Week 5 Flashcards
What are the 3 muscle layers from back, around flanks, to the front of the abdomen
- external abdominus obliques
- internal abdominus obliques
- transverse abdominus
Why are the liver and spleen difficult to palpate unless they are enlarged?
because they are located up under the rib cage
Solid vs hollow viscera
Solid - organs that maintain their shape consistently
Hollow - organs that can change shape
Solid Viscera examples (7)
liver pancreas spleen adrenal glands kidneys ovaries uterus
Hollow viscera examples
Stomach Gallbladder Small intestine Colon (large intestine) bladder
pancreas anatomy and location
soft, lobulated gland behind the stomach
kindey
Bean-shaped
retroperitoneal, or posterior to abdominal contents
Why does the right kindey rest 1-2 cm lower than left kidney?
because of placement of liver
abdominal well is divided into ____ quadrants; how is it divided?
4 quadrants; divided by a vertical and horizontal line bisecting umbilicus
When the abdomen is divided into 4 quadrants by a vertical and horizontal line bisecting umbilicus, what are the quadrants termed?
Right upper quadrant (RUQ)
Left upper quadrant (RUQ)
Left lower quadrant (LLQ)
Right lower quadrant (RLQ)
if the abdomen was drawn like a tic-tac-toe board, what are the middle rows called, starting at the top and going down
Epigastric
umbilical
hypogastric or suprapubic
What organs are in the Right upper quadrant (RUQ)
liver gallbladder duodenum head of pancreas right kidney and adrenal gland hepatic flexure of colon part of ascending and transverse color
What organs are in the left upper quadrant (LUQ)
Stomach spleen left lobe of liver body of pancreas left kidney and adrenal gland splenic flexure of color part of transverse and descending colon
What organs are in the Right lower quadrant (RLQ)
cecum appendix right ovary and tube right ureter right spermatic cord
What organs are in the Left lower quadrant (LLQ)
part of descending color sigmoid colon left ovary and tube left ureter left spermatic cord
What are 3 midline organs
aorta
uterus, if enlarged
bladder, if distended
Developmental Competence: Pregnant Women and morning sickness
n/v or “morning sickness” is an early sign of pregnancy for most pregnant women, starting between first and second missed periods
morning sickness: cause
unknown; may be due to hormonal changes, such as production of human chorionic gonadotropin (hCG)
morning sickness s/s
n/v
“acid indigestion” (heartburn aka pyrosis) causes by esophageal reflux
Developmental Competence: Pregnant Women - describe gastrointestinal mobility
it decreases, which prolongs gastric emptying time
Developmental Competence: Pregnant Women – how does decreased motility cause constipation
decreased motility causes more water to be reabsorbed from colon, which leads to constipation
Developmental Competence: Pregnant Women – what may leave preg women at increased risk of hemorrhoids?
constipation and increased venous pressure
Developmental Competence: Pregnant Women – how are the positioning of the organs differ?
Enlarging uterus displaces intestine upward and posteriorly
appendix displaced up and to the right
Developmental Competence: Pregnant Women – bowel sounds
diminished
Developmental Competence: Pregnant Women – skin changes
skin changes on abdomen include striae and linea rigra
Developmental Competence: Aging Adults
– impacts of changes of the GI system with aging
changes of the GI system with aging, but most do not significantly affect function as long as no disease is present
Developmental Competence: Aging Adults
salvation
decreases, leading to dry mouth and decreased sense of taste
Developmental Competence: Aging Adults
- gastric emptying
esophageal emptying and gastric acid secretion are delayed
Developmental Competence: Aging Adults - gallbladder
increased incidence of gallstones
Developmental Competence: Aging Adults - liver function
although liver size decreases, most liver function remain normal; however, drug metabolism is impaired
Developmental Competence: Aging Adults - BM
aging adults often report constipation
Developmental Competence: Aging Adults - appearance in abd.
aging alters appearance of abdominal wall
Common causes of constipation
decreased PA low h20 low fiber medications IBS bowel obstruction hypothyroidism age inadequate toilet facilities; hard time ambulating to toilet may cause person to deliberately retain still until it becomes hard and difficult to pass
Visceral pain
f
Parietal pain
g
referred pain
f
Abdominal assessment - auscultate or or palpate first?
auscultate prior to palpation and percussion
inspection of abdomen: contour
Stand on person’s right side and look down at abdomen. Then, stoop or sit to gaze at abdomen. Your head should be slightly higher than the abdomen. Determine profile from rib margin to pubic bone; contour describes nutritional state and normally ranges from flat to rounded
Inspection of abdomen: symmetry
Shine a light across abdomen toward you, or shine it lengthwise across the person
– abdomen should be symmetric bilaterally
Contour of abdomen: Flat
abdoment remains flat when client is lying supine
Contour of abdomen: Scaphoid
the lower area of the abdomen is sunkent in
Contour of abdomen: rounded
the lower area of the abdomen pops out a little bit
Contour of abdomen: Protuberant
the entire stomach is pushed out
Inspection of Abdomen: umbillicus
Normally it is midline and inverted, with no sign of discoloration, inflammation or hernia
Inspection of Abdomen: Skin
smooth and same color
fine venous network may be visible in this people
good turgor
Why do striae occur
occur when elastic fibers in reticular layer of skin are broken after rapid or prolonged stretching (pregnancy, weight gain)
- new are pink or blue, then they turn silvery white
Inspection of Abdomen: scars
if scar is present, draw the location in persons chart, indicating length in cm
Inspection of Abdomen: pulsations or movement
normally, you may see pulsations from aorta beneath skin in epigastric area, particularly in this persons with good muscle wall relaxation
Inspection of Abdomen: hair distribution
pattern of pubic hair growth normally has diamond shape in adult males and in inverted triangle in adult females
Inspection of Abdomen: Demeanor
comfortable person is relaxed quietly on examining table and has a benign facial expression and slow, even respirations
Auscultation of bowel and vascular sounds - why is this first?
because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds
what part of stethoscope do we use for auscultation of abdomen?
diaphragm with light pressure
Where do we begin auscultating the abdomen?
RLQ at ileocecal valve because bowel sounds are normally always present here
how many bowel sounds should be heard per minute?
5-30
What do bowel sounds originate from
movement of air and fluid through small intestine
borborygmus
the sound of hyper-peristalsis
how long should you listen if you are not hearing any bowel sounds
5 minutes
Costovertebral angle tenderness - assessing kidney
to assess kidney, place one hand over 12th rib the the costovertebral angle on back
Ascites
free fluid in the peritoneal cavity
why might you think someone has ascites
distended abdomen, buldging, flanks, and an umbilucus that is protruding and displaced downward
how can you differentiate ascites from gaseous distention
fluid wave test
shifting dullness test
Palpate Surface and Deep Areas
judge size, location, and consistency of certain organs and screen for an abdominal mass or tenderness
because most people are naturally inclined to protect abdomen, you need to use additional measures to enhance complete muscle relaxation
how do you perform light palpation of the abdomen
make gentle rotary motion, sliding fingers and skin together
– objective is not to search for organs but to form an overall impression of skin surface and superficial musculature
– with first four fingers close together, depress skin about 1 cm, then lift fingers (do not drag), and move clockwise to next location and around abdomen
how do you perform deep palpation
same technique as light palpation but push down 5-8 cm (2-3 inches)
moving clockwiese
light and deep palpation of abdomen: if you ID a mass, what should you note
location size shape consistency surface (smooth, nodular) mobility pulsality tenderness -- rebound tenderness
how would you palpate the liver
place left hand under person’s back parellel to 11th and 12th ribs and lift up to support abdominal contents
- place right hang on RUQ with fingers parellel to midline
- push deeply down and under right costal margin
palpation of spleen
usually not palpable - must be enlarged three times is normal size to be felt
how to search for spleen
reach your left hand over abdomen and behind left side at the 11 and 12 ribs
life up for support; place your right hand obliquely with LUQ with fingers pointing toward left axilla and just inferior to rib margin
push hand deeply down and under left costal margin, ask person to take deep breath
you should feel nothing firm
what would you feel if you were palpating the spleen and it it enlraged
when enlarged, spleen slides out and bumps fingertups
palpation of aorta
using opposing thumbs and fingers, palpate aortic pulsation in upper abdomen slightly to left midline
how big is aorta pulse in adult
normally 2.5 to 4 cm wide in adult and pulsates in an anterior direction
causes of abdominal distention
tumor obesity air or gas ascites ovarian cyst pregnancy feces
common types of hernia
umbilical hernia
epigastric hernia
incisional hernia
diastasis recti
diastasis recti
separation in the abdominal muscle that is detached – they pull off to the side and may see a large bulge down the middle. Common in babies, abnormal in adults especially women after pregnancy.
Abnormal findings of abdominal ausculation
peritoneal friction rub
arterial bruit
venous hum
abnormal findings on palpation of organs
Enlarged…
liver, nodular liver, gallbladder, spleen, kidney
aortic aneurysm
Tests for appendicitis: normal findings
rebound tenderness
psoas sign
obturator sign
perform hypertensitivity test
Special abdominal tests: tests for cholecystitis
RUQ pain or tenderness
murphy sign
Gastrointestinal Reflux disease (GERD): causes
stomach acid / contents flow back into the esophagus
– reflex irritates the lining of the esophagus
Gastrointestinal Reflux disease (GERD): chronic irritations
- esophageal structure (narrowing)
- esophageal ulcer
- barret esophagus (precancerous)
Gastrointestinal Reflux disease (GERD): s/s
horseness laryngitis chronic, dry cough asthma or worsening asthma feeling as a lump in throat sudden increase in saliva halitosis earaches chest pain/discomfort
Risk assessment for Gastrointestinal Reflux disease (GERD):
obesity asthma hiatal hernia diabetes pregnancy delayed stomach emptying smokings ct disorders dry mouth alc. consumption
Summary checklist – Abdomen Examinatiion
- Inspection
- contour, symmetry, umbillicus, skin, pulsations or movement, hair distribution, and demeanor - ausculation
- bowel sounds; note any vascular sounds - percussion
- all 4 quadrants and borders of liver and spleen - palpation
light and deep palpation in all 4 quadrants, and palpate for liver and spleen
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
inversation
moving sole of foot inward at ankle
eversion
moving sole of foot outward at ankle
rotation
moving head around central axis
protraction
moving body part forward, parellel to groun
retraction
moving body part backward, parellel to ground
elevation
raising body part
depression
lowing a body part
what has a fetus formed by 3 months
by 3 months, fetus has formed skeleton of cartilage
describe the growth of bone in infants and children
bone growth continues rapidly during infancy and steadily in childhood, until the adolscent growth spurt closes at age 20
what causes increased mobility in joints for pregnant women
increased levels of circulating hormones (estrogen, relaxin from corpus letuem, and corticosteriods) cause increased mobility in joints
what contributes to noticeable changes in maternal posture
increased mobility in sacroilliac, sacrococcygeal and symphysis pubis joints in pelvis contributes to noticeable changes in maternal posture
What is the most characteritic change in the sketetal muscle in preg women
progressive lordosis, which compensates for enlarging fetus by shifting weight farther back on lower extremities
skeletal muscle changes in aging adults
postural changes - decreased height
reabsoption occurs more rapidly than deposition
ortolani’s maneuver
checks infants hips for congenital dislocation; should be done at every visit until infant is one year old
what to inspect for skeletal muscles in infants hands and arms
inspect hands noting shape, number and position of fingers and palmar creases
palpate length of clavicles; the bone most frequently is fractured during birth
what to inspect for skeletal muscles in infants back
Note the C-curve, length of spine for tuft of hair, dimple in midline, cycst, or mass
kyphosis
bad posture; backward head tilt to compensate for poor posture in older adults
Assessment of musculoskeletal system
Inspect:
- size / contour of joint
- inflammatory conditions
- rheumatoid arthritis
- ankylosing spondylitis
- degenerative conditions
- osteoarthritis / osteoporosis
- skin color and characteristics
Palpation of joint area
- skin, muscles, bony articulations and joint capsules
ROM
active, passive
- measure with goniometer
Muscle testing
- strength testing bilaterally
- with and without gravity
- 0-5 grade
