objective 16 Flashcards
extends from the diaphragm to the top of the pelvis
Bordered in the back by the vertebral column and paravertebral
muscles
Bordered at the sides by the lower rib cage and abdominal muscles
abdomen
what do the 4 lrg flat muscles of ventral abdominal wall do?
- Protect the organs
- Hold the organs in place
- Flex the vertebral column
all organs inside the abdominal cavity are called the…
viscera
maintain a characteristic shape
solid viscera
shape depends on the contents
hollow viscera
what does the solid viscera consist of>
liver,
pancreas, spleen, adrenal glands, kidneys, ovaries, uterus
what does the hollow viscera consist of?
stomach,
gallbladder, small intestine, colon, bladder
what are the 4 quadrants of the abdomen?
RUQ
LUQ
RLQ
LLQ
Liver, gallbladder, duodenum, head of the pancreas, right kidney and adrenal
gland, hepatic flexure of the colon, parts of the ascending and transverse colon
RUQ
Stomach, spleen, left lobe of the liver, body of pancreas, left kidney and adrenal
gland, splenic flexure of the colon, parts of the transverse and descending colon
LUQ
Cecum, appendix, right ovary and fallopian tube, right ureter, right spermatic
cord
RLQ
Parts of the descending colon, sigmoid colon, left ovary and fallopian tube, left
spermatic cord
LLQ
what are the developmental considerations for infants and children?
- In newborns, umbilical cord is prominent on the abdomen
- Liver takes up proportionately more space at birth than later in life
- Bladder is located higher in the abdomen in newborns than in adults
- 2 bulges are common: umbilical hernia ( measure if found) and
diastasis recti - Children with gastroenteritis (esp. less than 1 year old) are at
increased risk of dehydration - Maintain a protuberant abdomen when standing until age 4
- Abdominal respirations until age 7
what are the developmental considerations for pregnancy?
- Shape and contour changes
- Morning sickness - Related to hormone changes
(production of HCG - human chorionic gonadotropin) - “Heartburn”
- Constipation
- Enlarging uterus displaces intestines upward and
posteriorly – bowel sounds are diminished
what are the developmental considerations for older adults?
*Fat deposition changes to abdomen
*Muscle tone decreases
*Organs may be easier to palpate than in early adulthood
*Peristalsis may be noted (unless client is obese) – abdominal
musculature is thinner and has less tone
*Salivation decreases – dry mouth and decrease in sense of taste
*Esophageal emptying delayed – increased risk aspiration if
eating in supine position
*Liver size decreases with age (esp. after 80 years old) but most
liver function remains normal
how do we promote abdominal relaxation?
- Client should empty their bladder
- Keep the room warm, warm the stethoscope endpiece,
and warm the examiner’s hands - Position the client supine, head on pillow, knees bent or
on pillow, arms at sides or across chest - Ask about painful areas and assess these last
how do we prep for assessment of the abdomen?
- Strong overhead light and secondary standing light
- Expose abdomen so it is fully visible, drape breasts and genitalia
- Use measures to enhance abdominal relaxation ( p. 587)
what equipment do we need?
- Stethoscope, alcohol wipe, may also need small cm ruler and
marking pen
how do we inspect contour of the abdomen?
- Contour (Describes nutritional state):
- Stand on the client’s right side and look down at the abdomen
- Stoop or sit down to gaze across the abdomen
- Determine the profile from the rib margin to the pubic bone
what are the normal and abnormal findings of inspection of contour of abdomen?
- Normal – flat & rounded
- Abnormal – scaphoid & protuberant
how do we inspect the symmetry of the abdomen?
- Shine a light across the abdomen (toward the examiner) or
lengthwise across the client - Step to the foot of the examination table to recheck symmetry
- Ask client to take a deep breath to further highlight any
change, abdomen should stay smooth and symmetrical - The examiner can also ask the client to sit up without
pushing up with the hands.
what are the normal and abnormal findings of inspecting of symmetry of abdomen?
- Normal: symmetrical bilaterally
- Abnormal: asymmetrical shape – bulges, masses, hernia,
enlarged liver or spleen may be noted
how do we inspect the umbilicus?
Positioning, whether inverted/everted, coloration,
inflammation, & presence of hernia
what are the normal and abnormal findings of the umbilicus?
- Normal – midline; inverted; no sign of discoloration, inflammation,
or hernia - Variation – everted and pushed upward during pregnancy
- Abnormal – everted (ascites or underlying mass), deeply sunken
(obesity), enlarged and everted (umbilical hernia)
how do we inspect the skin of the abdomen?
Smoothness of surface, color, presence of pigmented nevi (moles) &
lesions, presence of veins & skin turgor
what are the normal and abnormal findings when inspecting pulsation of abdomen?
- Normal:
- Pulsations of the aorta beneath the skin in the epigastric area
- Respiratory movement in men
- Waves of peristalsis may be visible in thin clients
- Abnormal:
- “Pulsation of the aorta is marked with widened pulse pressure” p. 590
(hypertension, aortic insufficiency etc.) - Marked visible peristalsis with abdominal distention (intestinal
obstruction) p. 590
what are the normal and abnormal findings of when inspecting hair distribution of abdomen?
- Normal: pubic hair growth – diamond shape in men, inverted
triangle shape in women - Abnormal: alteration in pattern with endocrine or hormonal
abnormalities
what are the normal and abnormal findings when inspecting the demeanor of the abdomen?
- Normal: client comfortable and relaxed quietly on the examination
table, benign facial expression, slow and even respirations - Abnormal: restlessness and constant turning to find comfort;
absolute stillness, resisting movement, upward flexing of the
knees, facial grimacing, uneven respirations indicate pain
how do we auscultate the abdomen?
Note the character and frequency -originate from the movement of air
and fluid through the small intestine
* High-pitched, gurgling, cascading sounds, occurring irregularly
between 5 – 30 times per minute
* Do not count bowel sounds – judge whether they are normal,
hypoactive, or hyperactive
* Use the diaphragm of the stethoscope to auscultate - bowel sounds are
relatively high-pitched. Hold the stethoscope lightly against the skin,
pushing too hard may stimulate more bowel sounds
* Listen in all 4 quadrants, beginning in the RLQ at the ileocecal valve area
because bowel sounds are normally always present here.
* Begin in the RLQ and progress around the abdomen to all 4 quadrants
clockwise. Listen in various spots in each quadrant.
loud, high-pitched, rushing, tinkling sounds that signal increased motility and may indicate an early mechanical bowel obstruction
hyperactive sounds
after abdominal surgery or with inflammation of peritoneum
hypoactive sounds or absent
what are the normal and abnormal sounds when auscultating for vascular sounds in abdomen?
- Normal: no vascular sounds/bruit are present
- Abnormal: note location, timing, and pitch of any sounds
auscultated, systolic bruit occurs with stenosis or occlusion of
an artery, venous hum and peritoneal friction rub are rare
how do we percuss the abdomen?
- Percuss lightly in all 4 quadrants to determine the
prevailing amount of tympany and dullness - Tympany should predominate - air in the intestines rises to
the surface when client is supine - Dullness is heard over: solid structures, a distended bladder,
adipose tissue, fluid or a mass - Hyperresonance is heard with gaseous distention
- Move clockwise when percussing
assesses for tenderness and any masses that are
near to the surface
* Use first 4 fingers close together
* Depress the skin approximately 1 cm
* Make a gentle rotary motion, sliding the fingers and skin together
* Lift fingers (do NOT drag them) to the next location
* Move clockwise around the abdomen
* As circle the abdomen, distinguish between voluntary muscle guarding and
involuntary muscle rigidity
light palpation
assists in judging the size, location,
and consistency of certain organs (depress skin 5-8 cm).
* It can also assess masses and tender areas.
* Not always appropriate (condition of the client, scope of
practice considerations).
* Same procedure as light palpation except for depth of
depression.
deep palpation
- Occurs when the client is cold, tense, ticklish
- Bilateral
- Examiner will feel the muscles relax slightly during exhalation
- Use relaxation measures to try and eliminate this type of guarding
voluntary guarding
- Constant board-like hardness of the muscles, rigidity will persist
despite relaxation measures - Protective mechanism accompanying peritonitis (acute
inflammation of the peritoneum) - May be unilateral, same area usually becomes painful with the
client attempts to sit up
involuntary rigidity
- Outlet of the GI tract; approximately 3.8 cm long in adults
- Lined with modified skin that merges with the rectal mucosa at
the anorectal junction - Canal slants forward toward the umbilicus
- Rectum only contains autonomic nerves
- – contains numerous somatic
sensory nerves so any trauma to the anal area will cause sharp
pain
anal canal
what are the 2 concentric layers of muscles surrounding the anal canal
internal and external sphincter
under involuntary control
by the autonomic nervous system
internal sphincter
under voluntary control
external sphincter
separates the internal and
external sphincters and is palpable
intersphincteric groove
- Folds of mucosa that extend vertically down from the rectum and
end in the anorectal junction - Each anal column contains an artery and a vein
- At the lower end of each column is an anal valve
anal columns
- 12 cm long distal portion of the large intestine
- Extends from the sigmoid colon and ends at the anal canal
- Rectal interior has 3 semilunar transverse folds called the valves of
Houston
rectum
Peritoneum covers only the upper two thirds of the rectum
peritoneal reflection
Anterior part of the peritoneum reflects down to
within 7.5 cm of the anal opening forming the retrovesical
pouch, and then covers the bladder
male peritoneal reflection
“called the rectouterine pouch and it extends
down to within 5.5 cm of the anal opening
female peritoneal reflection
round or heart shaped. Measures 2.5 cm long and 4 cm in
diameter
* Surrounds the bladder neck and the urethra and has 15-30 ducts that
open into the urethra
* Secretes a thin, milky alkaline fluid that helps with sperm viability
prostate
shallow groove that separates the lateral lobes
median sulcus
secrete a fluid that is rich in fructose which
nourishes the sperm and contains prostaglandins
two seminal vesicles
located inferior to the prostate on
either side of the urethra and secrete a clear, viscid mucus
two bulbourethral glands
- Named for its S shape course in the pelvic cavity
- Extends form the iliac flexure of the descending colon and ends at
the rectum - 40 cm long
- Accessible to examination only through colonoscopy
sigmoid colon
what are the developmental considerations for infants and children?
- First stool is passed within 24 – 48 hours of birth
- Dark green meconium – indicates anal patency
- Usually - stool with each feeding
- Response to eating is a wave of peristalsis called the gastrocolic reflex
- Infant passes stool by reflex
- Voluntary control of the external anal sphincter cannot occur until the nerves
supplying the area have become fully myelinated (usually age 1 ½ - 2 years) - Toilet training usually starts after age 2
what are the developmental considerations of older adults?
- Prostate continually starts to enlarge in the middle adult years
- Benign prostatic hypertrophy (BPH) is present in 1 per 10
men at the age of 40 years and increases with age - Risk of developing prostate cancer increases with age
- As an older client performs the Valsalva maneuver, the
following may be noted: - Relaxation of the perianal musculature
- Decreased sphincter control
how do we prep for a recal exam?
- Perform a rectal examination on all adults (particularly those in
the middle and older years)Examine a male client in the left
lateral decubitus or standing position - Instruct the standing male to point his toes together
- Place the female client in the lithotomy position if the genitals are
being examined as well - use the left lateral decubitus position for examination of the
rectal area alone - Place the transgender woman in a gender-affirming lithotomy
position
what equipment do u need for a rectal exam?
- gloves, penlight, lubricating jelly (internal
examination), specimen container (may be required)
what are the normal and abnormal findings of inspection of the anus?
- Normal:
- looks moist and hairless, with coarse folded skin that is more
pigmented than the perianal skin - anal opening tightly closed
- no lesions
- Abnormal
- inflammation
- lesions, scars, linear split (fissure)
- hemorrhoid or thrombosed hemorrhoid
- small round opening in the anal area (fistula)
what are the normal and abnormal findings of inspection of the sacrococcygeal area?
- Normal – appears smooth and even
- Abnormal – inflammation or tenderness, swelling, tuft of hair or dimple at
tip of coccyx may indicate a pilonidal cyst
