Chapter 22- Abdomen Flashcards
Inside abdominal cavity, all organs are called ___
viscera
__ lines abdominal wall (parietal) and covers surface (visceral) or most organs.
Peritoneum
Solid viscera maintain their characteristic shape. examples:
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus
The shape of hollow viscera depends on the contents. examples:
stomach, gallbladder, small intestine, colon, and bladder
The abdominal wall is divided into 4 quadrants by a vertical and horizontal line bisecting thr unbilicus. 4 Q’s are :
Right Upper Quadrant (RUQ)
Right Lower Quadrant (RLQ)
Left Upper Quadrant (LUQ)
Left Lower Quadrant (LLQ)
Midline of the abdominal cavity:
Aorta
Bladder
Uterus
What quadrant contains: Liver Gallbladder Duodenum Head of pancreas Right kidney and adrenal gland Hepatic flexure of colon Part of ascending and transverse colon
Right Upper Quadrant
What quadrant contains: Stomach Spleen Left lobe of Liver Body of pancreas Left kidney and adrenal glad Splenic flexure of colon Part of transverse and descending colon
Left Upper Quadrant
What quadrant contains: Cecum Appendix Right ovary and tube Right ureter Right spermatic cord
Right Lower Quadrant
What quadrant contains: Part of descending colon Sigmoid colon Left ovary and tube Left ureter Left spermatic cord
Left Lower Quadrant
In newborn, umbilical cord shows prominently on the ___.
abdomen
The umbilical cord contains ___ and ____.
2 arteries and 1 vein.
The __ takes up proportionately more space in abdomen at birth than in later life.
liver
___ located higher in abdomen in infants/children than in adult.
Urinary Bladder
During early childhood, abdominal wall is ___ muscular, so organs may be ___ to palpate.
less
easier
In healthy neonates, lower edge may be palpated __ to __ below right costal margin.
0.5 to 2.5 cm
Pregnant women: Constipation and increased venous pressure in lower pelvis leads to ___
Hemorrhoids
Pregnant women: enlarged __ leads to displacement of abdominal organs
uterus
__ changes in the abdomen such as striae, linea, and nigra.
Skin
Again adult: Although liver size ___, most liver functions remain __; however, drug metabolism is impaired.
decreases
normal
Again adult: __ decreases, leading to a __ mouth.
salivation
dry
Aging adults frequently report ___.
constipation
the digestive enzyme necessary for absorption of lactose.
Lactase
People who are ____ have abdominal pain, bloating, and flatulence when milk products are consumed.
Lactose intolerant
Their is an ___ variation seen in people who are lactose intolerant.
ethnic
Estimated incidence of lactose intolerance is: \_\_\_ whites \_\_\_ mexican americans \_\_\_ of blacks \_\_\_ american indians.
20-30% Whites
70% Mexican Americans
80% Blacks
100% American Indians
What is the autoimmune disorder that includes being intolerant of gluten?
Celiac disease
Contour of Abdomen:
Determine profile from rib margin to pubic bone. Contour describes nutritional state and normally ranges from flat to rounded.
Demeanor of Abdomen:
A comfortable person is relaxed quietly on the examining table and has a benign facial expression and slow, even respirations
Auscultation bowel sounds should be done before percussion and palpation.. why?
Because palpation and percussion can increase peristalsis, which would give false interpretation of bowel sounds.
Use ___ end piece of stethoscope because bowel sounds are relatively ___.
diaphragm
high pitched
Begin in ___ at ileocecal valve area because bowel sounds are normally always present here.
RLQ
Bowel sounds originate from ___.
movement of air and fluid through small intestine
High pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5-30 times per minute
bowel sounds
Abnormal bowel sounds:
Hypoactive- decreased, can follow abdominal surgery or with inflammation
Hyperactive- loud, high-pitched signal increased motility.
The sound of hyper peristalsis
Borborygmus
perfectly “silent abdomen” is ____. and you must listen to bowel sounds for ___ minutes before deciding they are ___.
uncommon
5 minutes
absent
How do you check if nasogastric tube is in place?
x-ray or check the pH of the stomach aspirate.
Do not use auscultation for initial placement of nasogastric tube insertion
Indirect fist percussion causes tissues to __ instead of produce a sound
vibrate
To assess kidney, place one hand over ___ at costovertebral angle on back.
12th rib
Mild tenderness normal present when palpating ___. Any other tenderness should be investigated.
Sigmoid colon
If you identify a mass, first ____
distinguish it from a normally palpable structure or an enlarged organ.
Palpating the Liver: place your left hand under a persons back parallel to ____ and lift up to support abdominal contents.
11th and 12th ribs
Palpating the Liver: Place your right hand on ___, with fingers parallel to midline. Push deeply down and under right costal margin.
Right Upper Quadrant
What is this test?
Place stethoscope over liver
With one fingernail, scratch short strokes over abdomen starting in RLQ, and moving toward liver
When scratching sound in stethoscope becomes magnified, you will have crossed boredee from over a hollow organ to a solid one.
Scratch Test
Normally spleen is ____ and must be enlarged 3 times it’s normal size to be ___.
Not palpable
felt
Finding spleen:
Reach your left hand over abdomen and behind left side at the 11th and 12th ribs.
Put right hand obliquely on LUQ with fingers pointing toward left axilla and just inferior to rib margin.
Push your hand deeply down and under left costal margin
Left kidney is 1cm ___ then Right kidney.
higher
Palpating the Aorta:
Use your opposing thumb and fingers, palpate aortic pulsating in upper abdomen slightly to left of midline.
Normally it is 2.5 to 4 cm wide in adult and pulsates in an anterior direction.
Widened in the prescence of abdominal aortic aneurysm
Free fluid in peritoneal cavity
Ascites
You can differentiate ascites from gaseous distnerion by performing :
fluid wave test
shifting dullness test
This procedure makes structures that are indented by palpation rebound sudden.
Rebound tenderness (Blumberg’s sing)
This test acquires you to hold your fingers under the liver border. Ask the person to take deep breaths, and they should be able to with no pain.
Inspiratory Arrest (Murphy sign)
What are these tests for? McBurney Point Tenderness Iliopsoas muscle test Obturator Test The Alvarado Score (AKA; Mantrels score)
appendicitis
Inspection of infant abdomen: contour of abdomen is ___ because of immature abdominal musculature.
Protuberant
Inspection of infant abdomen:
What are the characteristics of the umbilical cord at birth?
It is white and contains two umbilical arteries and one vein surrounded by mucous connective tissue, called Wharton’s jelly,
What happened to the umbilical stump?
It dries within a week, hardens, and falls off by 10-14 days. Skin covers area by 3-4 weeks
A separation of recurs muscles with a visible bulge along midline
Diastasis recti
a high pitched musical sound that indicates a hollow space filled by air or gas in the stomach or intestine.
Tympany
What are these sounds: Succession splash Marked peristalsis Hypoactive bowel sounds Hyperactive bowel sounds
Abnormal bowel sounds
What are these? Umbilical hernia Epigastric hernia Incisional hernia Diastasis recti
Abnormal findings from inspection
Inspection:
Contour, symmetry, umbilicus, skin, pulsation or movement, hair distribution, and demeanor
Auscultation:
Bowel sounds
Percussion
All 4 quadrants and borders of liver and spleen
Palpation
Light and deep palpation in all 4 quadrants, and palpate for liver and spleen.
Why might you see increased deposit is of subcutaneous fat on abdomen and hips?
Because it is redistributed from extremities
Abdominal musculature is __ and has __ tone than that of a younger adult, so in absence of obesity tou may note peristalsis.
thinner
less
Under age 4, abdomen looks protuberant when child is __ and ___.
supine and standing
After age 4. potbelly remains when __ because of lumbar lordosis, but abdomen looks __ when supine.
standing
flat
School-age child has a __ abdominal shape as he or she loses potbelly.
slim
Percussion in an infant:
__ over stomach and __ over the liver
tympany
dullness
