Module 4 Abdomen & Musculoskeletal Flashcards
Anatomy of the abdomen: how many quadrants are there?
4 quadrants:
RUQ. LUQ
RLQ. LLQ
Anatomy of the abdomen: how many regions are there?
9 regions:
Epigastric for the area between the costal margins
Umbilical for the area around the umbilicus
Hypogastric or suprapubic for are above pubic bone
An atomic location of organs by RUQ: (7)
Liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal, hepatic flexure of colon, part of ascending and transverse colon
An atomic location of organs by LUQ: (7)
Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal, splenic flexure of colon, part of transverse and descending colon
An atomic location of organs by RLQ: (5)
Cecum, appendix, right ovary and tube, right ureter, right spermatic cord
An atomic location of organs by LLQ: (5)
Part of descending colon, sigmoid colon, left ovary tube, left return, left spermatic cord
Inspection of abdomen
CONTOUR
- determine profile from rib margin to pubic bone (flat, scaphoid, rouded, protuberant
- contour describes nutritional state and normally ranges from flat to rounded
Inspection of abdomen
SYMMETRY
- Abdomen should be symmetric bilaterally
- Note any localized bulging, visible mass, or asymmetric shape
- Ask client to take a deep breath, which may make masses and enlarged organs more visible
Inspection of abdomen
UMBILICUS
Normally midline and inverted, with no sign of discoloration, inflammation, or hernia
Skin inspection
- Surface smooth and even, with homogeneous color
Pigmented nevi (moles), circumscribed brown macular or
papular areas, common on abdomen
Normally lesions and rashes are not present
Surgical scars may be present; if a scar is present, assess it’s
cause and document location and length
Fine venous network may be visible in thin persons
One common pigment change is striae
Inspection:
Pulsation or movement
Normally, you may see pulsations from aorta beneath skin
in epigastric area, particularly in thin persons with good
muscle wall relaxation
Respiratory movement also shows in abdomen,
particularly in males
Waves of peristalsis sometimes are visible in very thin persons
When auscultating with diaphragm, what are you noting?
Character & frequency of bowel sounds, beginning in RLQ.
When auscultating, normal sounds are:
High pitched, gurgling, cascading in nature
In Auscultation, hyperactive BS =
loud, high pitched, rushing, tinkling sounds d/t
increased motility associated with early obstruction, gastroenteritis, diarrhea, laxatives, subsiding paralytic ileus
In auscultating, hypoactive or absent BS =
d/t abdominal surgery, peritonitis, paralytic
ileus or complete obstruction
When do you establish abscense in auscultation?
Establish absence only after 5 mins. of continuous auscultation to 4 quadrants
What kind of sounds do we auscultate for?
Auscultate for vascular sounds or bruits over abdominal
aorta, renal, iliac & femoral arteries
What is a bruit?
Swishing sound and it is considered abnormal
What is percussion?
Percuss to assess relative density of abdominal contents, to locate organs, and to screen for abnormal fluids or masses
What are the 3 types of percussion?
- Tympany
-high pitched, musical
-presence of air in stomach & intestine - Dullness
-medium intensity, duration, & pitch
-solid organs, masses, fluid, adipose tissue & distended bladder - Hyperresonance
-very loud intensity, low pitch, long duration
-gaseous distention
Light palpitation
▪ Depress abdominal wall ~ 1cm
▪ Objective is not to search for organs but to form an overall impression of skin surface and superficial musculature
▪ Note increased resistance or muscle guarding & tenderness (normally abdomen is soft & smooth)
Deep palpatation
- Depress abdominal wall ~ 5-8 cm
▪ Use bimanual technique for very large or obese patient
Rebound tenderness
▪ Determines presence of peritoneal irritation or inflammation
▪ Firmly & slowly press into abdomen at 90 degree angle at non-
tender area
▪ Quickly withdraw fingers
▪ Normally no pain occurs when fingers withdrawn
Musculoskeletal system
Assessment of joints, muscles, and bones
➢ Functional assessment of ADLs
Types of joints
Fibrous joints
▪ Bones united by interjacent fibrous tissue or cartilage and do not move
(sutures in skull)
➢ Cartilaginous joints
▪ Separated by fibrous cartilage and are slightly moveable (vertebrae)
➢ Synovial joints
▪ Freely moveable joints separated from one another and enclosed in a cavity
lined with synovial membrane that secretes fluid
Inspection of joints
➢ Note size & contour of joints
➢ Inspect skin and tissue overlying joints for color, swelling,
masses or deformity
Palpation of joints
➢ Palpate each joint for:
▪ Skin temperature
▪ Muscles
▪ Bony articulations
▪ Joint capsule
➢ Joints normally non-tender when palpated
ROM w/ joints
➢ Have client move through active ROM
➢ If limitation occurs, move joint through passive ROM
➢ Compare joints bilaterally
➢ Normally no tenderness, pain, or crepitation is present
Skeletal muscles produce the following ROM movements:
Flexion: bending limb at joint
Extension: straightening limb at joint
Abduction: moving limb away from midline of body
Adduction: moving limb toward midline of body
Pronation: turning forearm so that palm is down
Supination: turning forearm so that palm is up
Circumduction: moving arm in circle around shoulder
Inversion: moving sole of foot inward at ankle
Eversion: moving sole of foot outward at ankle
Rotation: moving head around central axis
Head-to Toe Approach:
TMJ Hip
Cervical spine Knee
Shoulder Ankle & Foot
Elbow Spine
Wrist & Hand
Muscle strength
➢ Assess strength of muscles surrounding each joint through
same motions as for AROM
➢ Muscle strength should be equal bilaterally and fully resist
opposing force
➢ Grade on 5-point scale
Abnormal findings in a joint:
Dislocation (complete loss of contact between the two bones in a joint)
Subluxation (2 bones in a joint stay in contact, but their alignment is off)
Contracture (shortening of a muscle leading to limited ROM of joint)
Ankylosis (stiffness or fixation of a joint)
Articular and extra- articular disease
Crepitation (crunching or grating)
