Ch. 18 Abdomen

Kehr sign

abdominal pain radiating to the left shoulder, due to peritoneal irritation from blood or other irritants

What identifies the Murphy sign?

abrupt cessation of inspiration on palpation of the gallbladder

Match the following clinical finding to a diagnosis: impairment of renal function causing an acute uremic episode

acute renal failure

Associated symptoms and findings of: cholecystitis

anorexia, N/V, fever, RUQ tenderness and rigidity, RUQ pain that refers to R subscapular region. + Murphy sign

Backflow caused by relaxation or incompetence of lower esophagus

reflux

Match the following clinical finding to a diagnosis: localized infection in the kidney cortex

renal abscess

Stones formed in the pelvis of the kidney from a physiochemical process; associated with obstruction and infections in the urinary tract

renal calculi

Match the clinical finding below to an abdominal condition: colic pain

renal stone

Sound obtained on percussion of a body part that can vibrate freely

resonance

Where is pain felt when an obturator muscle test is positive?

right hypogastric area

In inspection of infants abdomen, the nurse would expect to find

rounded, dome-shaped abdomen that moves with respirations

A concave contour of the abdomen; a sign that suggests diaphragmatic hernia in the newborn

scaphoid abdomen

Associated symptoms and findings of: peritonitis

shallow breathing, N/V, guarding, decreased bowel sounds, (+) obturator and ilopsoas test. pain can be sudden or gradual, generalized or localized; increase in pain with deep breaths + Markle sign, balance sign, and blumberg's sign

Anatomic correlates of L inguinal region

sigmoid colon, L ureter, L spermatic cord, L ovary

Describe venous hum sound

soft, low pitched, and continuous

The _______ is usually palpable at 1-2 cm below costal margin during first few weeks after birth

spleen

Abdominal pain radiating to the left shoulder may be indicative of what?

splenic rupture

Patients with splenomegaly from mononucleosis have an increased risk of

splenic rupture

Associated symptoms and findings of: Ectopic pregnancy

spotting, hypogastric tenderness, mass on bimanual pelvic exam; with rupture: shock, rigid abdominal wall distention lower quadrant pain that may refer to shoulder; agonizing pain if ruptured + Cullen and Kehr sign

A bruit may indicate

stenosis or an aneurysm

Anatomic correlates of L hypochondriac region

stomach, spleen, tail of pancreas, splenic flexure of colon, upper pole of L kidney, L adrenal gland

Commonly known as "stretch marks"

striae

Murphy sign

test for cholecystitis

Which finding on a newborn infant suggests a congenital anomaly?

the umbilical cord has one artery and one vein

Superficial veins are usually visible in

thin infants

Normal percussion findings of the abdomen

tympani over the stomach and small intestine. dull over the solid organs

Low-pitched, resonant, drumlike sound obtained by percussing the surface of a large, air-containing body space

tympany

Match the clinical finding below to an abdominal condition: burning pain

ulcer

What would you auscultate for in the umbilical area?

venous hum

Twisting of the intestine, resulting in an obstruction

volvulus

Anatomic correlates of right hypochondriac region

R lobe of liver, gallbladder, portion of duodenum, hepatic flexure of colon, part of R kidney, R adrenal gland

Nromal bowel sounds

5-30 per minute; high-pitched, gurgling, and irregular sounds

Match the following clinical finding to a diagnosis: relaxation or incompetence of the lower esophageal sphincter

gastroesophageal reflux

Match the following clinical finding to a diagnosis: part of the stomach passing through the esophageal hiatus

hiatal hernia

Describe a friction rub

high pitched; may be heard in association with respiration

Anatomic correlates of hypogastric region

ileum, bladder, uterus (if enlarged)

Possible associated condition for the following auscultation sound: venous hum

increased collateral circulation between portal and systemic venous systems

What does a venous hum suggest?

increased collateral circulation between portal and systemic venous systems

The examiner is unable to palpate the liver or kidney on the pt. Which of the following techniques will help assess tenderness to these organs?

indirect fist percussion

The examiner observes venous return on the abdomen of the patient that moves upward from the pubis to the chest. This finding should make the examiner consider:

inferior vena cava obstruction

What might a friction rub indicate?

inflammation of peritoneal surface from tumor or infection

Possible associated conditions for the following auscultation sound: friction rub

inflammation of peritoneal surface from tumor, infection, or infarction

HPI: Jaundice

onset, duration, character of stools/urine, associated symptoms, exposure to hepatitis, recreational drugs, high risk sexual activity; medications (acetaminophen high dose, antipsychotics, antiepileptics, antibiotics)

Match the following clinical finding to a diagnosis: ulceration, fibrosis, and malabsorption from an inflammatory disorder

Crohn disease

Which statement suggests that a pt may be at risk for contracting viral hepatitis A?

"I have recently been overseas"

The nurse should expect to hear peristalsis every _____- _____ seconds in infants

10 to 30

The umbilical cord should contain

2 arteries and 1 vein

The abdomen protrudes until about ______

3 years of age

Which rule states that the farther away from the navel abdominal pain occurs, the more likely it is to be of physical importance?

Apley rule

A palpation technique used to assess an organ or a mass

Ballottement

Peritoneal irritation is associated with what sign?

Blumberg

Loud, prolonged gurgles

Borborygmi

Past Medical History

GI disorders, hepatitis or liver cirrhosis, surgery/injury, UTI, major illness, blood transfusions, STIs, immunization status

Ecchymosis of the flanks associated with pancreatitis is identified as which of the following signs?

Grey Turner

Ballance sign

Resonance over right flank with patient lying on left side (spleen rupture)

A hiatal hernia is best described as

a protrusion of the stomach through the esophageal opening in the diaphragm

IN which of the following pts would a slight pulsation in the epigastric area be considered a normal inspection finding?

a very thin pt

Match the clinical finding below to an abdominal condition: bruit

aortic aneurysm

Where would you auscultate for bruits in the abdomen?

aortic, renal, iliac, and femoral arteries

Anatomic correlates of R lumbar region

ascending colon, lower half of R kidney, portion of duodenum and jejunum

A pathologic increase in fluid in the peritoneal cavity; may be suspected in the patient with risk factors

ascites

Blumberg sign

assessment technique elicited during abdominal assessment to check for peritonitis (positive = rebound tenderness)

HPI: Nausea

associated vomiting, particular stimuli; medications (antiemetics)

Cullen sign

bruising around umbilicus (pancreatitis or ectopic pregnancy)

Anatomic correlates of R inguinal region

cecum, appendix, lower end of ileum, R ureter, R spermatic cord, R ovary

HPI: Urinary Frequency

change in usual pattern/volume; associated with dysuria or other urinary characteristics; change in urinary stream; medications (diuretics)

HPI: Dysuria

character, associated fever or other systemic signs of illness, increased frequency of sexual intercourse or high-risk sexual activity, amount of fluid intake

HPI: Diarrhea

character, associated symptoms, relationship to: food intake, stressors; travel history medications (laxatives, stool softeners, antidiarrheals)

HPI: Fecal incontinence

character, associated with (laxative use, underlying disease), relationship to: intake, immobilization; medications (laxatives, stool softeners, diuretics)

HPI: Indigestion

character, location, relationship to; onset, palliative factors, medications (antacids)

HPI: Constipation

character, pattern, diet, medications (laxatives, stool softeners, iron, diuretics)

HPI: Vomiting

character, quantity, frequency, ability to keep food/liq down, associated symptoms, related to __, medications (antiemetics)

HPI: Hematuria

character; associated symptoms (pain on voiding, pain, wormlike clots); alternate possibilities (ingestion of red vegetable dyes or phenolphthalein); medications (NSAIDs, anticoagulants, diuretics, antibiotics)

HPI: Urinary Incontinence

character; associated with urgency, previous surgery, coughing, sneezing, walking up stairs, nocturia, menopause; medications (diuretics)

Match the following clinical finding to a diagnosis: stone formation in the gallbladder

cholelithiasis

Match the following clinical finding to a diagnosis: destruction of the liver parenchyma

cirrhosis

You note that the midclavicular liver span of an adult male pt is 18 cm. With palpation, you note that the liver is enlarged and nontender. What do these findings suggest?

cirrhosis

Spasmodic pains in the abdomen

colic

A 61 year old men has a presenting complaint of frequent constipation. He tells the examiner that there has been a change in his BM habits- he gets constipated easily, the stool is very "skinny looking," and it is a different color than usual. He denies pain. What do these symptoms suggest?

colon or rectal cancer

Family History

colorectal cancer/ familial colorectal cancer syndromes, gallbladder disease, kidney disease, malabsorption syndrome, Hirschsprung disease, familial mediterranean fever

What are some expected finding unique to pregnancy?

decreased bowel sounds, linea nigra, striae, diastasis recti, quickening, and venous pattern

Anatomic correlates of L lumbar region

descending colon, lower half of L kidney, portions of jejunum and ileum

Mrs. Cody is 36 weeks pregnant. She tells the examiner she feels like her stomach muscle is splitting. A light protrusion of the abdomen midline is observed. This is recognized as:

diastasis recti

Match the following clinical finding to a diagnosis: LLQ pain, anorexia, N/V, possible constipation

diverticulosis

Grey-turner sign

ecchymoses of the flanks associated with fulminant hemorrhagic pancreatitis; very poor prognostic sign

Pulsations in the the ________ are common in newborns and infants

epigastrium

Associated symptoms and findings of: Pancreatitis

fever, epigastric tenderness, vomiting, sudden and dramatic LUQ/umbilical/epigastric pain that may refer to L shoulder + Grey- Turner sign and Cullen sign

Associated symptoms and findings of: Renal Calculi

fever, hematuria, intense flank pain extending to groin and genitals + Kehr sign

Possible associated conditions for the following auscultation sound: increased bowl sounds

gastroenteritis, early intestinal obstruction, or hunger

What is the correct sequence for examining the abdomen?

inspection, auscultation, percussion, palpation

Possible associated condition for the following auscultation sound: high-pitched tinkling sounds

intestinal fluid and air under pressure, as in early obstruction

Match the clinical finding below to an abdominal condition: pain with gradual onset

intraabdominal infectious process

A 21/2 year old child presents with abdominal pain and stools that are red currant jelly in appearance. Which problem would the examiner suspect?

intussusception

Prolapse, or telescoping, of one segment of intestine into another causing intestinal obstruction; commonly occurs in infants between 3 and 12 months of age

intussusception

Match the following clinical finding to a diagnosis: abdominal pain, bloating, constipation, and diarrhea

irritable bowel syndrome (IBS)

Anatomic correlates of LUQ

left lobe of liver, spleen, stomach, body of pancreas, L adrenal gland, portion of L kidney, splenic flexure of colon, portions of transverse and descending colon

The _________ may be palpable 1-3cm below right costal margin in infants and toddlers

liver edge

Match the clinical finding below to an abdominal condition: dark-yellow urine

liver or biliary disease

Anatomic correlates of RUQ

liver, gallbladder, pylorus (stomach), duodenum (SI), head of pancreases, R adrenal gland, part of R kidney, hepatic flexure of colon, and portions of ascending and transverse colon

Anatomic correlates of LLQ

lower part of L kidney, sigmoid colon, portion of descending colon, bladder (if distended), ovary and salpinx, uterus (if enlarged), L spermatic cord, and L ureter

Anatomic correlates of RLQ

lower part of R kidney, cecum, appendix, part of ascending colon, bladder (if distended), ovary and salpinx, uterus (if enlarged), R spermatic cord, and R ureter

An examiner may wish to use a bimanual technique for abdominal palpation when:

meeting muscle resistance while performing deep palpation

Fan-shaped fold of peritoneum that anchors the small intestine to the abdominal wall

mesentery

The functional ability of the GI tract most severely affected by aging is

motility

Abnormal abdominal venous patterns

normal pattern would have two directions: one going up from the umbilicus and one going down from the umbilicus

Personal and Social History

nutrition, first day of last menstrual period, alcohol intake, recent major life events/stressors, exposure to infectious diseases, trauma, use of drugs, tobacco use

Anatomic correlates of umbilical region

omentum, mesentery, lower part of duodenum, jejunum, and ileum

HPI: Abdominal pain

onset and duration, character, location, associated symptoms, related to; stool and urine characteristics, medications (ASA, NSAIDs, steroids)

Markle sign

pain elicited in a certain area of the abdomen when the standing patient drops from standing on toes to the heels with a jarring landing

Match the clinical finding below to an abdominal condition: knifelike pain

pancreatitis

An enzyme that acts to digest proteins

pepsin

Which of the following techniques is used to confirm the presence of abdominal ascites?

percussion of dullness over dependent areas of the abdomen

The examiner palpates an organ in the left costal margin. Which technique should the examiner use to differentiate between an enlarged left kidney and an enlarged spleen?

percussion, listening for dullness

Muscular contractions that move the products of digestion through the alimentary canal

peristalsis

Serous membrane lining the abdominal cavity

peritoneum

Possible associated conditions for the following auscultation sound: decreased bowel sounds

peritonitis and paralytic ileus

Match the following clinical finding to a diagnosis: hypertrophy of the muscle of the pylorus

pyloric stenosis

Distal section of the stomach

pylorus

Anatomic correlates of epigastric region

pylorus, duodenum, pancreas, portion of liver

Which of the following examination findings is indicative of peritoneal irritation or appendicitis?

rebound tenderness on palpation