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186 Cards in this Set
- Front
- Back
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abdominal borders : superiorly by ....
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costal margins
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abdominal borders : inferiorly by ....
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symphysis pibic and inguinal canals
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abdominal borders : laterally by ...
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flanks
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the top third region of your abdominen is known as
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epigastric
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the middle region of your abdominen is known as
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umbilical
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the lower third region of your abdomien is known as
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hypgastric/subrapubic
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LOWER POLE OF R KIDNEY
CECUM AND APPENDIX PORTION OF ASCENDING COLON BLADDER (IF DISTENDED) OVARY AND SALPINX UTERUS (IF ENLARGED) R SPERMATIC CORD R URETER |
RIGHT LOWER QUADRANT RLQ
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LIVER AND GALLBLADDER
PYLORIS DUOEDENUM HEAD OF PANCREAS RIGHT ADRENAL GLAND PORTION OF RIGHT KIDNEY HEPATIC FLEXURE OF COLON PORTION OF ASCENDING AND TRANSVERSE COLON |
RIGHT UPPER QUADRANT RUQ
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L 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 |
LEFT UPPER QUADRANT LUQ
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LOWER POLE OF L KIDNEY
SIGMOID COLON PORTION OF DESCENDING COLON OVARY AND SALPINX UTERUS IF ENLARGED L SPERMATIC CORD L URETER |
LOWER LEFT QUADRANT LLQ
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What are the 4 quadrants of ab
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right upper quadrant
right lower quadrant left upper quadrant left lower quadrant |
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which organs are palpable in the right upper quadrant?
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LIVER
RIGHT KIDNEY ASCENDING/TRANSVERSE COL |
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which organs are palpable in right lower quadrant
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ASCENDING COLON
RIGHT KIDNEY |
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which orgrans are palpable in the left upper quadrant
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TRANSVERSE/DESECENDING COL
SPLEEN IF ENLARGED! |
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which organs are palpable in the left lower quadrant
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DESCENDING/SIGMOID COLON
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the bladder, uterus and prostate gland are located where
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Midline
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what is left of the umbilicus, can see pulsations on very thin patients, and feel pulsation
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Aorta Left Midline
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the bladder, uterus and prostate are palpable where?
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Midline
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name the abdominal wall muscles
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Abdominal Oblique
Internal Abdominus Oblique Transverse Abdominus |
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what protect the internal organs, allow normal compression of internal organs during functional activities (coughing, sneezing, urinating, childbirth)
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Abdominal Wall
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thin shiny serous membrane that lines abdominal cavity is called
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Periotoneum
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aorta, blood vessels are considered what kind of structures
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vascular structures
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all internal organs (solid, hollow)
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VISCERA
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organs that maintain their shape
LIVER PANCREAS SPLEEN ADRENAL GLANDS KIDNEYS OVARIES UTERUS |
SOLID viscera
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shapes change dpeending on content
STOMACH GALLBLADDER SMALL INTESTINE COLON BLADDER PREGNANT UTERUS |
HOLLOW viscera
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what supplies the abdominen with ARTERIAL BLOOD (left midline)
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abdominal aorta
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what can be palpated in RLQ and LLQ
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branches of the aorta below the umbilicus
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what is frequently visible and palpate midline in the upper abdomen?
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pulsations
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what is the BIGGEST indication of an abdominal problem - along with pain, indigestion, n/v, dypshagia?
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CHANGE IN BOWEL PATTERN
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what are the 3 types of pain
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visceral
parietal referred |
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peritoneum becomes inflamed as in appendecitus or periotonitis, it is localized and characterized by severe and steady
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parietal pain
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Occurs when hollow abdominal organs such as the intestines, become distended or contract forecfully
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visceral pain
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bottom of ascending colon on the right side is where you would find an inflammation known as
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Appendecitis
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Occurs at distant sites that are innervated, travels from Primary site and highly localized at a distant site
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Reffered Pain
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what is characterized as dull, aching, burning, colicky, hard to pinpoint, poorly defined, intermittent pain?
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visceral pain
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in referred pain : right shoulder pain indicates
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gallbladder
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in referred pain : left should pain indicates
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spleen/pancreas
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in referred pain : the right or left shoulder pain indicates
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pneumonia
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name some aggravating factors of indigestion
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caffeine, etoh, smoking
ex) belching,. heartburn, gerd |
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hematemesis ulcers is also known as
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bloody ulcers
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look for a change in __________ when observing appetite as well as a 24 hour dietary recall
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taste buds, gain.loss of weight
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CHANGE IN PATTERN OF __________ is the biggest sign of abdominal pain
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bowel elimination
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occult blood is linked to a
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malignancy
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pencil shaped bowel is linked to
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obstruction
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clay colored bowel is linked to
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liver disease
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iron and narcotics majoir side effect is
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constipation
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asa, ibufroen , steroids major side effect is
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gi bleeding/ ucler disease
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overuse of laxative can cause
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incontinence or constipation
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Colace/ Pericolace is a
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stool softener
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metamucil is a
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Bulk/Fiber medication
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senokot is a
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laxative
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dulcolax is a
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laxative
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colon cancer in afamily history is important because it is very
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hereditary
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long term etoh can cause
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liver, pancreas disease
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what affects Gi and muscle tone
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stress
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hepatitis risk HAV =
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Contaminated food, water , feces of contaminated person
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hepatitis risk HBC
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infected bodily fluids
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hepatitis risk HCV =
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infected blood, blood transfusion, tattoos, dialysis
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4 most common diagnosis of acute abdomen
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appendecitis
cholecsistitis SBO small bowel obstruction GYN disorders |
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usually presents as a pain in the right upper quadrant. This is usually a constant, severe pain. caused by gallstones in the gallbladder.
This is usually accompanied by a low grade fever, vomiting and nausea. |
cholecysistitis (RUQ pain)
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what is the BEST tool to use for abdominal assessments
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CAT scan
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what is best used with the CAT scan to see blood flow and tumors
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IV contrast
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what must always be checked prior to using Contrast!?
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KIDNEY FUNCTION (nephrology consult)
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what is the most important thing to do before doing an assessment of the abdomen
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ask patient to empty bladder
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what is the pts position during an abdomen assessment
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lay supine head on pillow with arms folded across chest . slightly flex legs by placing a rolled blanket under knees to relax abdomen muscles
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what is the normal order of an ASSESSMENT
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INSPECT
PALPATE PERCUSS ASUCULTATE |
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what is the normal order of an AB ASSESSMENT
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INSPECT
AUSCULTATE PERCUSS PALPATE LAST ALWAYS! |
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what do you do after inpsection but before percussion
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auscultate abdomen
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what do you examine for in ab assesment
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skin, stomach, bowel, spleen, liver, kindeys, aorta, bladder
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abdominal edema/swelling is called
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ascites
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abdominal masses indicate
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growths or constipation
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blue discolored around umbilicus, cause is intra-ab bleeding is known as
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cullens sign
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flank area is discolored, intra-ab bleeding is knwon as
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gray turners sign
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star like capillaries on chest, signs of a heavy drinker or early liver disease
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spider angionoma
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what should be clean without drainage, midline and inverted
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umbilicus
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abdomen should be symmetric?
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yes
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a protrustion of ab structure through the wall that contains it is known as
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hernias
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a small midline bulge in epigastric region detected while pt is standing by running your finger along linea alba (posterior muscle)
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epigastric hernia
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bulging around incision, can spread incision apart - SPLINT
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incisional hernia
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buliging of umbilicus, can appear sitting or standing
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umbilical hernia
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midline ridged bulging due to separation of 2 rectus ab muscles related to obesity or pregnancy
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diastasis recti (obesity / pregnancy)
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what kind of hernia can be manipulated back?
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reduced
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what kind of hernia is a medical emergency- need surgery immediately, trapped and looped hernia
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incarcerated
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what kind of hernia is a med emergency, need surgery immediately - blood vessels constricted by neck of hernia sac (Ischemic gangrene)
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strangulated hernia
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what are the major causes of DISTENTION
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SIX F'S
FAT FECES FLATUS FLUID FETUS FIBROID FATAL TUMOR |
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a non cancerous tumor usually of uterus, slows then disappears with menipause is known as
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Fibroid
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accumulation of fluid in peritoneal cavity -
skin tight looking - cirrhosis, tumor, cardiac failure |
ascites
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when feces is in the colon, usually in the LOWER LEFT QUDARANT, disappeares with bowel movement or enemas is called
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constipation
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blood vessels constricted by neck of hernia sac is called
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ischemic gangrene
causes strangulated hernias |
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intestinal obstruction, percuss tympany is what kind of distenetion
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gaseous distention
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symmetrical distention
name some |
obesity
ascites gaseous constipation |
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name some assymetrical distentions
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pregnancy
tumors hernias bowel obstruction spinal curvature |
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poor skin turgot is a sign of
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dehyrdation
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a pulsation of aorta would be found where
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left midline, indicative of COPD
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what kind of movement is normally not seen
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peristalsis
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what is the direction of an ABDOMINAL ASSESSMENT for
auscultation |
RLQ and clockwise
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auscultate 2-5 min in each quadrant, lift dont drag steth,
for high pitch sounds ...use the |
diaphragm
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for low pitch sounds (MURMOS) use the
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bell
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for bowel sounds, use the _____________ of the stethoscope
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DIAPHRAGM
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bowel sounds - a long/stomach growling boborygmi is known as
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hyperactive bowel sounds
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bowel sound most active in RLQ (ileoccecal valve), high picture/tinkling sound caused by obstruction
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hypoactive bowel sounds
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bowel sounds should hear gurgles,soft clicks - what is a normal rate
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5-30 times / minute
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a full 5 minutes is necesasry before documenting bowe sounds as
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absent
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a rigid and boardlike abdomen is a sign of
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perforation
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HYPOACTIVE bowel sounds are most active in _________ due to ________-
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most actuve in the RLQ -
due to the ILEOCECAL VALVE |
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no parastalsis, parlyzed, without feeling - is called a
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parlytic ileus
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absent bowel sounds examples are a
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parlytic ileus and ruptured appendix
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for vascular sounds , you use what side of stethsecope
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bell
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when ausculating for vascular sounds, bruits and low pitched murmors are signs of
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stenosis/obstruction
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where do you listen forbruits
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ab aorta
renal artery ileac artery femoral artery if present = obstruction |
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the main artery to listen for bruits, located at the MIDLINE is
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abdominal aorta
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what artery is located on the RIGHT side
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renal artery
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what artery is located on the RIGHT side and DOWN
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Ileac artery
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what artery is located at the bottom
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Femoral artery
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what is a normal sound when percussing
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TYMPANY (GAS/AIR)
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when percussing an organ , mass, distended bladder, fluid what sound will you hear
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Dullness
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an enlarged liver OVER 6-12cm,
indicative of tumor, abscess, cirrhosis |
HEPATOMEGALY
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the normal span of the liver is
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6-12 cm
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what is supine and slightly on the right side, the last interspaces on left at axillary line with inspiration
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SPLEEN
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a normal spleen is NO GREATER THAN
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7CM
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an enlarged spleen OVER 7CM indicates trauma, mono, portal hypertension
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SPLENOMEGALY
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blunt CVA (12th rib and vertebral column) you will find
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kidneys
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PAIN at CVA indicative of
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inflammation/inflamed kidney
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ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). If the infection is severe, the term "urosepsis" is used interchangeably (sepsis being a systemic inflammatory response syndrome due to infection
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polynephritis
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flank pain could =
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cva tenderness
positive cva tenderness = infected kidney |
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posterior , 12th rib and verterbral column is known as the
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CVA ANGLE
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What does splenomegaly indicate
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trauma
mono portal HTN |
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dullness in LUQ is what organ
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spleen
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dullness in RUQ is what organs
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Liver
Gallbladder |
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dullness in LLQ is what
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LLQ = STOOL
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dullness MIDLINE is what
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enlarged uterus
distnended bladder (symphis pubis) |
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palpate for areas of tenderness using light palpation with
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fingertips
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start palpation with what area first
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NON TENDER
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PALPATE umbilicus for what
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swelling/ masses
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to palpate ______ use thumb and first finger and palpate deeply into Epigastrium slightly to the Left of the midline
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Aorta
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never palpate a pulsating midline mass as it could be dissecting
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aneurysm
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pain with palpation over the liver causing patient to take in a deep breath (cholecystitis)
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murphy sign
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the bladder is normally not palpable
y/n |
yes
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smooth, round and somewhat firm mass, extending up to umlicus
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distended bladder
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to palpate _____ begin at symphybis pubis and move upwards
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urinary bladder
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when doing a bladder scan, you must
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void, measure residual
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to measure abdominal girth, you should measure at the same time each day - how...
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standing
use umbilicus as starting point, measure in inches |
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abnormal fluid found in abdomen, abnormal, could be fluid, stool, airdue to heart failure, liver disease
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ascites
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what diagnoses associate with DISTENTION?
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ASCITES
CHF Liver DISEASE PANCREATIC CANCER |
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ASK PATIENT TO PLACE ULNAR SIDE OF HAND AND LATERAL SIDE OF FOREARM ALONG MIDLINE OF ABDOMEN -FIRMLY PLACE PALMAR SIDE OF FINGERS AND HAND AGASINT ONE SIDE OF ABDOMEN AND USE OTHER HAND TO TAP OPPOSITE WALL -
MOVEMENT OF FLUID WILL SUGGEST |
ASCITES
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If ascites is found, you must follow up with
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Ultrasound
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Fluid Moves but air does not move
t/f |
true
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palpate where pain is and suddenly release - a sharp stabbing pain with release
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rebound tenderness
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what is rebound tenderness also called
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BLUMBERG SIGN
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raise right leg, place hand on lower thigh, and pressure on thigh while patient tries to keep leg elevated
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Lliopsoas sign
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pain in RLQ is positive of
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appendecitis
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IF You palpate LLQ and pain is in RLQ - its known as
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rovsings sign
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support R knee and anklle, rotate internally and externally, pain in RLQ =
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Obturator sign
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stroke abdomen with sharp object, if pain in RLQ =
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hypersensitivity
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ALL PAIN IN RLQ =
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Appendecitis
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hepatomegaly is an enlared liver, what signs of disease does it equal
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cirrohiscis
liver disease |
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air/gas sounds are
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tympany
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most common signs and symptoms of abdiominal disease
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change in bowel movement
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severe itching (pruritus) =
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crf, hepatic disease, gi cancer
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start symmetrical inspection where
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foot of bed for symmetry
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percuss where?
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all 4 quadrants
borders of liver and spleen |
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where do you palpate and how
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light and deep
liver and spleen distended bladder |
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you must auscultate for
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bowel sounds
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RLQ PAIN = SUDDEN ONSET =
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Appendecitis
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RUQ = radiates to RIGHT SCAPULA, sudden onset - brought on by food (fatty foods)
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Cholecystitis (Fatty foods)
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LLQ , cramping, radiates to BACK
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diverticulitis
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aching, gnawing, epigastric, RELIEVED BY FOOD
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DUODENAL ULCER (Relieved by food)
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distention, spasms and aching
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Intestinal Obstruction
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pain brought on by food =
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cholecystitis
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pain relived by food =
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duodenal ulcer
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epigastric pain =
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gastritis
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heartburn, chest pain =
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gerd
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RUQ , knifelike pain, deep, radiates to BACK
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pancreatitis
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LLQ pain, diarreah, increased after eating and decreased after BM
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irritable bowel (diarreah)
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RUQ = what organ
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pancreas
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gallbladder disease is increased in what race
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native americans
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hepatitis C and colon cancer is increased in
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blacks
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lactose intolerance incraeses in
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jews
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gastric cancer increases in
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japanese
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for light skin, jaundice is in the
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sclera of eyes
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for dark skin, jaundice is in the
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hard palate of mouth
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ELDERLY =
Liver decreased in size (Drug metabolism), increased gallstones. decreased GI motility (Constipation) |
decreased stomach acid (pernicious anemia, iron deficiency, poor calcium absorption), stomach more rounded due to increae muscle tone, decreased emptying = risk of aspiration
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when examining a pt , the nurse susects intra abdominal bleeding in a patient 4 days post MVA...what sign did the nurse note on texam
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CULLENS SIGN
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discolaration around umbilicus indicative of intra-abdominal bleeding -=
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cullens sound
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what would the nurse conclude when a liver span of an elderlay adult man measures 6cm
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6CM = NORMAL SIZE LIVER
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what would nruse supsect if on inspiration, a dullness is percussed at the LAST INTERSPACE LEFT MIX AXILLARY LINE
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Splenomegaly (liver)
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