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
