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.