Assessing the Abdomen

Question 1

abdomen anatomy

Answer 1

four quadrants. abdominal wall muscles

Question 2

four quadrants

Answer 2

RLQ, RUG, LLQ, LUQ

Question 3

Abdominal wall muscles - three layers

Answer 3

external abdominal oblique (outer), internal abdominal oblique (middle), transverse abdominis (inner layer)

Question 4

internal anatomy

Answer 4

peritoneum - thin shiny serous membrane, lines abdominal cavity, provides protection of internal abdominal organs

Question 5

solid viscera

Answer 5

liver, pancreas, spleen, kidneys, uterus, ovaries

Question 6

pancreas

Answer 6

not normally palpable, endocrine gland, accessory organ of digestion

Question 7

spleen

Answer 7

not normally palpable, filter blood of cellular debris, digest microorganisms, return breakdown products to liver

Question 8

kidneys

Answer 8

filter blood

Question 9

Hollow viscera

Answer 9

stomach, gallbladder, small/large intestine, urinary bladder

Question 10

What do hollow viscera do?

Answer 10

store things for the body

Question 11

vascular structures

Answer 11

perfusion by abdominal aorta/major branches, pulsations of aorta frequently visible/palpable midline in upper abdomen, pulsations of right/left iliac arteries may be felt in RLQ/LLQ

Question 12

History of present concern

Answer 12

any abdominal pain (COLDSPA), indigestion (COLDSPA), n/v - triggers, increase/decrease in appetite - weight/BMI change/extended illness causing weight increase/decrease, yellowing of skin/sclera - jaundice, bowel elimination

Question 13

bowel elimination

Answer 13

describe stools, change in pattern, constipation/accompanying symptoms, diarrhea/accompanying symptoms, clay colored stool - liver disease

Question 14

Personal health history

Answer 14

any GI disorders, UTIs, viral hepatitis - abc, surgery/trauma, OTC

Question 15

Family history

Answer 15

GI cancer, other GI disorders

Question 16

lifestyle

Answer 16

alcohol, types of food, exercise, stress - affect eating/elimination, current GI disorder/how affecting lifestyle

Question 17

abdominal pain terms

Answer 17

visceral, parietal, referred pain

Question 18

visceral pain

Answer 18

when hollow abdominal organs become distended or contract forcefully, or capsules of solid organs stretched. poorly defined - dull, aching, burning

Question 19

parietal pain

Answer 19

parietal peritoneum becomes inflamed. ex: appendicitis or peritonitis - localized, severe, steady

Question 20

referred pain

Answer 20

distant sites that are innervated at approximately same levels as disrupted abdominal organ, travels from primary site to become highly localized at distant site

Question 21

physical assessment

Answer 21

routine screening. inspection, auscultation, percussion, palpation

Question 22

Routine screening includes

Answer 22

observe color, vascularization, scars, rashes, lesions of abdomen, observe umbilicus, abdominal contour/symmetry, aortic pulsations/peristaltic waves, auscultate bowel sounds, percuss four quadrants, lightly palpate four quadrants

Question 23

inspection

Answer 23

observe color, note vascularity, note striae, scars, lesions/rashes, umbilicus should be midline at lateral line, contour of umbilicus, abdominal contour, abdominal symmetry - supine, signs of hernia/mass/diastasis recti - raise head, abdominal movement when breathing, aortic pulsations, peristaltic waves

Question 24

new striae are

Answer 24

pink or blue

Question 25

old striae are

Answer 25

silvery, white, linear, uneven stretch marks

Question 26

Abdominal contour

Answer 26

flat, rounded, scaphoid, should be evenly rounded

Question 27

Aortic pulsations

Answer 27

slight pulsation of abdominal aorta in epigastrium full length in thin people

Question 28

Peristaltic waves

Answer 28

normally not seen, maybe if thin, abnormal in LUQ or RLQ - obstruction

Question 28

Auscultate bowel sounds

Answer 28

diaphragm of stethoscope, warm, start RLQ/proceed clockwise, 5 min before document no bowel sounds, minimum 1 min per quadrant to confirm no bowel sounds, normally every 5-15 sec. note intensity, pitch, frequency

Question 29

Auscultate vascular sounds

Answer 29

bell, listen for bruits (abnormal), auscultate abdominal aorta/renal/iliac/femoral arteries

Question 30

Listen for venous hum

Answer 30

bell, epigastric/umbilical areas

Question 31

Listen for friction rub

Answer 31

over liver and spleen, use diaphragm, over right/left lower rib cage

Question 32

percussion

Answer 32

lightly/systematically through all quadrants, determine span and height of liver by determining upper/lower borders - normal decreases after 50, spleen dullness should be noted left 10th rib/slightly posterior to MAL. blunt percussion on liver/kidneys

Question 33

Blunt percussion on liver and kidneys

Answer 33

assess for tenderness, over CVA - costovertebral angles

Question 34

palpation

Answer 34

light, deep, bladder

Question 35

light palpation

Answer 35

abdomen should be non tender/soft

Question 36

deep palpation

Answer 36

all four quadrants, detect subtle masses, mild tenderness normal over diploid, aorta, cecum, sigmoid colon, ovaries

Question 37

palpate for

Answer 37

masses, umbilicus/surrounding for swelling, bulges, masses, palpate aorta, liver/spleen/kidneys - rarely palpable

Question 38

palpate bladder

Answer 38

empty not palpable or tender, distended smooth/round/firm

Question 39

Blumberg sign

Answer 39

abdominal pain/tenderness when examiner tests for rebound tenderness - palpate at 90 degrees into abdomen halfway between umbilicus/anterior iliac crest

Question 40

signs

Answer 40

psoas, obturator, murphy, rovsing

Question 41

Psoas sign

Answer 41

pain in RLQ when leg hyperextended, appendicitis

Question 42

Obturator sign

Answer 42

pain in RLQ when hip/knee are flexed, leg rotated internally/externally, irritation of obturator muscles due to appendicitis or perforated appendix

Question 43

Murphy sign

Answer 43

pain when pressure applied under liver border at right costal margin and client inhales deeply, inflammation of gallbladder

Question 44

Rovsing sign

Answer 44

pain in RLQ during pressure in LLQ, acute appendicitis