210 Final
the absence of bowl sounds is established after listening for:
5 full minutes
Distinguish abdominal wall masses from intra-abdominal masses.
Abdominal wall masses are most commonly umbilical, epigastric, incisional, or spigelian hernias; benign and malignant neoplasms; infections; and hematomas. An intra-abdominal mass is any localized enlargement or swelling in the human abdomen.
Differentiate between light and deep palpation, and explain the purpose of each.
Deep- press 5-8cm in noting the location, size, consistency, and mobility of organs and the presence of any tenderness (occurs with inflammation of peritoneum or underlying organ), enlarged liver, enlarged spleen, enlarged kidney, and Kidney masses. light - press about 1 cm in to get an overall impression of the skin surface and superficial musculature; Muscle guarding, rigidity, large masses, tenderness.
Name the organs that are normally palpable in the abdomen.
Liver, Spleen, Kidneys, Aorta
hypoactive bowel sounds
Sounds following abdominal surgery or with inflammation of the peritoneum.
normal abdominal sounds
There are a wide range of normal bowel sounds and are high pitched, gurgling, cascading sounds occurring irregularly anywhere from 5 to 30 times per minute.
Pyrosis is:
a burning sensation in the upper abdomen.
abdomen
a large oval cavity extending from the diaphragm down to the brim of the pelvis.
Moles on the abdomen:
are common
Paralytic ileus
complete absence of peristaltic movement that may follow abdominal surgery or complete bowel obstruction
pyloric stenosis
congenital narrowing of pyloric sphincter, forming outflow obstruction of stomach
Pyloric stenosis is a(n):
congenital narrowing of the pyloric sphincter.
Aneurysm
defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defect
pyrosis
heartburn; burning sensation in upper abdomen due to reflux of gastric acid
Referred abdominal pain: liver
hepatitis may have mild to moderate dull pain in the right upper quadrant or epigastrium along with anorexia, nausea, malaise, and low grade fever
hyperactive bowel sounds are
high pitched, rushing, tinkling
tympany
high-pitched, musical, drumlike percussion note heard when percussing over the stomach and intestine
A dull percussion note forward of the left midaxillary line is:
indicative of splenic enlargement
Linea alba
midline tendinous seam joining the abdominal muscles
Epigastrium
name of abdominal region between the costal margins
peritoneal friction rub
rough grating sound heard through the stethoscope over the site of peritoneal inflammation
Which of the following can be noted through inspection of a patients abdomen? A. fluid waves and abdominal rigidity B. umbilical eversion and murphy's sign C. venous pattern, peristaltic waves, and abdominal contour D. peritoneal irriation, general tympany, peristaltic waves
venous pattern, peristaltic waves, and abdominal contour
The four layers of large, flat abdominal muscles form the:
ventral abdominal wall
All the internal organs inside the abdominal cavity are called the _______
viscera
striae
(lineae albicantes) silvery white or pink scar tissue formed by stretching of abdominal skin as with pregnancy or obesity
List 4 conditions that may alter normal percussion notes heard over the abdomen.
Obesity, Air or Gas, Ascites, large Ovarian Cyst
epigastric hernia
Protrusion of abdominal structures presents as a small, fatty nodule at epigastrium in midline, through the linea alba. Usually one can feel it rather than observe it. May be palpable only when standing.
The left lower quadrant contains
a portion of the descending colon, sigmoid colon, left ureter, and left ovary and fallopian tube (in women) or left spermatic cord (in men).
Ascites
abnormal accumulation of serous fluid within the peritoneal cavity, associated with heart failure, cirrhosis, cancer, or portal hypertension
Hepatomegaly
abnormal enlargement of the liver
splenomegaly
abnormal enlargement of the spleen
Hernia
abnormal protrusion of bowel through weakening in abdominal musculature
scaphoid
abnormally sunken abdominal wall, as with malnutrition or underweight
Ascites is defined as:
an abnormal accumulation of serous fluid within the peritoneal cavity.
Shifting dullness is a test for:
ascites
umbilicus
depression on the abdomen marking site of entry of umbilical cord
Referred abdominal pain: esophagus
gastroesophageal reflux disease (GERD) is a complex of symptoms of the esophagitis, including burning pain in the midepigastrium or behind lower sternum that radiates upward or "heartburn." occur 30 to 60 minutes after eating; aggravated by lying down or bending over.
Cholesystitis
inflammation of the gallbladder
The sequence of techniques used to exam the abdomen is
inspection, auscultation, percussion, palpation
Air or gas
inspection: single round curve auscultation: depends on cause of gas (e.g. decreased or absent bowel sounds with ileus); hyperactive with early intestinal obstruction percussion: tympany over large area palpation: may have muscle spasm of abdominal wall
Obestity
inspection: uniformly rounded, umbilicus sunken auscultation: normal bowel sounds percussion: tympany, scattered dullness over adipose tissue palpation: normal, may be hard to feel through thick abdominal wall
viscera
internal organs
suprapubic
name of abdominal region just superior to pubic bone
Contrast rigidity with voluntary guarding.
voluntary guarding - Person is cold, tense, or ticklish. Bilateral and will feel the muscles relax slightly during exhalation rigidity - Constant, board-like hardness of the muscles, Unilateral; Painful in localized area when person attempts a sit-up.
Describe the procedure and rationale for determining costovertebral angle/CVA tenderness.
-Place hand over 12th rib at the costovertebral angle on the back. -Thump the hand with the ulnar edge of the other first Pain occurs with inflammation of the kidney or paranephric area
the normal range of liver span in the right midclavicular line in the adult is:
6 to 12 cm
The abdomen normally moves with breathing until the age of __ years.
7
Incisional hernia
A bulge near an old operative scar that may not show when person is supine but is apparent when the person increases intra-abdominal pressure by a sit-up, by standing, or by the Valsalva maneuver.
Describe the proper positioning and preparation of the patient for the examination.
Make sure the room is a warm temp, use good lighting & drape breast and genitals. Ask the patient if their bladder is empty. Position the patient supine, with head on a pillow, the knees bent or on a pillow, and the arms at sides or across the chest. Discourage the pt from placing arms over their head because this tenses abdominal musculature.
Discuss inspection of the abdomen, including findings that should be noted.
Note: Contour, Symmetry, Umbilicus Skin, Pulsation, Hair distribution and Demeanor.
State the rationale for performing auscultation of the abdomen before palpation or percussion.
Percussion and palpation can increase peristalsis and give a false interpretation of bowel sounds.
Contrast visceral pain and somatic/parietal pain.
Somatic, parietal pain is from inflammation of the overlying peritoneum: sharp, precisely localized, aggravated by movement. Visceral pain is from an internal organ: dull, general, poorly localized.
Describe the procedure for auscultation of bowl sounds.
Use the diaphragm of the stethoscope to press lightly on the skin. Listen to all four quadrants starting in the RLQ at the ileocecal valve. Note characteristic and frequency of bowel sounds. Listen for 5 minutes to determine that bowel sounds are completely absent. Vascular sounds can be heard using the bell to listen for bruits/ARIF, aorta, renal, iliac, and femoral.
succession splash
Very loud splash heard over the upper abdomen when an infant is rocked side to side; indicates increased air and fluid in the stomach as seen with pyloric obstruction or large hiatus hernia.
Costovertebral angle (CVA)
angle formed by the 12th rib and the vertebral column on the posterior thorax, overlying the kidney
auscultation of the abdomen may reveal bruits of the ______ arteries
aortic, renal, iliac, and femoral
Referred abdominal pain: appendix
appendicitis typically starts as dull, diffused pain in periumbilical region that later shifts to severe, sharp, persistent pain and tenderness localized in the right upper quadrant (McBurney point). Pain is associated with anorexia, then nausea and vomiting, fever.
To obtain subjective data ask about
appetite and dysphagia, food intolerances, abdominal pain or nausea and vomiting, bowel habits, past abdominal history or surgery, current medications, and nutrition.
The symptoms occurring with lactose intolerance include: A. bloating and flatulence B. gray stool C. hematemesis D. anorexia
bloating and flatulence
Bruit
blowing, swooshing sound heard through a stethoscope when an artery is partially occluded
Auscultating the abdomen is begun int he right lower quadrant because:
bowel sounds are always normally present here
Referred abdominal pain: gallbladder
cholecystitis is biliary colic, sudden pain in the right upper quadrant that may radiate to right or left scapula and that builds over time, lasting 2 to 4 hours, after ingestion of fatty foods, alcohol, or caffeine. associated with nausea and vomiting and with positive Murphy sign or sudden stop in inspiration and jolt in pain with right upper quadrant palpation
Older adults have: A. decreased salivation leading to dry mouth B. increased gastric acid secreation C. increased liver size D. decreased incidence of gallstones
decreased salivation leading to dry mouth
The abdomen extends from the _______ to the ______.
diaphragm, pelvis
Dysphagia
difficulty swallowing
Referred abdominal pain: duodenum
duodenal ulcer typically has dull, aching, gnawing pain; does not radiate; may be relieved by food; and may awaken the person from sleep
Cecum
first or proximal part of large intestine
Referred abdominal pain: stomach
gastric ulcer pain is dull, aching, gnawing epigastric pain, usually brought on by food and radiates to back or substernal area. pain of perforated ulcer is burning epigastric pain of sudden onset that refers to one or both shoulders
Referred abdominal pain: small intestine
gastroenteritis has diffused, generalized abdominal pain with nausea, diarrhea
Intestinal obstruction
history of previous abdominal surgery with adhesions vomiting absence of stool or gas passage distended abdomen (after second day) x-ray shows dilated air-filled loops of small bowel with multiple air-fluid levels hyperactive bowel sound sin early obstruction dehydration and loss of electrolytes accumulation of fluid and gas in bowel proximal (above) to obstruction colicky pain from strong peristalsis above the obstruction fever pressure from excess fluid and gas may cause leaking fluid into peritoneum hypovolemic shock (low blood pressure, cool skin if left untreated)
Ovarian cyst (large)
inspection: curve in lower half of abdomen, midline. everted umbilicus auscultation: normal bowel sounds over upper abdomen, where intestines are pushed superiorly percussion: top dull over fluid. intestines pushed superiorly. large cysts produce fluid wave and shifting dullness palpation:transmits aortic pulsation, whereas ascites does not
Tumor
inspection: localized distention auscultation: normal bowel sounds percussion: dull over mass if reaches up to skin surface palpation: defined borders. distinguished from enlarged organs or normally palpable structure
Feces
inspection: localized distention auscultation: normal bowel sounds percussion: tympany predominates. scattered dullness over fecal mass palpation: plastic like or rope like mass with feces in intestines
Ascites (examination)
inspection: single curve, everted umbilicus. bulging flanks when supine. taut glistening skin; recent weight gain; increase in abdominal girth auscultation: normal bowel sounds over intestines, diminished over ascitic fluid percussion: tympany at top where intestines float. dull over fluid. produces fluid wave and shifting dullness palpation: taut skin and increased intra-abdominal pressure limits palpation
Pregnancy
inspection: single curve, umbilicus protruding, breasts engorged auscultation: fetal heart tones, bowel sounds diminished percussion: tympany over intestines, dull over enlarging uterus palpation: fetal parts, fetal movements
Referred abdominal pain: kidney
kidney stones prompt sudden onset of severe colicky flank or lower abdominal pain
Referred abdominal pain: colon
large bowl obstruction has moderate, colicky pain of gradual onset in lower abdomen and bloating. irritable bowel syndrome (IBS) has sharp or burning cramping pain over a wide area; does not radiate. brought on by meals, relieved by bowel movement
Inguinal ligament
ligament extending from pubic bone to anterior superior iliac spine, forming lower border of abdomen
The organ in the right upper quadrant of the abdomen is the: A. spleen B. liver C. cecum D. sigmoid colon
liver
Right upper quadrant tenderness may indicated pathology in the:
liver, pancreas or ascending colon
Anorexia
loss of appetite for food
Borborygmi
loud, gurgling bowel sounds signaling increased motility or hyperperistalsis; occurs with early bowel obstruction, gastroenteritis, diarrhea
hyperactive abdominal sounds
loud, high pitched rushing, tinkling sounds that signal increased motility
Costal margin
lower border of rib margin formed by the medial edges of the 8th, 9th, and 10th ribs
To obtain objective data
make sure that the patient's abdominal wall is relaxed and that his or her bladder is empty.
rectus abdominis muscles
midline abdominal muscles extending from rib cage to pubic bone
Diastasis recti
midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles
A positive Murphy's sign is best described as:
pain felt when taking a deep breath when the examiner's fingers are on the approximate location of the inflamed gallbladder
Referred abdominal pain: pancreas
pancreatitis has acute, boring midepigastric pain radiating to the back and sometimes to the left scapula or flank, severe nausea and vomiting
A postive Blumberg sign indicates:
peritoneal inflammation
Methods to enhance abdominal wall relaxation during examination include: A. a cool environment B. having the patient place arms above head C. examining painful areas first D. positioning the patient with knees bent
positioning the patient with knees bent
umbilical hernia
protrusion of the intestine through a weakness or incomplete closure in the umbilical ring. brought on by increased intra-abdominal pressure as with crying, coughing, vomiting, or straining; most common with premature infants. in adults it occurs with pregnancy, chronic ascites or chronic intrathoracic pressure (asthma, chronic bronchitis)
Describe rebound tenderness.
rebound tenderness -abdominal pain -Choose site away from painful area -Hold hand at 90 degrees and push down slowly and deeply -Lift hand up quickly - A normal response is no pain.
Tenderness during abdominal palpation is expected when palpating the:
sigmoid colon
A female patient has a stiae on the abdomen. Which color indicates a long-standing striae?
silvery white
the left upper quadrant contains the: A. liver B. appendix C. left ovary D. spleen
spleen
The midline of the abdomen contains
the aorta, bladder (if distended), and uterus (if enlarged in women).
The right lower quadrant of the abdomen contains
the cecum, appendix, right ureter, and right ovary and fallopian tube (in women) or right spermatic cord (in men).
The right upper quadrant of the abdomen contains
the liver, gallbladder, duodenum, head of the pancreas, right kidney and adrenal gland, hepatic flexure of the colon, and part of the ascending and transverse colon.
The left upper quadrant contains
the stomach, spleen, left lobe of the liver, body of the pancreas, left kidney and adrenal gland, splenic flexure of the colon, and part of the transverse and descending colon.