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67 Cards in this Set
- Front
- Back
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Small intestine
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where much of the digestion and absorption of food takes place
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Parts of the small intestine?
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Duodenum
Jejunum Ileum |
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Large intestine
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Its function is to absorb water from the remaining indigestible food matter.
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How long does it take to break food down in the Large intestine?
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16-24 hours
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The large intestine is ______ but ______ than the small intestine
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wider (diameter); shorter
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Best place to hear bowel sounds?
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Small intestine
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What is the function of the stomach?
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Consists of 3 lobes: fundus, body, pylorus Aids in the breakdown of food particles, very little absorption takes place in the stomach. Secretes hydrochloric acid and digestive enzymes to breakdown fats and proteins. Two digestive enzymes include: Pepsin acts to digest proteins Gastric lipase acts on emulsified fats
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Where is the liver and gallbladder located?
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RUQ
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Where is the spleen and stomach located?
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LUQ
Spleen under diaphragm; Stomach under Xyphoid process |
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Why is do we have acid reflux or gerd?
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b/c of cardiac sphincter issues. If it becomes weak or damaged, it may not open and close at appropriate times. This often causes the contents of the stomach, including stomach acid, to go back through the sphincter into the esophagus.
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Ulcers can occur in the Duodenum.
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True
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What does the liver do?
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Produces bile, cholesterol, breakdown fat and Vit A,D,E,K * and stores RBC before they are broken down.
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Best time to give statins? Why?
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At night, because that's when the liver "wakes up"
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What is the peritoneum?
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thin membrane that lines the abdominal and pelvic cavities, and covers most abdominal viscera (organs).
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What does the peritoneum do?
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shifts fluid across so it can be eliminated.
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What is the viscera?
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all the internal abdominal organs.
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What is the linea alba
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tendinous seam (white line)
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rectus abdominis
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"abs" protect and hold organs in place; flex the vertebral column.
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Order of abdominal exam
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Inspection, Auscultation, Percussion, Palpation
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When inspecting the abdomen, look for?
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shape, contour, symmetry, pulsations, bulges, color, hair distribution
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Types of abdomen contours...
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flat, round, scaphoid, protuberant.
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Why do we auscultate before percussion and palpation in the abdomen?
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Because percussion and palpation can increase peristalsis (muscle contractions) which can give a false interpretation of bowel sounds. (also, least invasive)
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What are bowel sounds? How often do they occur?
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high pitched, gurgling, cascading sounds. 5 to 30 times per minute.
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Types of bowel sounds?
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Normo-active, Hyperactive, Hypoactive
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Example of hyperactive?
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borborygmus "Stomach growling"
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How do hyperactive bowel sounds sound?
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loud, high pitched, rushing, tinkling sounds that signal increased motility.
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When do you usually get hypoactive or absent bowel sounds?
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post surgery or with inflammation of the peritoneum.
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How long must you listen before you can stay "Absent" bowel sounds?
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5 minutes.
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Are vascular (vesicular) (bruits) sounds usually heard? Where are they heard?
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No but listen for pts with HTN. also a few people under 40 may have bruits from celiac artery (heard bt x. process and umbilicus)
Listen at the aorta, renal artery, illac and femoral arteries. |
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Why do we percuss the abdomen?
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To assess density, to locate organs and to screen for abnormal fluids or masses.
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When percussing the spleen you will hear a ________ sound from the 9th to 11th intercostal space.
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dull
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A dull note forward of the midaxillary line indicates enlargement of the spleen, trauma and infection.
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True
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Enlargement of the spleen is usually a sign of....
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mononucleosis
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CVA tenderness is a type of...used for what?
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indirect fist percussion; to assess the kidneys.
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Should hear _____ sounds in the liver, kidney, spleen
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dull
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Percuss in the _________ space
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intercostal
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What is ascites?
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free fluid in the peritoneal cavity.
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What two percussion test differentiate ascites from gaseous distention?
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Fluid wave test, Shift test
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Fluid wave test is?
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Put pt's hand (ulnar edge) on chest. Put left hand on pts right flank. strike pts left flank with right hand. Ascites is present if you feel a distinct tap on (other) non-striking hand.
If abdomen is distended bc of gas or adipose tissue ....you will feel no change. |
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Shift test.
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Supine position. goes from tympany to dull (as you go from middle of ab to side). Pt turns to right side. goes from tympany to dull (as you go from navel to side). The shifting of dullness indicates presence of fluid.
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Why do we palpate the abdomen?
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For size, location, mass, tenderness
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How far do we go in for light palpation? deep?
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1 cm; 5 to 8 cm (1-1.5 inches)
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For very obese pts, how to we palpate?
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bimanual technique. Hand over hand.
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Use the hook technique to palpate the liver.
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True
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Are the liver and spleen usually palpable in adults?
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no
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When can the spleen be felt?
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When its three times its normal size.
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How to palpate the abdominal aorta?
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pinch/poke near belly button
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When to use rebound tenderness?
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When pts reports abdominal pain or when you feel pain during palpation.
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Rebound tenderness...how to?
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choose site away from painful area. hold hand at 90 degrees. push down slow and deep then lift up quickly.
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Results of rebound tenderness?
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Normal= no pain or release.
Pain on release confirms rebound tenderness which indicates peritoneal inflammation which accompanies appendicitis. |
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Umbilical cord on infants...
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contain 2 arteries and one vein
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The Liver on infants
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In infants the liver takes more space in the abdomen at birth than later in life.
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The urinary bladder in infants...
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The urinary bladder in infants is located higher in the abdomen than in the adult. Its bt the umbilicus and symphysis.
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During early childhood, the abdominal wall is ______ muscular, so the organs may be easier to __________
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less; palpate
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What is the contour of an infants abdomen?
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protuberant because of immature abdominal musculature.
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the umbilical stump, dries and hardens? fall off? skin covers?
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dries and hardens within a week.
falls off 10-14 days. skin covers the area 3-4 weeks. |
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Infant auscultation
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should only hear bowel sounds, no vascular sounds.
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Infant percussion stomach/abdomen sounds
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tympany
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Infant percussion liver sounds
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dull
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Infant percussion bladder
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can hear dulllness
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In the aging adult you may notice __________ in the absence of obesity
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peristalsis.
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Elderly also easier to _______ organs because of a thinner softer wall.
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palpate
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Symptoms of pregnancy
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N/V, unknown why but some suspect hCC.
Constipation Also acid reflux. |
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Pregnant woman bowel sounds
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Diminished
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In pregnant women, the enlarged uterus does what?
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Displaces the intestines upward and posteriorly. Bowel sounds diminished.
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With the aging adult...
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less salivation causing dry mouth; harder to break down food. gallstones increase with age; liver decreases 25%; constipation.
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With the aging adult, esophageal emptying is delayed so if fed in supine postion...
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increased risk for aspiration
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