Chapter 23

Question 1

peritoneum

Answer 1

lining of the abdominal cavity; two layers parietal and visceral

Question 2

LUQ

Answer 2

most of the stomach, the spleen, the pancreas, and part of the large intestine. The left kidney is behind the abdominal lining.

Question 3

RUQ

Answer 3

most of the liver, the gallbladder, and part of the large intestine. The right kidney is behind the abdominal lining

Question 4

RLQ

Answer 4

the appendix (a worm-shaped structure extending from the beginning of the large intestine), part of the large intestine, and the female reproductive organs.

Question 5

LLQ

Answer 5

Contains part of the large intestine and the female reproductive organs.

Question 6

hollow organ

Answer 6

contain some type of substance that might leak into the abdominal cavity if the organ is perforated or injured. When a hollow organ is perforated or injured, any substance that leaks into the abdominal cavity can lead to chemical or bacterial peritonitis

Question 7

solid organ

Answer 7

vascular (contain many vessels and a large amount of blood). Some are covered by a thick fibrous capsule; blood filled

Question 8

hollow organs

Answer 8

appendix
bladder
bile duct
fallopian tube
gallbladder
instestines
stomach
uterus
ureters

Question 9

Solid organs

Answer 9

kidney
liver
ovaries
pancreas
spleen

Question 10

stomach

Answer 10

saclike, stretchable pouch located below the diaphragm that receives food from the esophagus
enables digestion by secreting a specialized fluid to aid in the breakdown and absorption of food

Question 11

duodenum

Answer 11

first part of the small intestine that connects to the stomach.

Question 12

small intestine

Answer 12

tubelike structure beginning at the distal end of the stomach and ending at the beginning of the large intestine. Its digestive function is to absorb nutrients from intestinal contents.

Question 13

large intestine

Answer 13

tubelike structure beginning at the distal end of the small intestine and ending at the anus. It reabsorbs fluid from intestinal contents, enabling the excretion of solid waste from the body.

Question 14

liver

Answer 14

filters the nutrients from blood as it returns from the intestines, stores glucose (sugar) and certain vitamins, plays a part in blood clotting, filters dead red blood cells, metabolizes medications and toxins, and aids in the production of bile. The liver is proportionally larger in the pediatric patient.

Question 15

gallbladder

Answer 15

pear-shaped sac that lies on the underneath right side of the liver. The gallbladder holds bile, which aids in the digestion of fats

Question 16

spleen

Answer 16

elongated oval solid organ. It aids in the production of blood cells as well as the filtering and storage of blood. The spleen is proportionally larger in the pediatric patient.

Question 17

pancreas

Answer 17

A gland composed of many lobes and ducts. aids in digestion and regulates carbohydrate metabolism.

Question 18

kidneys

Answer 18

Paired organs located behind the abdominal wall lining (retroperitoneal), one on each side of the spine. The kidneys excrete urine and regulate water, electrolytes, and acid–base balance.

Question 19

urinary bladder

Answer 19

saclike structure that acts as a reservoir for the urine received from the kidneys

Question 20

three mechanism of abdominal pain

Answer 20

Mechanical forces (stretching)

Inflammation

Ischemia (organ and tissue hypoxia, or oxygen deficiency)

Question 21

visceral pain

Answer 21

poorly localized, intermittent, crampy, dull, or aching pain

produced by ischemia, inflammation, infection, or mechanical obstruction of an organ

Question 22

parietal/somatic pain

Answer 22

localized intense, sharp, constant pain, associated with irritation of the peritoneum

Question 23

peritonitis

Answer 23

occurs when blood, pus, bacteria, or chemical substances leak into the peritoneal cavity. The onset and type of the abdominal pain a patient experiences are somewhat dependent on the type of substance leaking into the peritoneum.

Question 24

s/s of peritonitis

Answer 24

Abdominal pain or tenderness

Nausea, vomiting, or diarrhea

Fever and chills

Lack of appetite (anorexia)

Positive Markle (heel drop or heel jar) test

Question 25

Markle “Heel Drop” or “Heel Jar” Test

Answer 25

instruct the patient to stand on his feet with his knees straight. Then ask him to raise himself onto his toes and drop suddenly down on his heels, flat-footed, with enough force to produce an audible thump. Because the patient will not know what you are clinically attempting to find out, it is difficult for a skewed response to occur. This is known as a “heel drop” test. This jars the torso, which, in turn, irritates the peritoneal linings

Question 26

rebound tenderness

Answer 26

push slowly down on a quadrant of the abdomen to slightly compress the tissues beneath and then suddenly release the pressure. When the abdominal contents reassume their original location, the peritoneal surfaces rub together. If there is inflammation to the peritoneal linings, it elicits pain in the patient.

Question 27

appendicitis

Answer 27

inflammation of the appendix that commonly causes an acute abdomen. Appendicitis is usually caused by a blockage in the intestines and results in inflammation and irritation. If left untreated, the inflammation eventually causes the tissue to die and rupture. This results in abscess formation (local pus collection), peritonitis, or shock.

Question 28

appendicitis s/s

Answer 28

Nausea and vomiting Low-grade fever and chills Lack of appetite (anorexia) Abdominal guarding Positive Markle (“heel drop” or “heel jar”) test Abdominal pain or cramping—Initially this can be dull, diffuse, and located around the umbilicus because of the distention of the appendix. Later this pain is usually localized to the RLQ medial to the iliac crest (pelvic wing), also called the McBurney point, because of peritoneal irritation.

Question 29

pancreatitis

Answer 29

inflammation of the pancreas, can cause severe pain in the middle of the upper quadrants (epigastric area) of the abdomen. This abdominal pain sometimes radiates to the mid to lower back. Pancreatitis can be triggered by a variety of causes including the ingestion of alcohol, gallstones, or infection

Question 30

pancreatitis s/s

Answer 30

Abdominal pain Nausea and vomiting Abdominal tenderness and distention Mild jaundice (depending on cause) Severe abdominal pain with radiation from the umbilicus (navel) to the back and shoulders Fever, rapid pulse, and signs of shock (in extreme cases)

Question 31

cholecystitis

Answer 31

inflammation of the gallbladder, is commonly associated with the presence of gallstones. This condition is more common in women than men and frequently occurs between the ages of 30 and 50

Question 32

cholecystitis s/s

Answer 32

Sudden onset of abdominal pain located from the middle of the upper quadrants (epigastric area) to RUQ areas (Pain is present more commonly at night and associated with ingestion of fatty foods. Pain can also be referred to the right scapula.) Tenderness upon palpation of the RUQ Belching or heartburn Nausea and vomiting (contents can be greenish)

Question 33

GI Bleeding

Answer 33

occur anywhere within the gastrointestinal tract and can be attributed to numerous causes. Gastrointestinal bleeds are usually classified as upper or lower, based on the location of the bleeding.

Question 34

Upper GI Bleeding

Answer 34

frequently caused by peptic ulcers, gastric erosion, and varices. They are more prevalent in adult males.

Question 35

Lower GI Bleeding

Answer 35

frequently caused by diverticulitis, ateriovenous malformations, or tumors and occur more in women.

Question 36

GI Bleeding s/s

Answer 36

Abdominal pain or tenderness Hematemesis Hematochezia Melena Altered mental status, weakness, or syncope Tachycardia Signs of shock

Question 37

Hematemesis

Answer 37

vomiting blood, which can be bright red or look like coffee grounds

Question 38

hematochezia

Answer 38

bright red blood in the stool normally signifying a rapid onset

Question 39

melena

Answer 39

dark tarry stools containing decomposing blood normally from the upper gastrointestinal system

Question 40

esophageal varices

Answer 40

bulging, engorgement, or weakening of the blood vessels in the lining of the lower part of the esophagus. These abnormalities are common to heavy alcohol drinkers or patients with liver disease usually identified with painless bleeding in the digestive tract.

Question 41

esophageal varices s/s

Answer 41

Large amounts of bright red hematemesis (vomiting of blood) Absence of pain or tenderness in the abdomen Rapid pulse Breathing difficulty Pale, cool, clammy skin Other signs and symptoms of shock Jaundice (yellowing) of the skin or sclerae of the eyes from liver disease (can be seen in some cases)

Question 42

gastroenteritis

Answer 42

inflammation of the stomach and small intestines, is commonly associated with the presence of abdominopelvic pain. can be chronic or acute. If left untreated, it can result in the breakdown of the mucosal layers in the gastrointestinal tract. This breakdown can lead to dehydration, hemorrhage, ulceration, and perforation. Hematemesis, hematochezia, or melena can be present in severe acute cases

Question 43

gastroenteritis s/s

Answer 43

Abdominal pain or cramping Nausea, vomiting, and diarrhea Abdominal tenderness Fever and dehydration severe cases, signs and symptoms of shock and hemorrhage can be present

Question 44

ulcers

Answer 44

open wounds or sores within the digestive tract, usually in the stomach or the beginning of the small intestine

Question 45

ulcer s/s

Answer 45

Gradual onset of abdominal pain described as a burning or gnawing-type pain before meals or during stressful events. An acute onset may indicate perforation. Nausea and vomiting Hematemesis, hematochezia, or melena or coffee-ground emesis in some cases Signs or symptoms of shock in cases of massive bleeding or perforation Peritonitis with a rigid abdomen in cases of perforation

Question 46

intestinal obstruction

Answer 46

a blockage that interrupts the normal flow of the intestinal contents within the intestines. This condition can occur in both the small and the large intestines and can be either partial or complete.

Question 47

intestinal obstruction s/s

Answer 47

Abdominal pain, moderate to severe, depending on location of obstruction—typically described as crampy and colicky Nausea and vomiting Constipation (difficulty in passing stool and flatus is the classic finding in intestinal obstruction) Abdominal distention and tenderness Abnormally prominent, high-pitched bowel sounds with auscultation in early stages (Bowel sounds can be diminished or absent in some later cases.)

Question 48

hernia

Answer 48

a protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall. Hernias are most commonly associated with chronic increases in pressure in the abdominal cavity during heavy lifting or straining, causing the peritoneum to be pushed into the weakness or opening

Question 49

hernia s/s

Answer 49

Sudden onset of abdominal pain (usually after heavy lifting or straining) Fever Rapid pulse Tender mass at point of hernia Others similar to intestinal obstruction

Question 50

abdominal aortic aneurysm AAA

Answer 50

a weakened, ballooned, and enlarged area of the wall of the abdominal aorta. The aneurysm can eventually rupture and is one of the most lethal causes of abdominal pain.

Question 51

aortic dissection

Answer 51

begins with a small tear of the inner vessel structure, which enables blood to leak between the walls of the aorta. The process of dissection continues with increasing pressure until, finally, the outer wall is damaged and blood leaks out behind the peritoneum or into the abdominal cavity.

Question 52

AAA s/s

Answer 52

Gradual onset of lower lumbar, groin, and abdominal pain Rupture associated with sudden onset of severe, constant abdominal pain. Can radiate to the lower back, flank, or pelvis. Can be described as a “tearing” pain. Testicular pain in the male patient Possible nausea and vomiting Mottled or spotty abdominal skin Pale, cool, clammy, and possibly cyanotic skin in legs from decreased blood and perfusion Absent or decreased femoral or pedal pulses If the abdomen is soft and thin, a pulsating abdominal mass can be felt. If the aneurysm has burst, the abdomen will be rigid and tender.

Question 53

acute anemia

Answer 53

Acute anemia can result from a sudden decrease in red blood cells resulting from a source of bleeding

Question 54

sickle cell anemia

Answer 54

some red blood cells have abnormal hemoglobin that does not carry adequate oxygen. As a result, the cells take on a crescent (sickle) shape and become fragile, stiff, and rigid. The sickled cells begin to stack up, blocking capillary blood flow. Cells and tissues become ischemic and can die. Patients with this disease often suffer infections from damaged red blood cells blocking the spleen.

Question 55

sickle cell crisis categories

Answer 55

bone crisis acute chest syndrome abdominal crisis joint crisis

Question 56

bone crisis

Answer 56

typically involves the bones in the back and the large long bones in the arm (humerus) and leg (femur and tibia), causing sudden severe pain

Question 57

acute chest syndrome

Answer 57

sudden onset of chest pain, possibly with dyspnea, hypoxia, and cough, which can be nonproductive, or the patient coughs up blood. A low-grade fever can be present.

Question 58

abdominal crisis

Answer 58

sudden, constant abdominal pain that can be general or localized. There might also be nausea, vomiting, and diarrhea

Question 59

joint crisis

Answer 59

an acute onset of one or more painful, stiff joints.

Question 60

hemophilia

Answer 60

a blood disorder that affects clotting. When a person with hemophilia is injured, it takes longer for the bleeding to stop because clots cannot form properly.

Question 61

deep vein thrombosis s/s

Answer 61

Swelling and increased size of the calf or the entire affected leg Pitting edema Erythema (redness) Increased warmth Tenderness to palpation Pain, which often starts in the calf, is described as cramping and soreness

Question 62

spontaneous abortion s/s

Answer 62

Lower abdominal or pelvic pain Abdominal tenderness Vaginal bleeding Rapid pulse Signs and symptoms of shock (rare)

Question 63

ovarian cyst s/s

Answer 63

Unilateral abdominopelvic pain that can radiate to the back Abdominal tenderness Vaginal bleeding that can be irregular or abnormal Pain during sexual intercourse or bowel movements

Question 64

endometritis

Answer 64

an inflammation of the endometrium. It is most commonly caused by an infection; however, it can also occur from childbirth, abortions, gynecologic procedures, or intrauterine devices

Question 65

endometritis s/s

Answer 65

Abdominopelvic pain or tenderness Fever Abdominal distention Vaginal bleeding or discharge Discomfort during a bowel movement

Question 66

endometriosis

Answer 66

condition in which endometrial tissue grows outside the uterus. The most common sites for endometrial tissue implantation are the abdomen and pelvis, but the tissue can be implanted anywhere in the body.

Question 67

endometriosis s/s

Answer 67

Abdominopelvic pain or tenderness that can be dull or cramping Dysmenorrhea Vaginal bleeding Pain during sexual intercourse or a bowel movement

Question 68

pelvic inflammatory disease PID

Answer 68

an infection of the female reproductive tract. Pelvic infections are caused by bacteria, fungi, or viruses. Most of these infections are caused by the same bacteria that lead to sexually transmitted diseases.

Question 69

PID s/s

Answer 69

Abdominopelvic pain or tenderness Vaginal discharge with an abnormal color, consistency, or odor Fever and chills Anorexia Nausea or vomiting Irregular vaginal bleeding or cramping Pain during sexual intercourse

Question 70

most transmitted std

Answer 70

chlamydia and gonorrhea

Question 71

UTI s/s

Answer 71

Abdominopelvic pain or tenderness Blood in the urine (hematuria) Urine with cloudiness or a foul or strong odor Pain or burning with urination or sexual intercourse Frequent or urgent need to urinate Genital or flank pain Fever or chills Nausea or vomiting Altered mental status

Question 72

kidney stones

Answer 72

crystals of substances such as calcium, uric acid, struvite, and crystine that are formed from metabolic abnormalities.

Question 73

kidney stone s/s

Answer 73

Abdominopelvic pain or tenderness Flank or back pain that is colicky and severe Groin pain Abnormal urine color Pain with urination Frequent or urgent need to urinate Fever or chills Nausea or vomiting

Question 74

kidney failure

Answer 74

not able to filter the wastes and maintain homeostasis as they normally would. Kidney failure is normally classified as either acute or chronic.

Question 75

acute kidney injury

Answer 75

occurs over a period of days and often results from a significant decrease in urine elimination. Some causes of acute renal failure are decreased blood flow to the kidneys from trauma, cardiac failure, surgery, shock, sepsis, and urinary tract obstruction. This condition is sometimes reversible, but many patients require dialysis.

Question 76

chronic renal failure

Answer 76

occurs over a period of years, and the symptoms range from mild at first to severe kidney failure. The causes of chronic renal failure are numerous; however, diabetes and hypertension are linked to many of the cases.

Question 77

kidney failure s/s

Answer 77

Blood in the urine or stools Altered mental status Edema of the feet, ankles, and legs Decreased urine output or cessation of urination Hypertension Swelling or easy bruising Anorexia Tachycardia

Question 78

bp and dialysis

Answer 78

take the blood pressure of a dialysis patient on the arm without the shunt or access sit