Chapter 21: Abdomen

Question 1

What are al internal organs in the abdominal cavity called?

Answer 1

Viscera

Question 2

Where is the small intestine located?

Answer 2

In all four quadrants

Question 3

Where is the spleen located

Answer 3

ULQ

Question 4

Where is the liver located?

Answer 4

URQ

Question 5

Where is the stomach primarily located?

Answer 5

ULQ

Question 6

Where is the descending colon primarily located?

Answer 6

LUQ

Question 7

Where is the ascending colon primarily located?

Answer 7

RUQ

Question 8

Where is the pancreas?

Answer 8

Mainly in LUQ but also crosses over into RUQ

Question 9

What are the midline organs?

Answer 9

Aorta, Uterus (if enlarged), Bladder (if distended)

Question 10

Reasons for abdominal pain

Answer 10

• Occurs in acute and chronic conditions

- Can be due to digestive, reproductive disorders or urinary system disorders

Question 11

Risk factors and considerations for abdominal pains

Answer 11

• Alcohol abuse
• H-pylori: peptic ulcer
• Medications
• Stress
• Smoking
• Congenital defects
• Travel to other countries

Question 12

When should you be concerned about an umbilical hernia?

Answer 12

Bulging of belly button, normal for the first 6 months but should not persist longer. Usually more prominent when baby cries

Question 13

Diastasis recti

Answer 13

separation of the abdominal rectus muscles with visible bulge along midline

Question 14

Liver size in infant and children

Answer 14

Liver takes up proportionately more space in the abdomen at birth than in later in life

Question 15

Pyloric Stenosis

Answer 15

narrowing of the opening of the pylorus causing food to come back up (congenital defect)

Question 16

Acute gastroenteritis

Answer 16

Stomach flu (An intestinal infection marked by diarrhea, cramps, nausea, vomiting, and fever.)

Question 17

Developmental competence in pregnant women

Answer 17

Nausea and vomiting, Production of hCG, Acid indigestion or “heartburn” “pyrosis” because of esophageal reflux, GI motility decreases prolonging gastric emptying leading to more water reabsorption and constipation, Hemorrhoids, Intestines move upward and posteriorly because the uterus is displaced, Striae and linea nigra are present

Question 18

Developmental competence in aging adults

Answer 18

Salivation decreases, Esophageal emptying is delayed, Gastric acid secretion decreases (leading to pernicious anemia , iron deficiency, anemia, calcium malabsorption)

Question 19

Reason for constipation in aging adults

Answer 19

Decreased physical activity, Low fiber diet, side effects of medications, bowel obstruction, hypothyroidism, inadequate toilet facilities

Question 20

Stool assessments

Answer 20

• Brown/light brown (normal)
• Dark, tarry stool can indicate upper intestinal bleed
• Bright red (frank) bleeding can indicate lower intestinal bleeding
• Clay colored (biliary system)
• Presence of bright red streaks often indicates hemorrhoids or fissures
• Constipation
• Diarrhea (frequency)

Question 21

Emesis Assessment

Answer 21

• Hematemesis
• Frank blood (Upper)
• Blood tinged (Lower)
• Food particles
• Bile
• Coffee ground
• Posttussive emesis
• Amount and Frequency

Question 22

When you’re percussing the abdomen what should it sound like?

Answer 22

• Tympany

- Dull in the upper quadrants, Dull if stool is present

Question 23

Ascites

Answer 23

Fluid in abdominal cavity that can cause change in sound

Question 24

Palpation of the abdomen

Answer 24

You do not want to deeply palpate, palpate last

• *Looking for masses
• *You do not want to feel organs
• *Do not palpate if the patient is immunocompromised or has mono/epstein barr

Question 25

4 contours of stomach

Answer 25

Flat Rounded Scaphoid: dip in the middle of the abdomen Protuberant: Distended at the bottom of the stomach

Question 26

When is Ascites common?

Answer 26

Portal hypertension Cirrhosis Kidney patients , Liver patients

Question 27

Auscultation of the bowels

Answer 27

- Sounds are irregular, gurgling sounds 5-30x/minute - Bowel sounds (How do you describe?) - Listen if there are Vascular sounds or Peritoneal friction rub

Question 28

Borborygmus

Answer 28

sound of hyperperistalsis

Question 29

What happens if abdomen is perfectly silent?

Answer 29

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

Question 30

Liver Span assessment

Answer 30

Percussing the abdomen to see where the liver border is (dull) Usually in the 5th intercostal space Liver usually 10.5 cm for males, 7cm for females

Question 31

Splenic Dullness

Answer 31

Often spleen obscured by stomach contents, but you may locate it by percussing for a dull note from 9th to 11th intercostal space just behind left midaxillary line

Question 32

CVA tenderness

Answer 32

Assessing for costovertebral angle tenderness (CVA) Normal: non tender Tenderness is causes by acute infection (pylonephritis)

Question 33

Ascites sound when percussed

Answer 33

Dull

Question 34

Hooking technique

Answer 34

An alternative method of palpating liver is to stand up at person’s shoulder and swivel your body to right so that you face person’s feet Hook your fingers over costal margin from above -Ask person to take a deep breath -Try to feel liver edge bump your fingertips

Question 35

Palpation of aorta

Answer 35

Using your opposing thumb and fingers, palpate aortic pulsation in upper abdomen slightly to left of midline

Question 36

Rebound tenderness (Blumberg's sign)

Answer 36

Put your hand in the area and pain is felt when the hand is taken off and pressure is no longer put on the spot

Question 37

Rovsing's sign

Answer 37

Pressure on left lower quadrant and the pain is felt on opposite side

Question 38

Inspiratory arrest (Murphys sign)

Answer 38

Sign of cholecystitis

Question 39

Psoas test

Answer 39

Lift left leg straight up while supine and see if pain is felt in McBurneys point

Question 40

Obturator sign

Answer 40

Inflamed appendix when knee is bent and pain is felt

Question 41

Reasons for abdominal distension

Answer 41

``` Obesity Air or gas Ascites Ovarian cyst Pregnancy Feces Tumor ```

Question 42

Succussion splash

Answer 42

Loud splash auscultated over the upper abdomen when infant is rocked side to side -Indicates increased air and fluid in the stomach

Question 43

Peristalsis with projectile vomiting in newborn suggests what?

Answer 43

Pyloric stenosis

Question 44

Hypoactive bowel sounds

Answer 44

Diminished or absent bowel sounds signalling decreased motility as a result of inflammation as seen with peritonitis Occurs with pneumonia

Question 45

Hyperactive bowel sounds

Answer 45

Loud gurgling “borborygmi” signal increased motility that occurs with early mechanical bowel obstruction (high pitched), gastroenteritis, brisk diarrhea, laxative use and subsiding paralytic ileus

Question 46

Peritoneal friction rub

Answer 46

rough grating sound like two pieces of leather rubbed together, indicated peritoneal inflammation

Question 47

Liver friction rub location

Answer 47

friction rub over lower right rib cage from abscess or metastatic tumor

Question 48

Spleenic friction rub location

Answer 48

friction rub over lower left rib cage in left anterior axillary line from abscess, infection or tumor

Question 49

Vascular sounds

Answer 49

Arterial -- bruit indicates turbulent blood flow as found in constricted, abnormally dilated, or tortuous vessels

Question 50

Aortic aneurysm sound

Answer 50

murmur is harsh, systolic, or continuous and accentuated with systole. Note in those with HTN

Question 51

Renal artery stenosis (location and sound)

Answer 51

murmur is midline or towards flank, soft, low to medium pitch

Question 52

Venous hum

Answer 52

In periumbilical region, originates from inf. vena cave. Medium pitches, continuous sound, Palpable thrill, Occurs with Portal HTN and cirrhotic liver

Question 53

Order of Abdomen Exam

Answer 53

Inspect, Auscultate, Percuss, Palpate (lightly)