Module 9: Abdomen Flashcards
1. Describe the gross anatomy of the gastrointestinal tract. 2. Describe the gross anatomy of the urinary tract. 3. Describe the techniques of examination of the abdomen. 4. Identify key abnormalities of the abdomen, liver, spleen, kidneys, bladder and aorta. 5. Identify pertinent information needed to obtain a focused history of conditions related to the abdomen and gastrointestinal system. 6. Describe the process of conducting a focused physical examination of clients presenting with cond
What are some different shapes of the abdomen?
Flat, scaphoid, distended, obese
When assessing the abdomen, what should you look for?
Shape, masses, bowel sounds, organomegaly, tenderness, inguinal nodes.
What are 3 terms used to help describe the abdomen?
Epigastric, umbilical, hypogastric (suprapubic)
What type of rotation should you move in when assessing the abdomen?
Clockwise
Where would you find the spleen?
Left upper quadrant.
Which ribs are responsible for protecting the spleen?
9th, 10th, and 11th
What can you expect to find in the right upper quadrant?
The liver, gallbladder, lower pole of right kidney.
What can often be felt in the left lower quadrant?
sigmoid colon.
Where would expect to find the bladder?
Lower midline.
What’s in the right lower quadrant?
Bowel loops and the appendix. In healthy people, there will be no palpable findings there.
The bladder accommodates roughly how much urine filtered by the kidneys?
300 mL
What makes you have the urge to pee?
Rising pressure in the bladder triggers the conscious urge to pee.
Which muscle is responsible for bladder contraction?
The detrusor muscle.
What helps to prevent incontinence?
Increased intraurethral pressure
Where do the kidneys lie?
Posteriorly.
What is the area to assess for kidney tenderness?
Costovertebral angle
What are some common complaints associated with GI disorders?
- Abd Pain, acute and chronic
- Indigestion, N/V, including blood, loss of appetite, early satiety.
- Dysphagia &/or odynophagia
- Diarrhea, constipation
- Jaundice
Common complaints associated with urinary and renal disorders?
- Suprapubic pain
- Dysuria, urgency, or frequency
- Hesitancy, decreased stream in males
- Polyuria or nocturia
- Urinary Incontinence
- Hematuria
- Kidney or flank pain
- Ureteral colic
What are common complaints associated with lower GI?
- Diarrhea
- Constipation
- Change in bowel habits
- Blood in the stool (bright red or dark tarry)
Visceral pain in the RUQ may result from liver distention against its capsule due in which disease?
Alcoholic Hepatitis
When hollow abdominal organs such as the intestine or biliary tree contract unusually forcefully or are distended or stretched results in what?
Visceral pain. Can be associated with sweating, pallor, nausea, vomiting, restlessness.
What is a sign of early acute appendicitis?
Visceral periumbilical pain. It eventually changes to parietal pain in the RLQ due to inflammation of the adjacent parietal peritoneum.
Where does parietal pain originate from?
the inflammation from the parietal peritoneum.
- It is described as a steady, aching pain that is usually more precisely located over the involved structure.
- aggravated by movement or coughing
- patient prefers to lie still.
Where is pain of duodenal or pancreatic origin referred to?
The back.
Pain felt in more distant sites, which are innervated at approximately the same spinal levels as the disordered structures.
Referred pain.
Why does referred pain develop?
The initial pain becomes more intense and radiates from the initial site.
What do neuropeptides like 5-hydroxytryptophan and substance P do?
Mediate interconnected symptoms of pain, bowel dysfunction, and stress.
A patient presents doubling over with cramping colicky pain, can radiate to the left or right lower quad, what is wrong?
Renal stone.
If a patient presents with sudden knifelike epigastric pain, what would suspect?
Gallstone pancreatitis.
What does RUQ and upper abdominal pain signify?
Cholecystitis
What deciphers angina from indigestion?
Precipitated by exertion and relieved by rest.
A subjective negative feeling that is non painful?
Discomfort.
What do you call swallowing air?
Aerophagia
Patients with chronic upper abdominal discomfort or pain complain primarily of what?
Heartburn, acid reflux, or regurgitation. Having these symptoms more than once a week, the patient is likely to have gastroesophageal reflux disease.
What are the risk factors for GERD:
- Reduced salivary flow, which prolongs acid clearance by damping action of the bicarbonate buffer.
- Delayed gastric emptying
- Selected Medications
- Hiatal hernia
What types of foods aggravate heartburn?
- Alcohol
- Chocolate
- Citrus fruits
- Coffee
- Onions
- Peppermint
What positions can aggravate heartburn?
- Bending over
- Exercising
- Lifting
- Lying supine
What are some other side effects of GERD?
Atypical Respiratory Symptoms
- Cough
- Wheezing
- Aspiration Pneumonia
Pharyngeal Symptoms
- Hoarseness
- Chronic sore throat
What are the “alarm symptoms” of GERD?
- Difficulty swallowing (dysphagia)
- Pain with swallowing (odyophagia)
- Recurrent vomiting
- Evidence of GI bleed
- Weight loss
- Anemia
- Risk factors for gastric cancer
If a patient is 55 yr or older and presents with those “alarm symptoms”, what should you do?
Endoscopy to help detect esophagitis, peptic strictures, or Barrett’s esophagus.
RLQ pain or pain that migrate from the periumbilical region, combined with abdominal wall rigidity on palpation.
Appendicitis. BUTTTTT in women, it could be pelvic inflammatory disease, ruptured ovarian follicle, and ectopic pregnancy.
What other symptoms are associated with left lower quad or diffuse abdominal pain?
Fever and loss of appetite. LLQ pain with a palpable mass may be diverticulitis.
Diffuse abdominal pain with absent bowel sounds and firmness, guarding, or recount on palpation may indicate what?
Small or large bowel obstruction.
What would a change in bowel habits with mass lesion indicate?
Colon Cancer.
Intermittent pain for 12 week of the preceding 12 months with relief from defecation, change in frequency of bowel movements, or change in form of stool (loose, watery, pellet-like), without structural or biochemical abnormalities.
Irritable bowel syndrome.
A general term for distress associated with eating that can have many meanings.
Indigestion.
What is retching?
Involuntary spasm of the stomach, diaphragm, and esophagus that precedes and culminates in vomiting.
The act of raising esophageal or gastric contents without nausea or retching.
Regurgitation. It can occur with GERD, esophageal stricture, and esophageal cancer.
T or F: Vomiting and pain indicate small bowel obstruction.
TRUE.
T or F: Fecal odor occurs with small bowel obstruction or gastrocolic fistula.
TRUE.
What color is gastric juice?
clear and mucoid.
Are small amounts of yellowish or greenish bile common in vomit?
Yes, it has no special significance.
Brownish or blackish vomitus with a “coffee grounds” appearance suggest what?
Blood.
Hematemesis
Coffee-grounds emesis or red blood. It may accompany esophageal or gastric varicose, gastritis, or PUD.
What are symptoms of blood lost?
Lightheadedness or syncope. They depend on the rate and volume of bleeding and are rare until blood loss exceeds 500 mL.
Loss of appetite.
Anorexia.
If a patient complains of unpleasant abdominal fullness after light or moderate meals, or early satiety, consider what?
Diabetic gastroparesis, anticholinergic medications, gastric outlet obstruction, gastric cancer; early satiety is seen in hepatitis.
Difficulty swallowing from impaired passage of solid foods or liquids from the mouth to the stomach.
Dysphagia
The sensation of a lump in the throat or the retrosternal area unassociated with swelling is not true dysphagia.
True.
If a patient has dysphagia below the the sternoclavicular notice, what does that indicate?
Esophageal Dysphagia.
Indicators for Oropharyngeal dysphagia:
- Drooling
- nasopharygeal regurgitation
- Cough from aspiration from muscular or neuro disorders affecting motility.
Gurgling or regurgitation of undigested occur in structural conditions such as?
Zenker’s diverticulum.
What is odynophagia?
Painful swallowing
What usually causes acute diarrhea?
Infection, VIRAL
When medications are commonly known to cause diarrhea?
Penicillins and macrolides, magnesium based antacids, metformin, and herbal and alternative medicines.
What classifies constipation?
Symptoms present for 12 weeks of the prior 6 months with at least fewer than 3 bowel moments per week or 25% or more defecations with either straining or sensation of incomplete evacuation, lump hard stools or manual facilitation.
Black, tarry stools.
Melena, it may appear with as little as 100 mL of upper GI bleeding.
Red or Maroon colored stools.
Hematochezia, may appear with more than 1000 mL of blood, usually from lower GI bleed.
What are the mechanisms of jaundice?
- Increased production of bilirubin
- Decreased uptake of bilirubin by the hepatocytes
- Decreased ability of the liver to conjugate bilirubin.
- Decreased excretion of bilirubin into the bile, resulting in absorption of conjugated bilirubin back into the blood.
What diseases are associated with impaired excretion of conjugated bilirubin?
Viral hepatitis, cirrhosis, primary biliary cirrhosis, and drug induced cholestasis.
What is intrahepatic jaundice?
It can be classified as hepatocellular (damage to the hepatocytes) or cholestatic (impaired excretion as a result of damaged hepatocytes or intrahepatic bile ducts)
What is extra hepatic jaundice?
It arises from obstruction of the extrahepatic bile ducts, most commonly the cystic and common bile ducts.
What are some questions to ask men who face benign prostatic hyperplasia?
- Trouble starting stream?
- Do you stand close to the toilet to void?
- Change in the force/size of your stream?
- Straining to void?
- Do you hesitate or stop int eh middle of voiding?
- Any dribble when you are through?
Disorders in the urinary tract may cause pain in either the ____ or ______.
Abdomen or back.
If you have urgency, what would you expect?
Bladder infection or irritation.
Pain on urination?
dysuria (can be called difficulty voided)
Where is prostatic pain felt?
Perineum and occasionally the rectum.
Significant increase in 24 hour urine volume.
Polyuria, exceeds 3L.
Urinary frequency at night
Nocturia
Involuntary loss of urine.
Urinary incontinence
Stress incontinence suggests what?
decreased contractility of urethral sphincter or poor support of bladder neck.
Urge incontinence?
suggests detrusor overactivity
Overflow incontinence?
when the bladder cannot be emptied until bladder pressure exceeds urethral pressure, indicates anatomical obstruction by prostatic hypertrophy or stricture or neurogenic abnormalities.
Functional incontinence?
May arise from impaired cognition, musculoskeletal problems, or immobility.
Blood in the urine
Hematuria
blood visible to the naked eye.
Gross hematuria
Blood only detected during microscopic urinalysis
Microscopic hematuria
Visceral pain usually usually produced by distention of the renal capsule and typically dull, aching, and steady.
Kidney pain.
Severe, colicky pain originating at the costovertebral angle and radiating around the truck into the lower quad of the abd., or possibly into the upper thigh and testicle or labium.
Ureteral pain.
Kidney pain with fever and chills.
Acute Pyelonephritis.
What is caput medusa?
A collateral pathway of recanalized umbilical veins radiating up the abdomen that decompresses portal vein hypertension.
How many people does alcohol affect in the US?
17.6 Million people or 8.5% of the US population.
What are 3 screening tools for evaluating the patient who drinks?
CAGE questionnaire, Alcohol Use Disorders Identification Test (AUDIT), or the screening question about drinks/day?
What are the cutoffs for risky or hazardous drinking?
Women: > or = to 3 drinks per occasion and > or = to 7 drinks per week.
Men: > or = to 4 drinks per occasion and > or = to 14 drinks per week.
What is the most effective way to prevent infection and transmission of Hep A and Hep B?
Vaccination
How do you transmit Hep A?
- Fecal
- Oral
- fecal shedding by those handling food (just EWWW)
- Travellers
Whats good for immediate protect for household contacts and travelers?
Immune serum globulin can be administered before and within 2 weeks of contact with Hep A.
What are the risks for Hep B?
- Sexual contacts
- People with percutaneous or mucosal exposure to blood.
- Travellers
- People with chronic liver dx & HIV infection
What are the strongest risk factors for Hep C?
- Injection drug use and transfusion with clothing factors before 1987.
- Hemodialysis
- Sex partners using injection drugs
- Blood transfusion or organ transplant before 1992.
- Undiagnosed liver disease
- Infants born to infected mothers.
- Occupational exposure
- Multiple sex partners.
Is sexual transmission common of hep c?
NO.
A little about Colon Cancer:
- More than 90% occur after age 50 primarily from neoplastic changes in adenomatous polyps
- Mortality rates are declining.
- Tests: FOBT every 5 years, Combined FOBT and flex sig, Colonoscopy every 10 years, double contract barium enema every 5 years.
Increased peristaltic waves seen in what?
Intestinal obstruction
What is borborygmi?
Prolonged gurgles of hyper peristalsis aka bowel sounds. he normal frequency of sound is 5-34 sounds per minute.
Bruits with both systolic or diastolic components suggest the turbulent blood flow of what?
Partial arterial occlusion or arterial insufficiency
What diseases would you hear with a liver friction rub?
Liver tumor, gonococal infection around the liver, splenic infarction.
When organs are reversed?
CRAP..No seriously situs inversus
Normal spans of liver:
4-8 cm in midsternal line
6-12 cm in midclavicular line
How do you ilicit the psoas sign?
Either:
- Have patient (supine) flex the right hip by raising the right leg against the resistance of your hand.
- Have pt roll oto left side and grasp right leg and ext. it at the hip.
Obturator Sign?
AKA Murphy’s Sign
Flex pt’s leg at hip and knee then internally rotate.
Rovsing’s Sign?
Press slowly and gently in the LLQ then quickly release your hand. Pain in the RLQ is a positive sign. YES START LEFT THEN PAIN IN RIGHT.
When assessing…
Always auscultate before palpating or percussing the abdomen
What is the preferred order for examination of the abdomen?
Inspection, auscultation, percussion, palpation
When examining the abdomen, you must always auscultate before palpating or percussing
What should you listen for when palpating the abdomen?
Percuss over all four quadrants, listening for tympany (hollow sounds) versus dullness (which could be a large stool or a mass)
Percuss the spleen using one of two techniques:
Percuss the left lower anterior chest wall between lung resonance above the costal margin (Traube’s space). Dullness can indicate an enlarged spleen; when tympany is prominent, splenomegaly is not likely.
How do you check the splenic percussion sign?
Percuss the lowest interspace in the left anterior axillary line. This area is usually tympanitic. Then have the patient take a deep breath and percuss again. If the spleen is a normal size the percussion remains tympanitic. Shifting from tympany to dullness with inspiration suggests an enlarged spleen. This is a positive splenic percussion sign.
A sign which confirms the presence of peritonitis is:
Rebound tenderness
When assessing for peritonitis, you assess for involuntary guarding. Place the diaphragm over the liver or spleen to listen for friction rub
