Module 7

Question 1

what are the four quadrants of the abdominal surface

Answer 1

Right upper, right lower, left upper, left lower

Question 2

what are the 3 midline finding abdominal surface terms

Answer 2

epigastric, periumbilical, suprapubic

Question 3

what organs are peritoneal

Answer 3

liver(RUQ), stomach (LUQ), gallbaladder, bladder

Question 4

this is behind peritoneal

signs are often different from true abdomen organs

Answer 4

retroperitoneal

Question 5

what organs are retroperitoneal

Answer 5

kidneys, pancreas vena cava, aorta

Question 6

what should you ask during personal history for abdomen

Answer 6

weight changes, change in appetite, food allergy/intolerance, food supplements, diet

Question 7

what do you ask about in weight changes

Answer 7

time frame

current weight, usual weight, highest and lowest weight has ever been

Question 8

what types of changes in appetite are you looking for

Answer 8

anorexia (decreased appetite) and polyphagia (increased appetite- may indicate diabetes)

Question 9

what do you look for during problems with digestion

Answer 9

eructation, pyrosis, nauseas with or without emesis

Question 10

what do you look for in characteristics of vomit

Answer 10

partially digested food
fecal material
frank blood
coffee grounds

Question 11

what are coffee grounds indicative of

Answer 11

coming from digestive(duodenum)

Question 12

what do you look for during timing of emesis

Answer 12

meals and activities

Question 13

what do you ask for relevant history

Answer 13

change in appetite, problems with digestion, characteristics of vomit, timing of emesis, changes in bowels, abdominal pain

Question 14

what do you look for in changes of bowel habits

Answer 14

diarrhea, constipation, frank blood, tarry stool

Question 15

what do you ask for during abdominal pain

Answer 15

timing, course, location, quality, and radiation

Question 16

what is hollow viscera referred to as

Answer 16

colic (common)

Question 17

what are characteristics of colic

Answer 17

crampy, poor localization, related to peristalsis, person writhes in pain

Question 18

what type of pain is more ominous (sign of profound problem)

Answer 18

peritoneal irritation

Question 19

infection or irritation of the peritoneum

Answer 19

peritonitis

Question 20

what are characteristics of peritoneal irritation

Answer 20

stead/constant, localized well, lies with knees up, not related to peristalsis

Question 21

is pain always confined to the abdomen

Answer 21

no organs move around

Question 22

pain pathways cross

Answer 22

referred pain

Question 23

this is referred pain
common in children
position is variable
pain varies with anatomy but moves to RLQ

Answer 23

appendicitis

Question 24

inflammation of gallbladder
due to obstruction of bile ducts by bile stones
can include infection and necrosis

Answer 24

cholecystitis

Question 25

pain generally felt on back kidneys can harbor stones for years(become large) occurs when stone is lodged in ureter

Answer 25

acute renal colic

Question 26

tips for inspecting patient

Answer 26

patient should have empty bladder lay supine with examiner on their right side quiet exam room watch for signs of discomfort

Question 27

what do you examine for during inspection

Answer 27

scars, striae, hernias, vascular changes, lesions, rashes

Question 28

how do you inspect the abdomen

Answer 28

look at configuration (at eye level) movement (peristalsis or pulsations) abdominal contour

Question 29

what is common after surgery

Answer 29

scars | obstruction and adhesion

Question 30

this should be done PRIOR to percussion and palpation

Answer 30

auscultation

Question 31

why do you auscultate first

Answer 31

sounds change with manipulation

Question 32

what are transmitted widely

Answer 32

bowel sounds so only one quadrant is necessary to check

Question 33

are bowel sounds good or bad

Answer 33

good/normal

Question 34

to conclude no bowel sounds what must be done

Answer 34

listen in all four quadrants for 5 min

Question 35

what part of the stethoscope do you use to check for bowel sounds and why

Answer 35

diaphragm-high pitched

Question 36

what sequence do you check the quadrants in

Answer 36

RLQ, RUQ, LUQ, LLQ

Question 37

click and gurgles irregular occur about every 5-35 seconds

Answer 37

normal bowel sounds

Question 38

hyperactive heard every 5 seconds or less borborygmi

Answer 38

increased bowel sounds

Question 39

hypoactive | heard every 35 seconds or more

Answer 39

decreased bowel sounds

Question 40

vascular sounds abnormal heard over arteries

Answer 40

bruits

Question 41

how do you listen to bruits

Answer 41

with the bell in five locations

Question 42

what are the five locations you listen to bruits over

Answer 42

aorta, R and L renal arteries, L and R iliac arteries

Question 43

to do this use blunt object stroke lightly on abdomen superficial

Answer 43

abdominal reflex

Question 44

what does abdominal reflex check for

Answer 44

the contraction of abdominal muscles and deviation of umbilicus towards stimulus

Question 45

do this BEFORE palpation, why

Answer 45

percussion as it causes less discomfort

Question 46

how do you percuss

Answer 46

check all four quadrants | indirect percussion

Question 47

what sounds will you hear during percussion

Answer 47

tympany (normal) OR | dull (abdominal mass)

Question 48

during this you are looking for areas of tenderness

Answer 48

light palpation

Question 49

what may be present during light palpation

Answer 49

voluntary or involuntary guarding

Question 50

what is the most sensitive indicator of tenderness

Answer 50

facial expression

Question 51

discomfort caused or increased by examination

Answer 51

tenderness

Question 52

sign

Answer 52

tenderness

Question 53

symptom

Answer 53

pain

Question 54

something the person tells you about as part of history

Answer 54

pain

Question 55

this helps identify deep tenderness | 3-4 cm into abdomen

Answer 55

deep palpation

Question 56

press deeply left of midline (above umbilicus) | easily felt on most individuals

Answer 56

palpation of aorta

Question 57

pulsatile mass | greater than 3 cm across

Answer 57

aortic aneurysm

Question 58

test for peritoneal irritation

Answer 58

rebound tenderness

Question 59

how do you check for rebound tenderness

Answer 59

warn person press deeply on abdomen then release pressure if hurts more when you release then rebound tenderness

Question 60

associated with renal disease and kidney stones

Answer 60

costovertebral angle tenderness

Question 61

how do you check for costovertebral angle tenderness

Answer 61

warn person, have them sit on table use heel of fist to strike costovertebral angle compare L and R NOT NORMAL

Question 62

what occurs in infants with breathing

Answer 62

synchronous chest and abdominal movement

Question 63

what are seen in premature infants

Answer 63

superficial veins

Question 64

what are common in the epigastric region of infants

Answer 64

pulsation

Question 65

what is the contour of infants

Answer 65

abdomen is round and protrudes

Question 66

where is the liver palpable in infants

Answer 66

1-3 cm below costal margin

Question 67

what is common in adolescents

Answer 67

tanning lines, fine venous networks, flat contour

Question 68

what is common in pregnancy

Answer 68

nausea/vomiting, diminished abdominal reflex, decreased peristalsis, abdominal striae, linea nigra

Question 69

separation of two halves of rectus abdominus

Answer 69

diastasis recti

Question 70

how do you check for diastasis recti

Answer 70

supine postion place fingers below umbilicus have person put chin on chest feel for separation

Question 71

what is common in elderly

Answer 71

decreased intestinal motility, abdominal wall is thin(less firm), fat pad is common, loss of muscle tone, midclavicular liver span decreases

Question 72

what occurs as a result of decreased midclavicular liver span

Answer 72

hepatic blood flow and liver cells decrease which effects drug metabolism