Chapter 21: Abdomen Flashcards
What are al internal organs in the abdominal cavity called?
Viscera
Where is the small intestine located?
In all four quadrants
Where is the spleen located
ULQ
Where is the liver located?
URQ
Where is the stomach primarily located?
ULQ
Where is the descending colon primarily located?
LUQ
Where is the ascending colon primarily located?
RUQ
Where is the pancreas?
Mainly in LUQ but also crosses over into RUQ
What are the midline organs?
Aorta, Uterus (if enlarged), Bladder (if distended)
Reasons for abdominal pain
- Occurs in acute and chronic conditions
- Can be due to digestive, reproductive disorders or urinary system disorders
Risk factors and considerations for abdominal pains
- Alcohol abuse
- H-pylori: peptic ulcer
- Medications
- Stress
- Smoking
- Congenital defects
- Travel to other countries
When should you be concerned about an umbilical hernia?
Bulging of belly button, normal for the first 6 months but should not persist longer. Usually more prominent when baby cries
Diastasis recti
separation of the abdominal rectus muscles with visible bulge along midline
Liver size in infant and children
Liver takes up proportionately more space in the abdomen at birth than in later in life
Pyloric Stenosis
narrowing of the opening of the pylorus causing food to come back up (congenital defect)
Acute gastroenteritis
Stomach flu (An intestinal infection marked by diarrhea, cramps, nausea, vomiting, and fever.)
Developmental competence in pregnant women
Nausea and vomiting, Production of hCG, Acid indigestion or “heartburn” “pyrosis” because of esophageal reflux, GI motility decreases prolonging gastric emptying leading to more water reabsorption and constipation, Hemorrhoids, Intestines move upward and posteriorly because the uterus is displaced, Striae and linea nigra are present
Developmental competence in aging adults
Salivation decreases, Esophageal emptying is delayed, Gastric acid secretion decreases (leading to pernicious anemia , iron deficiency, anemia, calcium malabsorption)
Reason for constipation in aging adults
Decreased physical activity, Low fiber diet, side effects of medications, bowel obstruction, hypothyroidism, inadequate toilet facilities
Stool assessments
- Brown/light brown (normal)
- Dark, tarry stool can indicate upper intestinal bleed
- Bright red (frank) bleeding can indicate lower intestinal bleeding
- Clay colored (biliary system)
- Presence of bright red streaks often indicates hemorrhoids or fissures
- Constipation
- Diarrhea (frequency)
Emesis Assessment
- Hematemesis
- Frank blood (Upper)
- Blood tinged (Lower)
- Food particles
- Bile
- Coffee ground
- Posttussive emesis
- Amount and Frequency
When you’re percussing the abdomen what should it sound like?
- Tympany
- Dull in the upper quadrants, Dull if stool is present
Ascites
Fluid in abdominal cavity that can cause change in sound
Palpation of the abdomen
You do not want to deeply palpate, palpate last
- *Looking for masses
- *You do not want to feel organs
- *Do not palpate if the patient is immunocompromised or has mono/epstein barr
4 contours of stomach
Flat
Rounded
Scaphoid: dip in the middle of the abdomen
Protuberant: Distended at the bottom of the stomach
When is Ascites common?
Portal hypertension
Cirrhosis
Kidney patients , Liver patients
Auscultation of the bowels
- Sounds are irregular, gurgling sounds 5-30x/minute
- Bowel sounds (How do you describe?)
- Listen if there are Vascular sounds or Peritoneal friction rub
Borborygmus
sound of hyperperistalsis
What happens if abdomen is perfectly silent?
you must listen for 5 minutes by your watch before deciding bowel sounds are completely absent
Liver Span assessment
Percussing the abdomen to see where the liver border is (dull)
Usually in the 5th intercostal space
Liver usually 10.5 cm for males, 7cm for females
Splenic Dullness
Often spleen obscured by stomach contents, but you may locate it by percussing for a dull note from 9th to 11th intercostal space just behind left midaxillary line
CVA tenderness
Assessing for costovertebral angle tenderness (CVA)
Normal: non tender
Tenderness is causes by acute infection (pylonephritis)
Ascites sound when percussed
Dull
Hooking technique
An alternative method of palpating liver is to stand up at person’s shoulder and swivel your body to right so that you face person’s feet
Hook your fingers over costal margin from above
-Ask person to take a deep breath
-Try to feel liver edge bump your fingertips
Palpation of aorta
Using your opposing thumb and fingers, palpate aortic pulsation in upper abdomen slightly to left of midline
Rebound tenderness (Blumberg’s sign)
Put your hand in the area and pain is felt when the hand is taken off and pressure is no longer put on the spot
Rovsing’s sign
Pressure on left lower quadrant and the pain is felt on opposite side
Inspiratory arrest (Murphys sign)
Sign of cholecystitis
Psoas test
Lift left leg straight up while supine and see if pain is felt in McBurneys point
Obturator sign
Inflamed appendix when knee is bent and pain is felt
Reasons for abdominal distension
Obesity Air or gas Ascites Ovarian cyst Pregnancy Feces Tumor
Succussion splash
Loud splash auscultated over the upper abdomen when infant is rocked side to side
-Indicates increased air and fluid in the stomach
Peristalsis with projectile vomiting in newborn suggests what?
Pyloric stenosis
Hypoactive bowel sounds
Diminished or absent bowel sounds signalling decreased motility as a result of inflammation as seen with peritonitis
Occurs with pneumonia
Hyperactive bowel sounds
Loud gurgling “borborygmi” signal increased motility that occurs with early mechanical bowel obstruction (high pitched), gastroenteritis, brisk diarrhea, laxative use and subsiding paralytic ileus
Peritoneal friction rub
rough grating sound like two pieces of leather rubbed together, indicated peritoneal inflammation
Liver friction rub location
friction rub over lower right rib cage from abscess or metastatic tumor
Spleenic friction rub location
friction rub over lower left rib cage in left anterior axillary line from abscess, infection or tumor
Vascular sounds
Arterial – bruit indicates turbulent blood flow as found in constricted, abnormally dilated, or tortuous vessels
Aortic aneurysm sound
murmur is harsh, systolic, or continuous and accentuated with systole. Note in those with HTN
Renal artery stenosis (location and sound)
murmur is midline or towards flank, soft, low to medium pitch
Venous hum
In periumbilical region, originates from inf. vena cave. Medium pitches, continuous sound, Palpable thrill, Occurs with Portal HTN and cirrhotic liver
Order of Abdomen Exam
Inspect, Auscultate, Percuss, Palpate (lightly)
