Chapter 22 - The Abdomen Flashcards
What forms the ventral abdominal wall?
four layers of large, flat muscles
Linea Alba
tendinous seam that joins the abdominal muscles
Rectus Abdominis
muscle strip extending the length of the midline
Role of Abdominal Muscles
protect and hold organs in place, flex vertebral column
Viscera
internal organs in the abdominal cavity
Solid Viscera
those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus)
Where is the liver?
fills most of the RUQ and extends over midclavicular line
Which organs can be palpable?
-lower edge of liver
-right kidney
-ovaries
Hollow Viscera
shape depends on contents (stomach, gallbladder, small intestine, colon, bladder)
When can hollow viscera be palpable?
with distention
Where is the stomach located?
just below diaphragm, between liver and spleen
Where is the small intestine located?
in all four quadrants
Spleen
soft mass of lymphatic tissue on posterolateral wall of abdominal cavity
Pancreas
soft, lobulated gland behind the stomach that stretched into the LUQ
Where are the kidneys?
behind the abdominal contents
Costovertebral Angle
angle formed by the twelfth ribs and vertebral column
Which kidney rests lower? Why?
right kidney is 1-2cm lower due to placement of the livers
Epigastric Region
area between costal margins
Umbilical Region
area around the umbilicus
Hypogastric (suprapubic) region
area above the pubic bone
Where are the following organs located: liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal gland, hepatic flexure of colon, parts of ascending and transverse colon?
right upper quadrant
Where are the following organs located: stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal gland, splenic flexure of colon, parts of transverse and descending colon?
left upper quadrant
Where are the following organs located: cecum, appendix, right ovary and fallopian tube, right ureter, right spermatic cord?
right lower quadrant
Where are the following organs located: part of descending colon, sigmoid colon, left ovary and fallopian tube, left ureter, left spermatic cord?
left lower quadrant
Where are the following organs found: aorta, uterus, bladder?
midline
Umbilical cord in newborns contains:
two arteries and one vein
Which organ in newborns takes up more space in the abdomen than later in life?
liver
Can the liver be palpated in healthy infants?
yes, 0.5-2.5cm below right costal margin
Which organ is located higher in newborns than adults?
urinary bladder - between symphysis and umbilicus
Why are organs in little kids easier to palpate?
abdominal wall is less muscular
Why are children under age 1 at increased risk for dehydration?
their small body weight and high turnover of water and electrolytes
Signs of dehydration in young kids:
altered responsiveness, sunken eyes, tachycardia, tachypnea, reduced skin turgor
What is an early sign of pregnancy?
N&V - “morning sickness”
When does morning sickness usually start?
between first and second missed periods
Why is acid reflux more common in pregnant women?
progesterone relaxes smooth muscle which prolongs gastric emptying time and increased GI motility
Why are pregnant women at higher risk of constipation?
decreased motility = more water reabsorbed
What can lead to hemorrhoid formation in pregnant women?
-constipation
-increased venous pressure in lower pelvis
Where do pregnant women experience appendicitis pain?
RLQ
Can you hear bowel sounds in pregnant women?
usually no or they are much quieter
How is salivation affected in older adults?
salivation decreases = dry mouth, decreased sense of taste
How does delayed esophageal emptying affect older adults?
increased risk for aspiration
How is oral medication admin affected with older adults?
decreased gastric acid secretion can cause pernicious anemia, iron deficiency anemia, malabsorption of calcium
Why are older adults more susceptible to dehydration?
ability to conserve water is reduced along with ability to respond to temp and thirst
How does liver size change with age?
-it decreases
-usually <80yoa
-influences medication metabolsim
How is renal function changed with age?
-it decreases
-increased risk of adverse med reactions
Incidence of _____________ increases with age
gallstones
Risk factors for constipation in older adults:
-decreased mobility
-hypothyroidism
-adverse medication events
-poor diet (esp. fluid and fibre intake)
-overuse of laxatives
-ignoring defecation urge
-sedentary lifestyle
-polypharmacy
Medications associated with constipation:
-opioids
-NSAIDs
-antacids containing aluminum or calcium
-anticholinergics
-diuretics
-calcium channel blockers
-calcium or iron supplements
Lactose Intolerance
-have lower levels of lactase, enzyme that digests lactose
Symptoms of Lactose Intolerance
-cramps
-bloating
-abdominal pain
-diarrhea
Celiac Disease
-inherited autoimmune condition
-intestinal tissue is damaged in response to eating gluten
Anorexia
loss of appetite that occurs with GI disease
Dysphagia
difficulty swallowing
Pyrosis
heartburn
Hematemesis
blood in vomit
Pica
eating non-edible foods
Scaphoid Abdomen
caves in
Protuberant abdomen
significant bulge
Hernia
protrusion of viscera through muscle wall
What is the next step after inspection in the abdominal exam?
auscultation - pa and pe can increase peristalsis and falsely interpret bowel sounds
If you hear a bruit…
avoid pa and pe
Which end of stethoscope do you use for bowel sounds?
diaphragm - bowel sounds are high pitched
Borborygmus
hyperperistalisis/stomach growling
How long must you listen before deciding bowel sounds are completely absent?
5 mins
Hyperactive Bowel Sounds
-loud
-high-pitched
-rushing
-tinkling
-signify increased motility
-may indicate bowel obstruction
Which end of the stethoscope do you use for vascular sounds?
bell
Why shouldn’t you palpate over a bruit?
risk of rupturing
__________ is heard over solid structure on percussion
dullness
_____________ is heard with gaseous distension
hyper-resonance
Voluntary guarding
occurs when the patient is cold, tense, or ticklish
Umbilical Hernia
appears 2-3 weeks after birth and is prominent when infant cries
Diastastis recti
separation of rectus muscles with a visible bulge along midline - more common in infants of African descent
When do you refer an umbilical hernia?
-larger than 2.5cm
-continues to grow after one month
-lasts more than 2 years (european) or 7 years (african)
Should you hear vascular sounds on abdomen of infant?
no
________ is not percussed in infants
spleen
Why shouldn’t you over palpate the spleen?
can easily rupture
Obesity
I - sunken umbilicus
A - normal
Pe - scattered dullness
Pa - normal
Air or Gas
I - single rounded curve
A - depends on cause of gas
Pe - tympany over large area
Pa - muscle spasms maybe
Ascites
I - single curve, everted umbilicus, bulging flanks in supine position, taut, glistening skin, recent weight gain
A - normal over intestine, diminished over fluid
Pe - tympany at top, dull over fluid
Pa - limited by taut skin (no aortic pulsation)
Ovarian Cyst
I - curve in lower half of abdomen, everted umbilicus
A - normal over upper abdomen
Pe - dull over fluid
Pa - aortic pulsation present
Pregnancy
I - single curve, protruding umbilicus, enlarged breasts
A - fetal heart tones, diminished bowel sounds
Pe - tympany over intestines, dull over uterus
Pa - fetal movement
Feces
I - localized distension
A - normal bowel sounds
Pe - mostly tympany, dull over fecal mass
Pa - ropelike mass
Tumour
I - localized distension
A - normal bowel sounds
Pe - dull over mass
Pa - used to define borders
Referred Pain
-pain might not be right over organ
-human brain has no image for internal organs
-pain is referred to a site where organ was in fetal development
Liver Pain
-mild to moderate main in RUQ or epigastric region
-anorexia, nausea, malaise, low-grade fever
Stomach Pain
-dull epigastric pain
-radiates to back or substernal area
Perforated Ulcer Pain
-burning epigastric pain in one or both shoulders
Esophageal Pain
-ie GERD
-burning pain in midepigastrium or behind lower sternum
-aggravated by lying down or bending over
Appendix Pain
-dull then sharp pain in RLQ (McBurney’s point)
-pain aggravated by movement, coughing, deep breathing
-anorexia, N&V, fever
Gallbladder Pain
-sudden pain in RUQ that can radiate to scapulae
-occurs after ingestion of fatty foods, alcohol, caffeine
-N&V
-positive Murphy’s sign
Murphy’s Sign
sudden stop in inspiration with inspiration with RUQ palpation
Kidney Pain
-over flank
-lower abdominal pain
Pancreas Pain
-midepigastric pain that radiates to the back and sometimes to left scapula or flank
-N&V
Small Intestine Pain
-diffuse, generalized abdominal pain
-nausea and diarrhea
Duodenal Pain
-dull, aching, gnawing pain
-food can help, may awaken patient from sleep
Colon Pain
-pain in lower abdomen and bloated
IBS Pain
-sharp or burning pain over a wide area
-does not radiate
-triggered by meals
-relieved by bowel movement
Succussion Splash
-loud splash auscultated over upper abdomen when infant is rocked side to side
-indicated air and fluid in stomach
-occurs with pyloric obstruction and hiatal hernia
Pyloric Stenosis
-pyloric valve obstruction
-congenital defect
-marked peristalsis, projectile vomiting
What is Blumberg’s sign?
rebound tenderness - choose a site away from the painful area, push down slowly and lift quickly, normal response is no pain
What does pain on blumberg’s sign show?
peritoneal inflammation
What is Murphy’s sign?
pain on palpation of galbladder or cholecystitis
What is the iliopsoas muscle test for?
suspected appendicitis
What are hypoactive bowel sounds mean?
diminished or absence of bowel sounds
What do hypoactive bowel sounds mean?
-decreased motility from inflammation, late BO, or surgery, also pneumonia
What are hyperactive bowel sounds?
loud, gurgling sounds
What do hyperactive bowel sounds mean?
increased motility - occur with early BO, gastroenteritis, diarrhea, laxatives
What is a peritoneal friction rub?
a rough sound indicating peritoneal inflammation
What causes a friction rub over the liver?
abscess or metastatic tumour
Splenic Friction Rub indicates:
abscess, infection, tumour
