Exam 2 abdomen

Question 1

appendix pain

Answer 1

right inguinal area in RLQ

Question 2

liver pain

Answer 2

ruq

Question 3

gallbladder

Answer 3

ruq

Question 4

RUQ structures

Answer 4

liver, gallbladder, duodenum, head of pancreas, right
adrenal gland, portion of kidney, hepatic flexure of
colon, ascending and transverse colon

Question 5

RLQ structures

Answer 5

right kidney, cecum, appendix, portion of ascending
colon, bladder, ovary and salpinx, uterus, right
spermatic cord, right ureter

Question 6

LUQ structures

Answer 6

left lobe of liver, spleen, stomach, body of pancreas, left
adrenal gland, a portion of the left kidney, splenic
flexure of colon, transverse and descending colon

Question 7

LLQ structures

Answer 7

portion of the left kidney, sigmoid colon, descending
colon, bladder, ovary and salpinx, uterus left spermatic
cord, left ureter

Question 8

white or beige stool

Answer 8

a problem with bile production or flow, potentially suggesting underlying liver, gallbladder, or bile duct issue

Question 9

pebble like stool

Answer 9

constipation

Question 10

prep for examination

Answer 10

Adequate lighting
 Expose abdomen so that it is fully visible; drape genitalia and female
breasts
 Position for comfort to enhance abdominal wall relaxation
* Empty bladder prior to examination with specimen saved if needed.
* Warm stethoscope and examine areas identified as painful last to prevent
guarding
 Auscultate prior to palpation and percussion
* Use distraction to keep patient relaxed and facilitate muscle relaxation

Question 11

abdomen inspection

Answer 11

umbilicus, skin, hair distribution, demeanor, pulsation and movement.

Question 12

umbilicus

Answer 12

Normally it is midline and inverted, with no sign of discoloration,
inflammation, or hernia (bulge)

Question 13

skin

Answer 13

 Surface smooth and even, with homogeneous color; assess skin turgor
 Inspect for pigment change and presence of lesions or scars
 Common pigment change striae (linea albicantes – stretch marks) &
pigmented nevi (moles)

Question 14

demeanor

Answer 14

a comfortable person is relaxed quietly on examining table and has a
benign facial expression and slow, even respirations

Question 15

pulsation and movement

Answer 15

Normally you may see pulsations from aorta beneath skin in epigastric
area, particularly in thin persons with good muscle wall relaxation

Question 16

hair distribution

Answer 16

Pattern of pubic hair growth normally has diamond shape in adult
males and an inverted triangle shape in adult females

Question 17

stethoscope technique for auscultation

Answer 17

Use diaphragm endpiece because bowel sounds are relatively
high pitched
 Hold stethoscope lightly against skin; pushing too hard may
stimulate more bowel sounds
 Begin in RLQ at ileocecal valve area because bowel sounds are
normally always present here

Question 18

bowel sounds

Answer 18

high pitched, gurgling, cascading sounds,
occurring irregularly anywhere from 5 to 30 times per minute - normoactive

Question 19

abnormal bowel sounds

Answer 19

• Hypoactive—decreased, can follow abdominal surgery or with
  inflammation
• Hyperactive—loud, high-pitched signal increased motility
  (diarrhea/IBD/IBS/obstruction/infection)

Question 20

absent bowel sounds

Answer 20

must listen to area for 5 minutes before declaring absent bowel sounds

Question 21

vascular sounds

Answer 21

use bell of stethoscope over the aorta, renal arteries, iliac and femoral arteries to check for bruits

Question 22

reasons for percussing the abdomen

Answer 22

 Size and density of organs (liver, spleen, kidneys)
 Presence of ascites (fluid)
 Presence of gastric distention (air)
 Presence of fluid-filled or solid masses

Question 23

how to percuss the abdomen

Answer 23

Percuss all quadrants of the abdomen in a clockwise manner,
and note whether tympany (expected) or dullness(only over liver) is present

Question 24

measuring the liver

Answer 24

Liver span, for example, is determined by percussing the upper
and lower borders and the extent to which the liver descends
below the ribs.

Question 25

CVA

Answer 25

Costovertebral Angle Tenderness

Question 26

how to assess CVA

Answer 26

place hand at 12th rib at costovertebral angle on back  Thump that hand with ulnar edge of your other fist while the pt is sitting up

Question 27

CVA tenderness

Answer 27

this indicates kidney inflammation (in a CVA test, this means that instead of just a thud, they felt pain)

Question 28

patient position for palpation

Answer 28

Bend the person’s knees, keep palpating hand low & parallel to the abdomen  Have the person breathe slowly  Keep examiner’s voice low & soothing  Use “emotive imagery”  Determine is individual is ticklish

Question 29

light palpation mechanism

Answer 29

Standing on the patient’s right side, the nurse lightly palpates all four quadrants using the palmar surfaces of the fingers and depressing the abdominal wall 1 cm with a light, even, circular motion.

Question 30

light palpation reason

Answer 30

assesses texture of the skin, presence of masses, tenderness, and muscle rigidity and guarding

Question 31

deep/moderate palpation

Answer 31

assesses whether the abdomen is soft or rigid and reveals the presence of tenderness.  Deep palpation is often reserved for advanced practice due to the risk for injury. Bimanual technique is used, exerting pressure with the top of the hand and concentrating on sensation with the bottom hand.  Deep palpation may be used to palpate the liver and to differentiate abdominal organs from pathologic masses.

Question 32

organs/structures felt with deep palpation

Answer 32

spleen, kidneys, aorta

Question 33

organs/structures felt with light palpation

Answer 33

liver

Question 34

constipation

Answer 34

-  Decreased physical activity  Inadequate intake of water  Low-fiber diet  Side effects of medications  Irritable bowel syndrome  Bowel obstruction  Hypothyroidism  Inadequate toilet facilities, that is, difficulty ambulating to toilet may cause a person to deliberately retain stool until it becomes hard and difficult to pass

Question 35

appendicitis

Answer 35

rebound tenderness, pain when flexing hip (iliopsoas test), pain in the RLQ, nausea, vomiting, fever

Question 36

Cholecystitis

Answer 36

an inflammation of the gallbladder, the organ that stores bile produced by the liver. It is typically caused by gallstones, which are small, hard deposits that form in the gallbladder

Question 37

Cholecystitis s/s

Answer 37

Right upper abdominal pain that may radiate to the back or shoulder Nausea and vomiting Fever Chills Indigestion Bloating

Question 38

ascites

Answer 38

free fluid in the peritoneal cavity - distended abdomen, bulging flanks, and an umbilicus that is protruding and displaced downward

Question 39

Bowel obstruction

Answer 39

(cause for constipation) Abdominal pain, cramping, or bloating Nausea and vomiting Constipation or diarrhea Inability to pass gas Abdominal distension