abdomen

Question 1

internal anatomy

Answer 1

Divided into 4 quadrants
 Right and left and upper and lower (RUQ,LUQ, RLQ & LLQ)
 Midline organs—aorta, uterus if enlarged and bladder if distended

Question 2

pregnant women - nausea and vomiting

Answer 2

morning sickness
 Cause unknown; may be due to hormone changes, such as production of human chorionic gonadotropin (hCG)
 “Acid indigestion” or heartburn (pyrosis) caused by esophageal reflux

Question 3

pregnant women - constipation

Answer 3

Gastrointestinal motility decreases, which prolongs gastric emptying time, decreases absorption, and leads to constipation

Question 4

developmental competence: the aging adult

Answer 4

 Changes of the GI system occur with aging, but most do not significantly affect function if no disease is present
 Salivation decreases, leading to a dry mouth and decreased sense of taste
 Esophageal emptying and gastric acid secretion are delayed (exam)
 Incidence of gallstones increases with age
 Although liver size decreases, most liver functions remain normal; however, drug metabolism is impaired
 Aging adults frequently report constipation

Question 5

lactose intolerance

Answer 5

 Lactase is a digestive enzyme necessary for absorption of carbohydrate lactose (milk sugar)
* These people are lactose intolerant and have abdominal pain, bloating, and flatulence when milk products are consumed
 Ethnic variation seen
 Lactase non-persistance affects estimate
* 21% of whites, 51% of Hispanic/Latinos, 75% of blacks and 79% American Indians & between 15-100% of Asian Americans

Question 6

celiac disease

Answer 6

 Autoimmune disorder
 Intolerant of gluten
 Gluten-free diet (GFD)

Question 7

subjective data

Answer 7

 Appetite
 Dysphagia
 Food intolerance
 Abdominal pain
 Nausea/vomiting
 Bowel habits
 Past abdominal history
 Medications
 Nutritional assessment

Question 8

bowel habits (exam)

Answer 8

are you having any black tarry stools? (likely old blood, upper GI bleed)
Are you having normal bowel movements?

Question 9

medications (exam)

Answer 9

ask if they are on iron

Question 10

preparation for collecting objective data

Answer 10

 Adequate lighting
 Expose abdomen so that it is fully visible; drape genitalia and female breasts
 Position for comfort to enhance abdominal wall relaxation
* Empty bladder prior to examination with specimen saved if needed.
* Lying on back with knees bent
* Warm stethoscope and examine areas identified as painful last to prevent
guarding

Question 11

auscultate when? (exam)

Answer 11

Auscultate prior to palpation and percussion
 Inspect, AUSCULTATE, percuss, palpate

Question 12

what equipment is needed to collect objective data

Answer 12

 Stethoscope, small centimeter ruler, and skin-marking pen
 Alcohol wipe to clean endpiece

Question 13

contour of the abdomen

Answer 13

Determine profile from rib margin to pubic bone; contour describes nutritional state and normally ranges from flat to rounded

Question 14

symmetry of the abdomen

Answer 14

Abdomen should be symmetric bilaterally

Question 15

umbilicus of the abdomen

Answer 15

Normally it is midline and inverted, with no sign of discoloration, inflammation, or hernia

Question 16

skin of the abdomen

Answer 16

 Surface smooth and even, with homogeneous color; assess skin turgor
 Inspect for pigment change and presence of lesions or scars
 Common pigment change striae (linea albicantes) & pigmented nevi (moles)

Question 17

inspection - pulsation or movement (exam)

Answer 17

Pulsation or movement
 Normally you may see pulsations from aorta beneath skin in epigastric area, particularly in thin persons with good muscle wall relaxation

Question 18

inspection hair distribution

Answer 18

Hair distribution
 Pattern of pubic hair growth normally has diamond shape in adult males and an inverted triangle shape in adult females

Question 19

inspection - demeanor

Answer 19

Demeanor
 A comfortable person is relaxed quietly on examining table and has a benign facial expression and slow, even respirations

Question 20

why is auscultation done first

Answer 20

This is done first because percussion and palpation can increase peristalsis,
which would give a false interpretation of bowel sounds

Question 21

how to auscultate for bowel and vascular sounds

Answer 21

 Hold stethoscope lightly against skin; pushing too hard may stimulate more
bowel sounds
 Begin in RLQ at ileocecal valve area because bowel sounds are normally always present here

Question 22

bowel sounds

Answer 22

 Note character and frequency of bowel sounds
 Bowel sounds originate from movement of air and fluid through small intestine
 Bowel sounds are high pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute

Question 23

hypoactive

Answer 23

 Hypoactive—decreased, can follow abdominal surgery or with
inflammation

Question 24

hyperactive

Answer 24

 Hyperactive—loud, high-pitched signal increased motility

Question 25

 Borborygmus

Answer 25

is the sound of hyper peristalsis (stomach growling)

Question 26

 Perfectly “silent abdomen” is

Answer 26

uncommon you must listen for 5 minutes by your watch before deciding bowel sounds are completely absent

Question 27

costovertebral angel tenderness

Answer 27

 To assess kidney, place one hand over 12th rib at costovertebral angle on back  Thump that hand with ulnar edge of your other fist  A person normally feels thud but no pain

Question 28

what does a positive finding for costovertebral angle tenderness mean

Answer 28

there is probably inflammation of the kidney

Question 29

palpation: light to deep

Answer 29

 Note location, size, consistency, and mobility of any palpable organs and presence of any abnormal enlargement, tenderness, or masses  Making sense of what you are feeling is more difficult than it looks  Be aware of voluntary guarding  Inexperienced examiners complain that abdomen “all feels same,” as if they are pushing their hand into a soft sofa cushion  Helps to memorize anatomy and visualize what is under each quadrant as you palpate  Also remember that some structures are normally palpable  Mild tenderness normally present when palpating sigmoid colon  Any other tenderness should be investigated  If you identify a mass, first distinguish it from a normally palpable structure or an enlarged organ

Question 30

palpation of the spleen

Answer 30

 Normally spleen is not palpable and must be enlarged three times its normal size to be felt  To search for it, reach your left hand over abdomen and behind left side at the 11th and 12th ribs  Lift up for support; place your right hand obliquely on LUQ with fingers pointing toward left axilla and just inferior to rib margin  Push your hand deeply down and under left costal margin, and ask the person to take deep breath  You should feel nothing firm

Question 31

enlargement of the spleen is seen with

Answer 31

 Enlargement seen with:  Mononucleosis, leukemia and lymphomas, portal HTN and HIV infection  Normally spleen is not palpable and must be enlarged three times its normal size to be felt  An alternative position is to roll a person onto his or her right side to displace spleen more forward and downward

Question 32

if the spleen is palpable what should you do (exam)

Answer 32

 If palpable, do not continue to palpate as it is friable and can rupture

Question 33

palpation of the aorta

Answer 33

 Using your opposing thumb and fingers, palpate aortic pulsation in upper abdomen slightly to left of midline  Normally it is 2.5 to 4 cm wide in adult & pulsates in an anterior direction  Widened in the presence of abdominal aortic aneurysm

Question 34

abnormal findings: abdominal distension

Answer 34

 Obesity  Air or Gas  Ascites  Ovarian Cyst (large)  Pregnancy  Feces  Tumor

Question 35

ascites (exam)

Answer 35

fluid on the abdomen - has a very protuberant appearance - can be caused by cirrhosis

Question 36

patient history and symptoms of intestinal obstruction

Answer 36

 Patient hx and symptoms  Hx of previous abdominal surgery with adhesions  Vomiting or fever  Absence of stool or gas passage  Colicky pain from strong peristalsis above the obstruction

Question 37

physical exam findings of intestinal obstruction

Answer 37

 Restless, ill appearing patient  Distended abdomen/tenderness to palpation  Hyperactive bowel sounds in early obstruction  hypoactive or silent in late obstruction  Progression to hypovolemic shock

Question 38

diagnostic tests for intestinal obstruction

Answer 38

 Evidence to support dehydration, electrolyte loss & possible sepsis  Imaging studies -> accumulation of fluid & gas in bowel proximal to obstruction

Question 39

abnormal findings on inspection

Answer 39

 Inspection  Umbilical Hernia  Epigastric Hernia  Incisional Hernia

Question 40

abnormal bowel sounds

Answer 40

 Abnormal Bowel Sounds  Succussion Splash * Marked peristalsis +projectile vomiting in newborn = pyloric stenosis  Hypoactive Bowel Sounds  Hyperactive Bowel Sounds

Question 41

palpation: murphy's sound

Answer 41

a positive murphy's sign can be acute cholecystitis - is when there may be significant pain that may be sharp when inhaling

Question 42

abdomen examination

Answer 42

 Inspection  Contour, symmetry, umbilicus, skin, pulsation or movement, hair distribution &demeanor  Auscultation  Bowel sounds; note any vascular sounds  Percussion (Usually by physician)  All four quadrants and borders of liver & spleen  Palpation  Light and deep palpation in all four quadrants, & palpate for liver and spleen

Question 43

occult blood

Answer 43

melana