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NURS 252 > Chapter 22 - The Abdomen > Flashcards

Chapter 22 - The Abdomen Flashcards

1
Q

What forms the ventral abdominal wall?

A

four layers of large, flat muscles

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2
Q

Linea Alba

A

tendinous seam that joins the abdominal muscles

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3
Q

Rectus Abdominis

A

muscle strip extending the length of the midline

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4
Q

Role of Abdominal Muscles

A

protect and hold organs in place, flex vertebral column

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5
Q

Viscera

A

internal organs in the abdominal cavity

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6
Q

Solid Viscera

A

those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus)

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7
Q

Where is the liver?

A

fills most of the RUQ and extends over midclavicular line

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8
Q

Which organs can be palpable?

A

-lower edge of liver
-right kidney
-ovaries

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9
Q

Hollow Viscera

A

shape depends on contents (stomach, gallbladder, small intestine, colon, bladder)

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10
Q

When can hollow viscera be palpable?

A

with distention

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11
Q

Where is the stomach located?

A

just below diaphragm, between liver and spleen

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12
Q

Where is the small intestine located?

A

in all four quadrants

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13
Q

Spleen

A

soft mass of lymphatic tissue on posterolateral wall of abdominal cavity

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14
Q

Pancreas

A

soft, lobulated gland behind the stomach that stretched into the LUQ

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15
Q

Where are the kidneys?

A

behind the abdominal contents

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16
Q

Costovertebral Angle

A

angle formed by the twelfth ribs and vertebral column

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17
Q

Which kidney rests lower? Why?

A

right kidney is 1-2cm lower due to placement of the livers

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18
Q

Epigastric Region

A

area between costal margins

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19
Q

Umbilical Region

A

area around the umbilicus

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20
Q

Hypogastric (suprapubic) region

A

area above the pubic bone

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21
Q

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?

A

right upper quadrant

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22
Q

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?

A

left upper quadrant

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23
Q

Where are the following organs located: cecum, appendix, right ovary and fallopian tube, right ureter, right spermatic cord?

A

right lower quadrant

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24
Q

Where are the following organs located: part of descending colon, sigmoid colon, left ovary and fallopian tube, left ureter, left spermatic cord?

A

left lower quadrant

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25
Q

Where are the following organs found: aorta, uterus, bladder?

A

midline

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26
Q

Umbilical cord in newborns contains:

A

two arteries and one vein

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27
Q

Which organ in newborns takes up more space in the abdomen than later in life?

A

liver

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28
Q

Can the liver be palpated in healthy infants?

A

yes, 0.5-2.5cm below right costal margin

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29
Q

Which organ is located higher in newborns than adults?

A

urinary bladder - between symphysis and umbilicus

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30
Q

Why are organs in little kids easier to palpate?

A

abdominal wall is less muscular

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31
Q

Why are children under age 1 at increased risk for dehydration?

A

their small body weight and high turnover of water and electrolytes

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32
Q

Signs of dehydration in young kids:

A

altered responsiveness, sunken eyes, tachycardia, tachypnea, reduced skin turgor

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33
Q

What is an early sign of pregnancy?

A

N&V - “morning sickness”

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34
Q

When does morning sickness usually start?

A

between first and second missed periods

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35
Q

Why is acid reflux more common in pregnant women?

A

progesterone relaxes smooth muscle which prolongs gastric emptying time and increased GI motility

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36
Q

Why are pregnant women at higher risk of constipation?

A

decreased motility = more water reabsorbed

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37
Q

What can lead to hemorrhoid formation in pregnant women?

A

-constipation
-increased venous pressure in lower pelvis

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38
Q

Where do pregnant women experience appendicitis pain?

A

RLQ

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39
Q

Can you hear bowel sounds in pregnant women?

A

usually no or they are much quieter

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40
Q

How is salivation affected in older adults?

A

salivation decreases = dry mouth, decreased sense of taste

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41
Q

How does delayed esophageal emptying affect older adults?

A

increased risk for aspiration

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42
Q

How is oral medication admin affected with older adults?

A

decreased gastric acid secretion can cause pernicious anemia, iron deficiency anemia, malabsorption of calcium

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43
Q

Why are older adults more susceptible to dehydration?

A

ability to conserve water is reduced along with ability to respond to temp and thirst

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44
Q

How does liver size change with age?

A

-it decreases
-usually <80yoa
-influences medication metabolsim

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45
Q

How is renal function changed with age?

A

-it decreases
-increased risk of adverse med reactions

46
Q

Incidence of _____________ increases with age

A

gallstones

47
Q

Risk factors for constipation in older adults:

A

-decreased mobility
-hypothyroidism
-adverse medication events
-poor diet (esp. fluid and fibre intake)
-overuse of laxatives
-ignoring defecation urge
-sedentary lifestyle
-polypharmacy

48
Q

Medications associated with constipation:

A

-opioids
-NSAIDs
-antacids containing aluminum or calcium
-anticholinergics
-diuretics
-calcium channel blockers
-calcium or iron supplements

49
Q

Lactose Intolerance

A

-have lower levels of lactase, enzyme that digests lactose

50
Q

Symptoms of Lactose Intolerance

A

-cramps
-bloating
-abdominal pain
-diarrhea

51
Q

Celiac Disease

A

-inherited autoimmune condition
-intestinal tissue is damaged in response to eating gluten

52
Q

Anorexia

A

loss of appetite that occurs with GI disease

53
Q

Dysphagia

A

difficulty swallowing

54
Q

Pyrosis

A

heartburn

55
Q

Hematemesis

A

blood in vomit

56
Q

Pica

A

eating non-edible foods

57
Q

Scaphoid Abdomen

A

caves in

58
Q

Protuberant abdomen

A

significant bulge

59
Q

Hernia

A

protrusion of viscera through muscle wall

60
Q

What is the next step after inspection in the abdominal exam?

A

auscultation - pa and pe can increase peristalsis and falsely interpret bowel sounds

61
Q

If you hear a bruit…

A

avoid pa and pe

62
Q

Which end of stethoscope do you use for bowel sounds?

A

diaphragm - bowel sounds are high pitched

63
Q

Borborygmus

A

hyperperistalisis/stomach growling

64
Q

How long must you listen before deciding bowel sounds are completely absent?

A

5 mins

65
Q

Hyperactive Bowel Sounds

A

-loud
-high-pitched
-rushing
-tinkling
-signify increased motility
-may indicate bowel obstruction

66
Q

Which end of the stethoscope do you use for vascular sounds?

A

bell

67
Q

Why shouldn’t you palpate over a bruit?

A

risk of rupturing

68
Q

__________ is heard over solid structure on percussion

A

dullness

69
Q

_____________ is heard with gaseous distension

A

hyper-resonance

70
Q

Voluntary guarding

A

occurs when the patient is cold, tense, or ticklish

71
Q

Umbilical Hernia

A

appears 2-3 weeks after birth and is prominent when infant cries

72
Q

Diastastis recti

A

separation of rectus muscles with a visible bulge along midline - more common in infants of African descent

73
Q

When do you refer an umbilical hernia?

A

-larger than 2.5cm
-continues to grow after one month
-lasts more than 2 years (european) or 7 years (african)

74
Q

Should you hear vascular sounds on abdomen of infant?

A

no

75
Q

________ is not percussed in infants

A

spleen

76
Q

Why shouldn’t you over palpate the spleen?

A

can easily rupture

77
Q

Obesity

A

I - sunken umbilicus
A - normal
Pe - scattered dullness
Pa - normal

78
Q

Air or Gas

A

I - single rounded curve
A - depends on cause of gas
Pe - tympany over large area
Pa - muscle spasms maybe

79
Q

Ascites

A

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)

80
Q

Ovarian Cyst

A

I - curve in lower half of abdomen, everted umbilicus
A - normal over upper abdomen
Pe - dull over fluid
Pa - aortic pulsation present

81
Q

Pregnancy

A

I - single curve, protruding umbilicus, enlarged breasts
A - fetal heart tones, diminished bowel sounds
Pe - tympany over intestines, dull over uterus
Pa - fetal movement

82
Q

Feces

A

I - localized distension
A - normal bowel sounds
Pe - mostly tympany, dull over fecal mass
Pa - ropelike mass

83
Q

Tumour

A

I - localized distension
A - normal bowel sounds
Pe - dull over mass
Pa - used to define borders

84
Q

Referred Pain

A

-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

85
Q

Liver Pain

A

-mild to moderate main in RUQ or epigastric region
-anorexia, nausea, malaise, low-grade fever

86
Q

Stomach Pain

A

-dull epigastric pain
-radiates to back or substernal area

87
Q

Perforated Ulcer Pain

A

-burning epigastric pain in one or both shoulders

88
Q

Esophageal Pain

A

-ie GERD
-burning pain in midepigastrium or behind lower sternum
-aggravated by lying down or bending over

89
Q

Appendix Pain

A

-dull then sharp pain in RLQ (McBurney’s point)
-pain aggravated by movement, coughing, deep breathing
-anorexia, N&V, fever

90
Q

Gallbladder Pain

A

-sudden pain in RUQ that can radiate to scapulae
-occurs after ingestion of fatty foods, alcohol, caffeine
-N&V
-positive Murphy’s sign

91
Q

Murphy’s Sign

A

sudden stop in inspiration with inspiration with RUQ palpation

92
Q

Kidney Pain

A

-over flank
-lower abdominal pain

93
Q

Pancreas Pain

A

-midepigastric pain that radiates to the back and sometimes to left scapula or flank
-N&V

94
Q

Small Intestine Pain

A

-diffuse, generalized abdominal pain
-nausea and diarrhea

95
Q

Duodenal Pain

A

-dull, aching, gnawing pain
-food can help, may awaken patient from sleep

96
Q

Colon Pain

A

-pain in lower abdomen and bloated

97
Q

IBS Pain

A

-sharp or burning pain over a wide area
-does not radiate
-triggered by meals
-relieved by bowel movement

98
Q

Succussion Splash

A

-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

99
Q

Pyloric Stenosis

A

-pyloric valve obstruction
-congenital defect
-marked peristalsis, projectile vomiting

100
Q

What is Blumberg’s sign?

A

rebound tenderness - choose a site away from the painful area, push down slowly and lift quickly, normal response is no pain

101
Q

What does pain on blumberg’s sign show?

A

peritoneal inflammation

102
Q

What is Murphy’s sign?

A

pain on palpation of galbladder or cholecystitis

103
Q

What is the iliopsoas muscle test for?

A

suspected appendicitis

104
Q

What are hypoactive bowel sounds mean?

A

diminished or absence of bowel sounds

105
Q

What do hypoactive bowel sounds mean?

A

-decreased motility from inflammation, late BO, or surgery, also pneumonia

106
Q

What are hyperactive bowel sounds?

A

loud, gurgling sounds

107
Q

What do hyperactive bowel sounds mean?

A

increased motility - occur with early BO, gastroenteritis, diarrhea, laxatives

108
Q

What is a peritoneal friction rub?

A

a rough sound indicating peritoneal inflammation

109
Q

What causes a friction rub over the liver?

A

abscess or metastatic tumour

110
Q

Splenic Friction Rub indicates:

A

abscess, infection, tumour

NURS 252 (14 decks)

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