Chapter 23 Flashcards
peritoneum
lining of the abdominal cavity; two layers parietal and visceral
LUQ
most of the stomach, the spleen, the pancreas, and part of the large intestine. The left kidney is behind the abdominal lining.
RUQ
most of the liver, the gallbladder, and part of the large intestine. The right kidney is behind the abdominal lining
RLQ
the appendix (a worm-shaped structure extending from the beginning of the large intestine), part of the large intestine, and the female reproductive organs.
LLQ
Contains part of the large intestine and the female reproductive organs.
hollow organ
contain some type of substance that might leak into the abdominal cavity if the organ is perforated or injured. When a hollow organ is perforated or injured, any substance that leaks into the abdominal cavity can lead to chemical or bacterial peritonitis
solid organ
vascular (contain many vessels and a large amount of blood). Some are covered by a thick fibrous capsule; blood filled
hollow organs
appendix
bladder
bile duct
fallopian tube
gallbladder
instestines
stomach
uterus
ureters
Solid organs
kidney
liver
ovaries
pancreas
spleen
stomach
saclike, stretchable pouch located below the diaphragm that receives food from the esophagus
enables digestion by secreting a specialized fluid to aid in the breakdown and absorption of food
duodenum
first part of the small intestine that connects to the stomach.
small intestine
tubelike structure beginning at the distal end of the stomach and ending at the beginning of the large intestine. Its digestive function is to absorb nutrients from intestinal contents.
large intestine
tubelike structure beginning at the distal end of the small intestine and ending at the anus. It reabsorbs fluid from intestinal contents, enabling the excretion of solid waste from the body.
liver
filters the nutrients from blood as it returns from the intestines, stores glucose (sugar) and certain vitamins, plays a part in blood clotting, filters dead red blood cells, metabolizes medications and toxins, and aids in the production of bile. The liver is proportionally larger in the pediatric patient.
gallbladder
pear-shaped sac that lies on the underneath right side of the liver. The gallbladder holds bile, which aids in the digestion of fats
spleen
elongated oval solid organ. It aids in the production of blood cells as well as the filtering and storage of blood. The spleen is proportionally larger in the pediatric patient.
pancreas
A gland composed of many lobes and ducts. aids in digestion and regulates carbohydrate metabolism.
kidneys
Paired organs located behind the abdominal wall lining (retroperitoneal), one on each side of the spine. The kidneys excrete urine and regulate water, electrolytes, and acid–base balance.
urinary bladder
saclike structure that acts as a reservoir for the urine received from the kidneys
three mechanism of abdominal pain
Mechanical forces (stretching)
Inflammation
Ischemia (organ and tissue hypoxia, or oxygen deficiency)
visceral pain
poorly localized, intermittent, crampy, dull, or aching pain
produced by ischemia, inflammation, infection, or mechanical obstruction of an organ
parietal/somatic pain
localized intense, sharp, constant pain, associated with irritation of the peritoneum
peritonitis
occurs when blood, pus, bacteria, or chemical substances leak into the peritoneal cavity. The onset and type of the abdominal pain a patient experiences are somewhat dependent on the type of substance leaking into the peritoneum.
s/s of peritonitis
Abdominal pain or tenderness
Nausea, vomiting, or diarrhea
Fever and chills
Lack of appetite (anorexia)
Positive Markle (heel drop or heel jar) test
Markle “Heel Drop” or “Heel Jar” Test
instruct the patient to stand on his feet with his knees straight. Then ask him to raise himself onto his toes and drop suddenly down on his heels, flat-footed, with enough force to produce an audible thump. Because the patient will not know what you are clinically attempting to find out, it is difficult for a skewed response to occur. This is known as a “heel drop” test.
This jars the torso, which, in turn, irritates the peritoneal linings
rebound tenderness
push slowly down on a quadrant of the abdomen to slightly compress the tissues beneath and then suddenly release the pressure. When the abdominal contents reassume their original location, the peritoneal surfaces rub together. If there is inflammation to the peritoneal linings, it elicits pain in the patient.
appendicitis
inflammation of the appendix that commonly causes an acute abdomen. Appendicitis is usually caused by a blockage in the intestines and results in inflammation and irritation. If left untreated, the inflammation eventually causes the tissue to die and rupture. This results in abscess formation (local pus collection), peritonitis, or shock.
appendicitis s/s
Nausea and vomiting
Low-grade fever and chills
Lack of appetite (anorexia)
Abdominal guarding
Positive Markle (“heel drop” or “heel jar”) test
Abdominal pain or cramping—Initially this can be dull, diffuse, and located around the umbilicus because of the distention of the appendix. Later this pain is usually localized to the RLQ medial to the iliac crest (pelvic wing), also called the McBurney point, because of peritoneal irritation.
pancreatitis
inflammation of the pancreas, can cause severe pain in the middle of the upper quadrants (epigastric area) of the abdomen. This abdominal pain sometimes radiates to the mid to lower back. Pancreatitis can be triggered by a variety of causes including the ingestion of alcohol, gallstones, or infection
pancreatitis s/s
Abdominal pain
Nausea and vomiting
Abdominal tenderness and distention
Mild jaundice (depending on cause)
Severe abdominal pain with radiation from the umbilicus (navel) to the back and shoulders
Fever, rapid pulse, and signs of shock (in extreme cases)
cholecystitis
inflammation of the gallbladder, is commonly associated with the presence of gallstones. This condition is more common in women than men and frequently occurs between the ages of 30 and 50
cholecystitis s/s
Sudden onset of abdominal pain located from the middle of the upper quadrants (epigastric area) to RUQ areas (Pain is present more commonly at night and associated with ingestion of fatty foods. Pain can also be referred to the right scapula.)
Tenderness upon palpation of the RUQ
Belching or heartburn
Nausea and vomiting (contents can be greenish)
GI Bleeding
occur anywhere within the gastrointestinal tract and can be attributed to numerous causes. Gastrointestinal bleeds are usually classified as upper or lower, based on the location of the bleeding.
Upper GI Bleeding
frequently caused by peptic ulcers, gastric erosion, and varices. They are more prevalent in adult males.
Lower GI Bleeding
frequently caused by diverticulitis, ateriovenous malformations, or tumors and occur more in women.
GI Bleeding s/s
Abdominal pain or tenderness
Hematemesis
Hematochezia
Melena
Altered mental status, weakness, or syncope
Tachycardia
Signs of shock
Hematemesis
vomiting blood, which can be bright red or look like coffee grounds
hematochezia
bright red blood in the stool normally signifying a rapid onset
melena
dark tarry stools containing decomposing blood normally from the upper gastrointestinal system
esophageal varices
bulging, engorgement, or weakening of the blood vessels in the lining of the lower part of the esophagus. These abnormalities are common to heavy alcohol drinkers or patients with liver disease
usually identified with painless bleeding in the digestive tract.
esophageal varices s/s
Large amounts of bright red hematemesis (vomiting of blood)
Absence of pain or tenderness in the abdomen
Rapid pulse
Breathing difficulty
Pale, cool, clammy skin
Other signs and symptoms of shock
Jaundice (yellowing) of the skin or sclerae of the eyes from liver disease (can be seen in some cases)
gastroenteritis
inflammation of the stomach and small intestines, is commonly associated with the presence of abdominopelvic pain. can be chronic or acute.
If left untreated, it can result in the breakdown of the mucosal layers in the gastrointestinal tract. This breakdown can lead to dehydration, hemorrhage, ulceration, and perforation. Hematemesis, hematochezia, or melena can be present in severe acute cases
gastroenteritis s/s
Abdominal pain or cramping
Nausea, vomiting, and diarrhea
Abdominal tenderness
Fever and dehydration
severe cases, signs and symptoms of shock and hemorrhage can be present
ulcers
open wounds or sores within the digestive tract, usually in the stomach or the beginning of the small intestine
ulcer s/s
Gradual onset of abdominal pain described as a burning or gnawing-type pain before meals or during stressful events. An acute onset may indicate perforation.
Nausea and vomiting
Hematemesis, hematochezia, or melena or coffee-ground emesis in some cases
Signs or symptoms of shock in cases of massive bleeding or perforation
Peritonitis with a rigid abdomen in cases of perforation
intestinal obstruction
a blockage that interrupts the normal flow of the intestinal contents within the intestines. This condition can occur in both the small and the large intestines and can be either partial or complete.
intestinal obstruction s/s
Abdominal pain, moderate to severe, depending on location of obstruction—typically described as crampy and colicky
Nausea and vomiting
Constipation (difficulty in passing stool and flatus is the classic finding in intestinal obstruction)
Abdominal distention and tenderness
Abnormally prominent, high-pitched bowel sounds with auscultation in early stages (Bowel sounds can be diminished or absent in some later cases.)
hernia
a protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall. Hernias are most commonly associated with chronic increases in pressure in the abdominal cavity during heavy lifting or straining, causing the peritoneum to be pushed into the weakness or opening
hernia s/s
Sudden onset of abdominal pain (usually after heavy lifting or straining)
Fever
Rapid pulse
Tender mass at point of hernia
Others similar to intestinal obstruction
abdominal aortic aneurysm AAA
a weakened, ballooned, and enlarged area of the wall of the abdominal aorta. The aneurysm can eventually rupture and is one of the most lethal causes of abdominal pain.
aortic dissection
begins with a small tear of the inner vessel structure, which enables blood to leak between the walls of the aorta. The process of dissection continues with increasing pressure until, finally, the outer wall is damaged and blood leaks out behind the peritoneum or into the abdominal cavity.
AAA s/s
Gradual onset of lower lumbar, groin, and abdominal pain
Rupture associated with sudden onset of severe, constant abdominal pain. Can radiate to the lower back, flank, or pelvis. Can be described as a “tearing” pain.
Testicular pain in the male patient
Possible nausea and vomiting
Mottled or spotty abdominal skin
Pale, cool, clammy, and possibly cyanotic skin in legs from decreased blood and perfusion
Absent or decreased femoral or pedal pulses
If the abdomen is soft and thin, a pulsating abdominal mass can be felt. If the aneurysm has burst, the abdomen will be rigid and tender.
acute anemia
Acute anemia can result from a sudden decrease in red blood cells resulting from a source of bleeding
sickle cell anemia
some red blood cells have abnormal hemoglobin that does not carry adequate oxygen. As a result, the cells take on a crescent (sickle) shape and become fragile, stiff, and rigid. The sickled cells begin to stack up, blocking capillary blood flow. Cells and tissues become ischemic and can die. Patients with this disease often suffer infections from damaged red blood cells blocking the spleen.
sickle cell crisis categories
bone crisis
acute chest syndrome
abdominal crisis
joint crisis
bone crisis
typically involves the bones in the back and the large long bones in the arm (humerus) and leg (femur and tibia), causing sudden severe pain
acute chest syndrome
sudden onset of chest pain, possibly with dyspnea, hypoxia, and cough, which can be nonproductive, or the patient coughs up blood. A low-grade fever can be present.
abdominal crisis
sudden, constant abdominal pain that can be general or localized. There might also be nausea, vomiting, and diarrhea
joint crisis
an acute onset of one or more painful, stiff joints.
hemophilia
a blood disorder that affects clotting. When a person with hemophilia is injured, it takes longer for the bleeding to stop because clots cannot form properly.
deep vein thrombosis s/s
Swelling and increased size of the calf or the entire affected leg
Pitting edema
Erythema (redness)
Increased warmth
Tenderness to palpation
Pain, which often starts in the calf, is described as cramping and soreness
spontaneous abortion s/s
Lower abdominal or pelvic pain
Abdominal tenderness
Vaginal bleeding
Rapid pulse
Signs and symptoms of shock (rare)
ovarian cyst s/s
Unilateral abdominopelvic pain that can radiate to the back
Abdominal tenderness
Vaginal bleeding that can be irregular or abnormal
Pain during sexual intercourse or bowel movements
endometritis
an inflammation of the endometrium. It is most commonly caused by an infection; however, it can also occur from childbirth, abortions, gynecologic procedures, or intrauterine devices
endometritis s/s
Abdominopelvic pain or tenderness
Fever
Abdominal distention
Vaginal bleeding or discharge
Discomfort during a bowel movement
endometriosis
condition in which endometrial tissue grows outside the uterus. The most common sites for endometrial tissue implantation are the abdomen and pelvis, but the tissue can be implanted anywhere in the body.
endometriosis s/s
Abdominopelvic pain or tenderness that can be dull or cramping
Dysmenorrhea
Vaginal bleeding
Pain during sexual intercourse or a bowel movement
pelvic inflammatory disease PID
an infection of the female reproductive tract. Pelvic infections are caused by bacteria, fungi, or viruses. Most of these infections are caused by the same bacteria that lead to sexually transmitted diseases.
PID s/s
Abdominopelvic pain or tenderness
Vaginal discharge with an abnormal color, consistency, or odor
Fever and chills
Anorexia
Nausea or vomiting
Irregular vaginal bleeding or cramping
Pain during sexual intercourse
most transmitted std
chlamydia and gonorrhea
UTI s/s
Abdominopelvic pain or tenderness
Blood in the urine (hematuria)
Urine with cloudiness or a foul or strong odor
Pain or burning with urination or sexual intercourse
Frequent or urgent need to urinate
Genital or flank pain
Fever or chills
Nausea or vomiting
Altered mental status
kidney stones
crystals of substances such as calcium, uric acid, struvite, and crystine that are formed from metabolic abnormalities.
kidney stone s/s
Abdominopelvic pain or tenderness
Flank or back pain that is colicky and severe
Groin pain
Abnormal urine color
Pain with urination
Frequent or urgent need to urinate
Fever or chills
Nausea or vomiting
kidney failure
not able to filter the wastes and maintain homeostasis as they normally would. Kidney failure is normally classified as either acute or chronic.
acute kidney injury
occurs over a period of days and often results from a significant decrease in urine elimination. Some causes of acute renal failure are decreased blood flow to the kidneys from trauma, cardiac failure, surgery, shock, sepsis, and urinary tract obstruction. This condition is sometimes reversible, but many patients require dialysis.
chronic renal failure
occurs over a period of years, and the symptoms range from mild at first to severe kidney failure. The causes of chronic renal failure are numerous; however, diabetes and hypertension are linked to many of the cases.
kidney failure s/s
Blood in the urine or stools
Altered mental status
Edema of the feet, ankles, and legs
Decreased urine output or cessation of urination
Hypertension
Swelling or easy bruising
Anorexia
Tachycardia
bp and dialysis
take the blood pressure of a dialysis patient on the arm without the shunt or access sit
