
Right Upper Quadrant includes
- liver
- gallbladder
- duodenum
- head of pancreas
- R kidney and adrenal
- hepatic flexure of colon
- part of ascending and transverse colon
Left Upper Quadrant includes
- stomach
- spleen
- L lobe of liver
- L kidney and adrenal
- splenic flexure of colon
- part of ascending and transverse colon
Right Lower Quadrant includes
- cecum
- appendix
- R ovary and tube
- R ureter
- R spermatic cord
Left Lower Quadrant includes
- part of descending colon
- sigmoid, colon
- L ovary and tube
- L ureter
- L spermatic cord
Midline, Epigastric, Umbilicus and Suprapubic includes
aorta, uterus if enlarged, bladder if distended
Cultural Considerations
A. lactose intolerant
B. Obesity
Cultural Considerations: Lactose Intolerant
African Americans, Hispanic and Caucasians groups at birth have an increased incidence of lactose intolerance.
Cultural Considerations: Obesity
- combinations of intake, physical activity and genetic predisposition.
- about 30-50% of US adults are obese, and stats vary among ethnic groups
What information would you need to obtain under the History (Subjective Data) category?
A. Any change in appetite, weight gain or weight loss
B. Dysphagia
C. Food intolerance
D. Abdominal Pain: location, character of pain
E. Nausea/Vomiting
F. Bowel Habits: frequency, consistency, details
G. Past Abdominal History: ulcer, hepatitis, appendicitis, colitis, hernia, surgery
H. Medications, alcohol use, smoking hx
I. Nutritional Assessment: 24 hour diet recall
What would you need to do under the Physical Exam/Assessment (Objective Data) category?
A. Inspection
B. Auscultate
C. Palpation
D. Percussion
Inspection of the Abdomen
note contour, symmetry, umbilicus and skin
Auscultation of the Abdomen
auscultate bowel sounds in all 4 quadrants (with diaphragm) and auscultate for vascular sounds (bruits) (with bell)
Palpation of the Abdomen
- light palpation
- deep palpation
- palpate liver and spleen (usually not palpable)
- palpate aortic pulsations (normal 2-4 cm wide)
Percussion of the Abdomen
- percuss all 4 quadrants, note general tympany and dullness
- percuss liver span (nl 6-12 cm) - enlarged liver span indicates hepatomegaly
- percuss costovertebral angle tenderness (CVA)
Special Procedures when assessing the abdomen
- Rebound Tenderness
- Inspiratory Arrest
- Iliopsoas Muscle Test
- Obturator Test
- Alvarado Score
Rebound Tenderness (Blumberg’s Sign)
associated with appendicitis
Inspiratory Arrest (Murphy’s Test)
hold fingers under liver border, have pt take a deep breath - normal response is no pain with procedure (not routinely done)
Iliopsoas Muscle Test
- lift R leg straight up, then push down over the lower part, while pt resists
- normal/negative if no pain in RLQ (not routinely done)
- can be used to check for appendicitis
Obturator Test
- lift R leg, flex at hip and 90’ at knee.
- hold the ankle and rotate leg internally and externally (not routinely done)
Alvarado Score
- one point for each criterion except where 2 points noted: pain migrating to right iliac fossa, anorexia, nausea/vomiting, RLQ pain (2 points), rebound tenderness, fever, WBC >10,000, neutrophils (>76% shift to left) (2pts)
- 4 points suspects appendicitis
Common Abdominal Abnormalities
A. Ascites B. Constipation C. Umbilical Hernia D. Hepatitis E. Gastroesophageal Reflux (GER/GERD) F. Aortic Aneurysm G. Appendicitis H. Gastroenteritis/Gastritis (AGE) I. Cholecystitis
Why must the abdomen be auscultated before percussion and palpation?
percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds
Bowel sounds
- high-pitched, gurgling, and cascading sounds that irregularly occur from 5 to 30 times per minute.
- originate from the movement of air and fluid through the small intestine.
Borborygmi
term used for hyperperistalsis when the person actually feels his or her stomach growling. (hyperactive bowel sound)
What happens to gastric acid secretion with aging?
decreased gastric acid secretion
Black stools may be tarry as a result of
occult blood (melena) from gastrointestinal bleeding
Before reporting a finding as silent bowel sounds, the nurse should listen for at least
5 minutes
Gaseous distension produces what kind of sound during percussion
hyperresonance
Air produces what kind of sound during percussion
tympany
Gray stools occur with
hepatitis
peptic ulcer disease occurs with
NSAIDS, alcohol, smoking and helicobacter pylori infection.
hernia
protrusion of abdominal viscera through abnormal opening in muscle wall
dullness occurs over
a distended bladder, adipose tissue, fluid or a mass
During palpation, what indicates that the liver is enlarged?
a liver palpated more than 1 - 2cm below the right costal margins is enlarged.
