Chapter 22: Abdomen Flashcards
1
Q
Aneurysm
A
Defect of sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect
2
Q
Anorexia
A
Loss of appetite for food
3
Q
Ascites
A
Abnormal accumulation of serous fluid within the peritoneal cavity, associated with heart failure, cirrhosis, cancer, or portal hypertension
4
Q
Borborygmi
A
Loud, gurgling bowel sounds signaling increased motility or hyper-peristalsis; occurs with early bowel obstruction, gastroenteritis, diarrhea
5
Q
Bruit
A
Blowing, swooshing sound heard through a stethoscope when an artery is partially occluded
6
Q
Cecum
A
First or proximal part of large intestine
7
Q
Cholecystitis
A
Inflammation of the gallbladder
8
Q
Costal margin
A
Lower border of rib margin formed by the medial edges of the 8th, 9th, and 10th ribs
9
Q
Costovertebral angle (CVA)
A
Angle formed by the 12th rib and the vertebral column on the posterior thorax, overlying the kidney
10
Q
Diastasis recti
A
Midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles
11
Q
Dysphagia
A
Difficulty swallowing
12
Q
Epigastrium
A
Name of abdominal region between the costal margins
13
Q
Hepatomegaly
A
Abnormal enlargement of liver
14
Q
Hernia
A
Abnormal protrusion of bowel through weakening in abdominal musculature
15
Q
Inguinal ligament
A
Ligament extending from pubic bone to anterior superior iliac spine, forming lower border of abdomen
16
Q
Linea alba
A
Midline tendinous seam joining the abdominal muscles
17
Q
Paralytic ileus
A
Complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction
18
Q
Peritoneal friction rub
A
Rough grating sound heard through the stethoscope over the site of peritoneal inflammation
19
Q
Peritoneum
A
Double envelope of serous membrane that lines the abdominal wall and covers the surface of most abdominal organs
20
Q
Peritonitis
A
Inflammation of peritoneum
21
Q
Pyloric stenosis
A
Congenital narrowing of pyloric sphincter, forming outflow obstruction of stomach
22
Q
Pyrosis
A
Heartburn; burning sensation in upper abdomen due to gastric reflux of gastric acid
23
Q
Rectus abdominis muscles
A
Midline abdominal muscles extending from rib cage to pubic bone
24
Q
Scaphoid
A
Abnormally sunken abdominal wall, as with malnutrition or underweight
25
Splenomegaly
Abnormal enlargement of the spleen
26
Striae
(Linea albicantes) silvery white or pink scar tissue formed by stretching abdominal skin as with pregnancy or obesity
27
Suprapubic
Name of abdominal region just superior to pubic bone
28
Tympany
High-pitched, musical, drumlike percussion note heard when percussing over the stomach and intestine
29
Umbilicus
Depression on the abdomen marking site of entry of umbilical cord
30
Viscera
Internal organs
31
Describe the proper positioning and preparation of the patient for the abdominal examination
Supine with head on pillow, knees bent, and arms at their side or across their chest.
Warm room, hands, and stethoscope.
32
Discuss the inspection of the abdomen, including findings that you should note.
Contour, color, symmetry, umbilicus, skin, pulsation/movement, hair distribution, and demeaner.
Note: bulges, masses, unusual movement, and colors.
33
State the rationale for performing auscultation of the abdomen before palpation or percussion.
Palpation and percussion may stimulate peristalsis - can cause hyperactive bowel sounds.
34
Describe the procedure for auscultation of bowel sounds.
Start in the RLQ at ileocecal valve (sounds are normally present here).
Continue clockwise.
35
Differentiate the following abdominal sounds: normal, hyperactive, and hypoactive bowel sounds; succession splash; bruit
Normal: high-pitched, gurgling, cascading.
Hyperactive: loud, high-pitched, rushing, tinkling, borborygmus (stomach growling).
Hypoactive: reduction in loudness, tones, or regularity.
Succession splash: sloshing sounds.
"Thrill": turbulent blood flow.
36
List 4 conditions that may alter normal percussion notes heard over the abdomen
* Pregnancy
* Obesity
* Ascites
* Air/gas distention
* Tumor
* Fecal - intestinal blockage
37
Name the organs that are normally palpable in the abdomen
* Liver
* Right kidney
* Pulsatile aorta
* Rectus muscles
* Ascending colon
* Cecum
* Sigmoid colon
* Uterus (gravid)
* Full bladder
* Sacral promontory
38
Differentiate between light and deep palpation, and explain the purpose of each.
* Light palpation: about 1 cm; forms an overall impression of skin surface and superficial musculature
* Deep palpation: about 5 to 8 cm; palpation of organs
39
List 2 abnormalities that may be detected by light palpation and 2 that may be detected by deep palpation.
* Light palpation
* Muscle gaurding
* Rigidity
* Large masses
* Tenderness
* Deep palpaption
* Enlarged liver
* Enlarged spleen
* Enlarged kidneys/masses
* Aortic aneurysm
40
Contrast rigidity with voluntary guarding.
Involuntary rigidity: a constant, boardlike hardness of the muscles; protective mechanism accompanying acute inflammation of peritoneum
Voluntary guarding: occurs when cold, ticklish, or tense
41
Contrast visceral pain and somatic (parietal) pain
Visceral pain: due to organ damage/inflammation/disease
Somatic (parietal) pain: from skin, muscle and soft tissue damage/injury
42
Describe rebound tenderness.
Assess when person reports abdominal pain or tenderness is elicit during palpation.
Hold hand at 90 degrees to abdomen, press down slowly and deeply, then lift up quickly - normally no pain.
43
Distinguish abdominal wall masses from intra-abdominal masses,
Abdominal wall masses:
* Umbilical, epigastric, incisional, or spigelian hernias
* Benign and malignant neoplasm
* Infections
* Hematomas
Intra-abdominal masses:
* Localized sweeling/enlargement of the abdomen
44
Describe the procedure and rationale for determining costovertebral angle (CVA) tenderness
1. Place one hand over the 12th rib at the CVA on the back
2. Thump that hand with ulnar edge of other first
Normal: feel thud, no pain
Abnormal: feel sharp pain (kidney or paranephric area inflammation)
45
Identify label a
Liver
46
Identify label b
Gallbladder
47
Identify label c
Ascending colon
48
Identify label d
Small intestine
49
Identify label e
Cecum
50
Identify label f
Appendix
51
Identify label g
Spleen
52
Identify label h
Stomach
53
Identify label i
Transverse colon
54
Identify label j
Descending colon
55
Identify label k
Sigmoid colon
56
Identify label l
Bladder
57
Identify label a
Inferior vena cava
58
Identify label b
Right kidney
59
Identify label c
Duodenum
60
Identify label d
Pancreas
61
Identify label e
Right ureter
62
Identify label f
Sacral promontory
63
Identify label g
External iliac artery
64
Identify label h
External iliac vein
65
Identify label i
Uterus
66
Identify label j
Bladder
67
Identify label k
Aorta
68
Identify label l
Left kidney
69
Identify label m
Small intestine
70
Identify label n
Left ureter
71
Identify label o
Common iliac artery
72
Identify label p
Common iliac vein
73
Identify label q
Peritoneum
74
Identify label r
Rectum
75
Identify label s
Ovary
76
Identify label t
Pubic symphysis
77
Select the sequence of techniques used during an examination of the abdomen.
a. Precussion, inspection, palpation, auscultation
b. Inspection, palpation, percussion, auscultation
c. Inspection, auscultation, percussion, palpation
d. Auscultation, inspection, palpation, percussion
c. Inspection, auscultation, percussion, palpation
78
Which of the following can be noted through inspection of a patient's abdomen?
a. Fluid waves and abdominal rigidity
b. Umbilical eversion and Murphy sign
c. Venous pattern, peristaltic waves, and abdominal contour
d. Peritoneal irritation, general tympany, and peristaltic waves
c. Venous pattern, peristaltic waves, and abdominal contour
79
Right upper quadrant tenderness may indicate pathology in the:
a. Liver, pancreas, or ascending colon
b. Liver and stomach
c. Sigmoid colon, spleen, or rectum
d. Appendix or ileocecal valve
a. Liver, pancreas, or ascending colon
80
Hyperactive bowel sounds are:
a. High-pitched
b. Rushing
c. Tinkling
d. All of the above
d. All of the above
81
The abscence of bowel sounds is established after listening for:
a. 1 full minute
b. 3 full minutes
c. 5 full minutes
d. None of the above
c. 5 full minutes
82
Auscultation of the abdomen may reveal bruits of the _____ arteries.
a. Aortic, renal, iliac, and femoral
b. Jugular, aortic, carotid, and femoral
c. Pulmonic, aortic, and portal
d. Renal, iliac, internal jugular, and basilic
a. Aortic, renal, iliac, and femoral
83
The left upper quadrant (LUQ) contains the:
a. Liver
b. Appendix
c. Left ovary
d. Spleen
d. Spleen
84
A woman has striae on the abdomen. Which color indicates long-standing striae?
a. Pink
b. Blue
c. Purple-blue
d. Silvery white
d. Silvery white
85
Auscultating the abdomen is begun in the right lower quadrant (RLQ) because:
a. Bowel sounds are always normally present here
b. Peristalsis through the descending colon is usually active
c. This is the location of the pyloric sphincter
d. Vascular sounds are best heard in this area
a. Bowel sounds are always normally present here
86
Shifting dullness is a test for:
a. Ascites
b. Splenic enlargment
c. Inflammation of the kidney
d. Hepatomegaly
a. Ascites
87
Tenderness during abdominal palpation is expected when palpating the:
a. Liver edge
b. Spleen
c. Sigmoid colon
d. Kidneys
c. Sigmoid colon
88
A positive Murphy sign is best described as:
a. The pain felt when the examiner's hand is rapidly removed from an inflamed appendix
b. Pain felt when taking a deep breath when the examiner's fingers are on the approximate location of the inflammed gallbladder
c. A sharp pain felt by the patient when one hand of the examiner is used to thumb the other at the costovertebral angle
d. This is not a valid examination technique
b. Pain felt when taking a deep breath when the examiner's fingers are on the approximate location of the inflammed gallbladder
89
A positive Blumberg sign indicates:
a. Possible aoritc aneurysm
b. Presence of renal artery stenosis
c. Enlarged, nodular liver
d. Peritoneal inflammation
d. Peritoneal inflammation
90
Your patient is complaining of abdominal pain. What are some common sites of referred abdominal pain? What subjective data may be necessary to determine what is wrong with the patient?
* Liver: mild-to-moderate dull pain in RUQ or epigastrum
* Esophagus: burning pain in midepigastrium
* Gallbladder: sudden pain in RUQ that may radiate to right or left scapula
* Pancreas: acute, boring midepigastric pain radiating to the back and sometimes to the left scapula or flank, severe nausea, and vomiting
* Duodenum: typically dull, aching, gnawing pain; noes not radiate
* Stomach: dull, aching, gnawing epigastric pain, radiates to back or substernal area
* Appendix: starts as dull, diffuse pain in periumbilical region that later shifts to severe, sharp, persistent pain and tenderness; pain aggrevated by movement, coughing, deep breathing
* Kidney: sudden onst of severe flank or lower abdominal pain
* Small intestine: diffuse, generalized abdominal pain
* Colon: moderate, colicky pain of gradual onset in lower abdomen and bloating
