Quiz #3 Abdomen Flashcards
Solid viscera
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus
Hollow viscera
stomach, gallbladder, small intestine, colon, bladder
Where can you palpate aortic pulsations?
the upper anterior abdominal wall
Abdomen in the infant
Abdominal wall thinner—easier to palpate organs
Liver takes up more abdominal space.
Bladder higher in abdomen.
Abdomen in the Pregnant Woman
Decreased motility of GI tract.
Intestines displaced upward and posterior by enlarging uterus.
Abdomen in the Aging Adult
Esophageal emptying delayed.
Gastric acid secretions decreased.
Incidence gallstones increased.
Drug metabolism by liver decreased.
Evaluation of constipation symptoms
Decrease in stool frequency (less than 3 times per week)
Straining
Hard stool
Feeling of incomplete evacuation and anorectal blockage
Is constipation a consequence of aging?
No
Common causes of Constipation
1) Decreased physical activity
2) Inadequate water intake
3) Low fiber diet
4) Side effects of medications
5) Irritable bowel syndrome
6) Bowel obstruction
7) Hypothyroidism
8) Inadequate toilet facilities
Subjective Data for Abdomen
- Change in appetite
- Dysphagia
- Food intolerances
- Abdominal pain
- N/V
- Bowel Habits
- Past GI history- ulcer/galbladder disease/hepatitis?
- Medications/Alcohol/Tobacco
- Nutritional assessment/24 hour recall
What to ask about N/V
How often; contents; odor; fever, chills, diarrhea, pain. eating and travel last 24 hours
What to ask about BM
frequency color consistency diarrhea/constipation laxative use
What to ask about abdominal hx
- ulcer
- GB disease
- hepatitis/jaundice
- appendicitis
- colitis
- hernia
- Any previous abdominal surgery? Any abdominal xray studies?
Infant Subjective Data for Abdomen
Ask about bottle vs. breast feeding; how tolerating formula; eating table food?; eating habits; bowel habits; water intake.
Overweight child Subjective data for Abdomen
diet pattern; family’s eating pattern; body image
Adolescent subjective data for abdomen
- eats breakfast
- eating pattern/habits
- exercise pattern
- If weight loss—ask how weight was lost
- ask about body image
- ask about menstrual irregularity
Aging adult subjective data for abdomen
Ask about acquiring groceries; who prepares meals?
24 hour diet recall
Any problems with bowels (constipation)?
Any medications which may increase dry mouth?
Inspection of the abdomen
1) Contour: flat; scaphoid; rounded; protuberant
2) Symmetry
3) Umbilicus
4) Skin
5) Pulsation or movement
6) Hair distribution
7) Demeanor
Auscultation of bowel sounds
character, frequency. Normal: high-pitched, gurgling, cascading
Hyperactive: loud, high-pitched, rushing, tinkling
Hypoactive: infrequent normal sounds
Auscultation of abdominal vascular sounds
firmer pressure with stethoscope
listen for bruits over aorta, renal arteries, iliac arteries, femoral arteries (esp. in clients with hypertension)
Note: location, pitch, timing
Percussion of the abdomen: use
to assess relative density of abdominal contents; locate organs; screen for abdominal fluid or masses.
What does marked pulsation of the aorta indicate?
Widened pulse pressure- hypertension, aortic insufficiency, thyrotoxicosis, or aortic aneurysm
What does visible peristalsis with distended abdomen indicate?
Intestinal obstruction
What do abnormal patterns of pubic hair growth indicate?
endocrine/hormonal abnormalities or chronic liver disease
Normal bowel sounds
high-pitched, gurgling, cascading
from 5-30x per minute
borborygmus
hyperperistalsis- “stomach growling”
How long to listen to determine if bowel sounds are absent
5 minutes
Hyperactive bowel sounds
loud, high-pitched, tinkling
Signifies increased motility
Hypoactive bowel sounds
Follow abdominal surgery or peritoneal inflammation
Bruit in the celiac artery
normal in 4-20% of healthy people
Systolic bruit
Pulsatile blowing sound
Occurs with stenosis or occlusion of an artery
Dullness on percussion
Indicates a distended bladder, adipose tissue, fluid, or mass
Hyperresonance
Present with gaseous distention
Normal liver span in an adult
6-12 cm
10.5 cm for males, 7 cm for females
hepatomegaly
liver enlargement, indicated by increased liver span
Liver in chronic emphysema
displaced downward by hyperinflated lungs. Overall span is still normal.
Splenic dullness
percussing for dull note from 9th to 11th ICS just behind the left midaxillary line.
Enlarged spleen
indicated by dull note forward of the midaxillary line (positive spleen percussion sign)
Costovertebral angle tenderness
Indirect fist percussion over 12th rib at the DVA
Sharp pain indicates inflammation of the kidney
Light palpation
1st four fingers; gentle rotary motion; sliding fingers and skin together; depress 1 cm.
Deep Palpation
using same technique as light palpation, depress 5-8 cm.
Palpation in a large or obese abdomen
use bimanual technique
If mass identified
Note:
a) Location
b) Size
c) Shape
d) Consistency (soft, firm, hard)
e) Surface (smooth, nodular)
f) Mobility (including movement with respirations)
g) Pulsatility
h) Tenderness
Fluid wave
firm strike to left flank; if felt on right flank, ascites indicated
Ascites
Fluid in the peritoneal cavity
Occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, cancer
Shifting dullness
Percussion shifts from tympanic to dull as you reach the flank. Indicates ascites.
involuntary rigidity
Constant, boardlike hardness of the muscles
Protective mechanism- accompanies acute inflammation of the peritoneum.
Palpating liver
underneath the right costal margin- normal to feel the edge of the liver as the diaphragm pushes it down during inhalation, often not palpable.
Causes of enlarged spleen
Occurs with mononucleosis, trauma, infection, malaria, leukemia, lymphoma. `
Palpating kidneys
“duck bill” position of hands at person’s right flank, ask pt to take a deep breath. normally nothing is felt. Right kidney may be palpable.
Palpating aorta
Normally 2.5-4cm wide, pulsates in the anterior direction. In the upper abdomen slightly left of midline. Use thumb and fingers to palpate.
Aortic aneurysm
Prominent lateral pulsation pushes the examiners fingers apart
Rebound tenderness (Blumberg sign)
pain on release of pressure- sign of peritoneal inflammation, may be appendicitis
Inspiratory arrest (murphy sign)
Sharp pain on inhalation when liver pushes the inflame gallbladder onto examiner’s hand- person stops inspiration
Illiopsoas muscle test
Press down on the leg as the person tries to lift it up- when positive, iliopsoas muscle is inflamed- indicates appendicitis
Older adult objective
Organs may be easier to palpate because of thinner abdominal wall
Liver & kidneys easier to palpate
Abdominal rigidity less common
Less pain in acute abdominal problems
Ovarian cyst S&S
I: curve in lower half of abdomen
A: normal bowel sounds over upper abdomen
Percussion: top dull over fluid, intestines pushed up, large cyst produces fluid wave and shifting dullness
Palpation: Transmits auortic pulsation- ascites does not
