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272 Cards in this Set
- Front
- Back
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This serous membrane lines the abdominal cavity and forms a protective cover for any of the abdominal structures.
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Peritoneum
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Double folds of peritonieum around the stomach =
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Greater and Lesser omentum
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A fan-shaped fold of the peritoneum, which covers most of the small intestine and anchors it to the posterior abdominal wall
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Mesentary
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How long is the alimentary tract?
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27 feet long
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How are food and the products of digestion moved along the length of the GI tract?
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Peristalsis
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What controls Peristalsis?
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Autonomic Control
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How long is the esophagus?
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10 inches long
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Where does the esophagus enter the stomach?
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at the Cardiac Orifice
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What are the 3 parts of the stomach?
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Fundus
Body Pylorus |
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What is the middle 2/3 of the stomach called?
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the Body
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What is the fxn of Pepsin?
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Digests proteins
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What is the fxn of Gastric Lipase?
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Emulsifies fats
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How long is the small intestine?
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21 feet long
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Where does the SI join the LI?
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Ileocecal valve
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How long is the duodenum?
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12 inches long
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Which part of the SI curves around the head of the Pancreas?
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the duodenum
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Where do the common Bile duct and Pancreatic duct open into?
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The Duodenum, at the duodenal papilla
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Where is the duodenal papilla located?
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~ 3 inches below the pylorus of the stomach
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How long is the Jejunum
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8 FEET
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How long is the Ileum?
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12 FEET!
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What prevents backward flow of material from the LI into the SI?
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the Ileocecal valve
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Where does absorption of nutrients mainly take place?
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SI
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What digestive stuff is in the SI
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Pancreatic enzymes
Bile Other enzymes |
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Where the Vermiform appendix attach and extend from
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the Cecum (LI)
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What are the 2 top corners of the LI called?
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Hepatic and splenic flexure
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How long is the LI?
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~ 4.5 - 5 feet long
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What is the diameter of the LI?
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2.5 inches
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What kind of absorption occurs in the LI?
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Water
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What kind of pH does the LI have and why?
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More alkaline pH, b/c LI's mucous glands secrete alkaline mucus to neutralize the acid formed from the bacteria
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What is the process of live bacteria decomposing undigested food residue, unabsorbed amino acids, and cell debri called?
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Putrefaction
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Which Quadrant does the liver lie in?
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RUQ
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How much does the liver usu weigh?
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3 lb
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How any lobes does the Liver have?
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4!
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Where does the bile secreted from the hepatocytes go?
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Outta the hepatocytes, and drains form the bile ducts into the hepatic duct --> Common Hepatic duct.
Then joins the Cystic duct to form the Common Bile Duct, then enters the Duodenum |
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Describe the blood flow of the Hepatic Artery
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Aorta straight to liver
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Describe the blood flow of the Portal Vein
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Carries blood from GI and Spleen TO Liver
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Describe the blood flow of the Hepatic Veins
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There are 3 of them, they carry blood FROM the Liver TO IVC
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What role does the Liver play with Glucose?
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It takes glucose and stores it as glycogen until its needed again, then it spits it out as glucose.
It can also do Gluconeogenesis (aa's to glucose) |
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Role of the liver in Fat metabolism
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1. Takes Fatty acids and oxidizes them to 2-carbon components in prep to enter the TCA
2. Uses Cholesterol to make Bile Salts 3. Makes fats from carbs and proteins |
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Role of liver in Protein metabolism
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Breaks proteins down into aa's via hydrolysis and their waste products ---> Urea to be excreted
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What are some other fxns of the liver?
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- Storage of Vitamins and iron
- Detox - Makes Ab's - Conjugate and excrete steroids - Makes PROTHROMBIN, fibrinogen, and coag factors - Converts fat-soluble wastes to water-soluble material for renal excretion |
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Length of GB
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4 inches long
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2 structures that form the common bile duct
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Cystic duct + Hepatic duct
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CCK is made where?
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Duodenum
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What does CCK do?
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Stimulates GB to relesase bile into the cystic duct
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What is bile made of?
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chosterol
bile salts pigments |
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Function of bile?
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To maintain the alkalinity of SI to permit emulsification of fats to they can be absorbed
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Where does the pancreas lie?
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Behind and Beneath the stomach
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What is the Duct of Wirsung?
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Pancreatic duct
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Pancreatic duct empties into____?
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Duodenum at duodenal papilla, along side the common bile duct
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When are pancreatic emzymes activated?
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Upon entering duodenum
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Where is the spleen located?
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LUQ, just below the diaphragm
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White pulp is
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Lymphoid, part od RES, most of the spleen
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Red pulp is
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capillary and venous netweork, to store blood and release blood
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What space does the kidney lay in, and at what vertebral LEVELS
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Retroperitoneal space
T12 - L3 |
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How many nephrons does each kidney contain?
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~ 1 million
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Each kidney gets how much of the CO?
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1/8 of the CO
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structural and functional unit of kidney
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nephron
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What is the capacity of the urinary bladder?
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400 - 500 mL
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What is the GFR in men and women?
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MEN: 125 mL/min
WOMEN: 110 mL/min |
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Which muscles make up/protect the abdomen?
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rectus abdominus anteriorly
internal, external obliques laterally |
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origin and insertion of linea alba?
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Xiphoid process to pubic symphisis
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LInea alba contains the __
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umbilicus
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Poupart ligament = ?
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Inguinal ligament
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O/I of Inguinal ligament
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ASIS -> Pubis, B/L
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Which side of the abdomen does the aorta descend?
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on the left side
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Where does the aorta bifurcate?
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at the level of the umbilicus
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Splenic and Renal aa branch off the aorta where?
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in abdomen
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Motility of GI develops in which direction?
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cephalocaudad direction
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What is meconium?
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End product of fetal metabolism
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Week 4 =
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Pancreatic bud
liver gall bladder |
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Week 17 =
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Amniotic fluid can be swallowed
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36 - 38 weeks =
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GI tract is capable of adapting to extrauterine life
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***** When does the GI reach adult levels? *****
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2-3 yrs old.
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Week 6
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Liver start to form Blood cells
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Week 9 =
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glycogen
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Week 12 =
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bile
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12 weeks
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pancreatic islet cells are developed
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When does pancreas start making insulin?
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12 weeks
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When does spleen begin to destroy blood cells in addition to storing them?
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after 1 yr old.
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When does the spleen start to form hemoglobin?
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after 1 yr old
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When is the kidney able to produce Urine? and thusthe bladder expands as a sac
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12 weeks
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When does nephrogenesis begin during fetal life?
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2nd embryonic month
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Development of NEW nephrons ceases when?
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by 36 weeks of gestation
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GFR before 34 weeks of gestation?
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0.5 mL/min
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the GFR grows in ___ fashion
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Linearly
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When do the rectus abdominus muscles separate?
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third trimester
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when does lightening occur?
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~ 2weeks before tern in a nullipara
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In the second trimester:
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decreased pressure of lower esophageal sphincter; peristaltic wave velocity decreases; gastric emptying is normal.
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GI transit time is prolonged during what part of pregnancy?
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2nd and 3rd trimesters
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Gall stones are more common when?
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2nd and 3rd trimesters
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Kidneys enlarge by how much during PREGNANCY?
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~ 1cm in length
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Dilation of ureters is greater on which side?
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Greater on Right side
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Renal function is most efficient in preg. women in which POSTITION?
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Lateral Recumbent - b/c it helps prevent compression ofhte vena cava and aorta
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How long do the urinary and bladder changes last after pregnancy?
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3-4 months
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What causes increased frequency and urgency during pregnancy?
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Bladder gets more sensitive and increased compression
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When is frequency and urgency most common in fregnancy
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1st and 3rd trimesters
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After 4th month: increase in uterin size, hyperemia, and hyperplasia of mm and CT --->
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elevation of the bladder trigone and thickening of posterior margin
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elevation and thickeining of trigone ---->
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deepening and widening of trigone by end of preg. and Increased MICROHEMATURIA
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What causes urgency during hte 3rd trimester?
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descent of the fetus can compress the bladder.
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Preg: colon is displaced:
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Laterally upward
& Posteriorly |
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Preg: peristalsis may...
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decrease
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Preg: water absorption is...
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increased
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Preg: Bowel sounds are....
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diminished
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Preg: APPENDIX is displaced____ and is ____ form McBurney's Point
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UPWARD and LATERALLY (High and to the Right)
and AWAY from McBurney's Pt. |
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What causes hemorrhoid formation?
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Bloof flow to pelvis INCREASES and so doe venoud pressure
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Immediately after delivery, the uterus gets to the size of __
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a 20 week preg.
at level of umbilicus |
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at the end of the first week after deliver, utersus is what size?
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= to 12 week preg. at pubic symphysis
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Pelvic floor needs how long to recover?
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6-7 weeks
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Immediately after delivery, the uterus gets to the size of __
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a 20 week preg.
at umbilicus |
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at the end of the first week after deliver, utersus is what size?
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= to 12 week preg. at pubic symphysis
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Pelvic floor needs how long to recover?
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6-7 weeks
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aging affects what part of the GI the most?
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Motility
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What happens to GI mucosal cells with old age?
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Lesser degree of differentiation
Secrete less mucous and digestive enzymes |
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Increasing obesity and DM Type II with aging put the liver at risk of what pathologic disease?
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Nonalcoholic Steatohepatitis
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When does liver size start to decrease?
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after age 50
which parallels the decrease in lean body mass |
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What happens to the bacterial flora in the GI w/ old age
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become less biologically active
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What happens to the main pancreatic duct and its branches with old age?
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they WIDEN
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Is pancreas size affect by old age?
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NO
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Where do you begin inspection of the abdomen?
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from a seated position, ad the patient's RIGHT side.
Allows a TANGENTIAL view. |
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Above the umbilicus, venous return should be ____, Below the umbilicus VR should be _____.
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Towards the head above Umb.
Towards feet below umb. |
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how do you determine the direction of venous return?
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put index fingers of both hands side by side over a vein. Press laterally, spearating fingers and milking empty section of vein. Release 1 finger and time refill. Do same for other finger. Faster filling side = direction of flow.
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What is Cullen's sign?
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Bluish periumbilical discoloration
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What does Cullen's sign indicate?
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intraabdominal bleeding
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Glistening, taut appearance =
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ascites
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Areas of REDNESS =
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inflammation
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Bluish periumbilical discoloration =
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intraabdominal bleeding (Cullen's sign)
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What can cause striae?
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Pregnancy
wt gain abdominal tumor ascites Cushing's disease |
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New striae =
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pink or blue
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older striae =
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silvery white
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purplish striae =
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Cushing's disease
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pearl-like, enlarged umbilical node =
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intraabdominal lymphoma
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Inspect the abdomen for..
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Contour, symmetry and surface motion
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What is contour?
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the abdominal profile from the rib margin to the pubis, viewed on the horizontal plane.
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Expected contours =
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Flat, round or scaphoid.
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FLAT contour =
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well-muscled, athletic adults
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Young children have ______contour
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ROUNDED / convex
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ROUNDED contour =
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Children or out of shape adults
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Scaphoid (concave) =
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Thin adults
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Maximum height of convexity of abd. should be where?
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at the umbilicus
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Umbilical inflammation, swelling or bulges =
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hernia
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Venous flow pattern in diagonal/star pattern =
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Portal hypertension
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Venous flow pattern in straight direction =
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normal
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Venous flow patter in swerve pattern around umbilicus =
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IVC obstruction
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Generalized symmetric distension may occur b/c of....
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Obesity
enlarged organs fluid/gas |
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Distension from umbilicus to symphysis =
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ovarian tumor
preg. uterine fibroids distended bladder |
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Distention of ippe half, above umbilicus =
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carcinoma
pancreatic cyst gastric dilation |
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Asymmetric distension/protrusion =
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Hernia
tumor cysts bowel obstruction organomegaly |
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Ask pt to raise head looks for
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superficial abd. wall masses or hernia
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Proturusion of navel =
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umbilical hernia
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A nonreducable hernia in which the blood supply is obstructed needs
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immediate sugical attention
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When does separation of the rectus abdominus mm becom apparent?
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when the pt raises their head.
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Diastasis recti is usu caused by...
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preg. or obesity
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males = __ movement wiht respiration
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abdominal
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females = __ movement with respiration
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thoracic
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limited abdominal movement w/respiration in MALES =
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peritonitis or disease
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Is surface motion from peristalsis normal? what does it indicate?
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Abnormal. = inestinal obstruction
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How is auscultation difference in teh abdominal exam?
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Its done before precussion an palpation, b/c they can alter the frequency and intensity of bowel sounds
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What part of hte stethoscope do u use to listen to BOWEL sounds??
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Diaphragm
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What part of hte stethoscope do u use to listen to VASCULAR sounds??
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BELL
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BOWEL sounds are: localized or generalized?
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Generalized, so can be heard in one spot
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VASCULAR sounds are: localized or generalized?
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Localized
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Which part of the stethoscope do u use to listen over the LIVER and SPLEEN (vascular sounds)
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Diaphragm
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In which region do u listen for bruits in the aortic, renal, iliac, and femoral arteries?
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EPIGASTRIC region
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Listen for venous hum: Use __ IN __ area.
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BELL, Epigastric region
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Venous hum is___
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Soft, LOW pitched and CONTINUOUS
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Venous hum occurs with....
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Increased collateral circulation between protal and systemic venous systems
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Musical note of higher pitch than resonance
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Tympany
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Pitch lies between tympany and resonance
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Hyperresonance
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Sustained note of MODERATE pitch
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Resonance
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Short, high-pitched note with littl eresonance
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Dullness
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Tympany is heard where?
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Over Air-filled viscera
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Hyperresonance is heard where?
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Base of LEFT LUNG
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Resonance heard where?
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Over lung tissue and sometimes over the abdomen
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Dullnes heard where?
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Over solid organs adjacent to air-filled structures
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The area of liver dullness is usu heard where?
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Costal Margin
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Where do you always start percussion of the liver?
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Right MidClavicular Line
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What causes downward displacement of the liver?
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Emphysema or other pulmonary disease
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Upper border of liver is usu. where?
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5th to 7th ICS
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Liver is larger in Males or Females???
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Males
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When is liver larger in Females?
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Early years of life - before AGE 2
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What causes OVERestimation of liver size?
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Pleural effusion or lung consolidation obscure the upper liver border
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What causes UNDERestimation of liver size?
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Gas in colon
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Using the side of your hand to palpate is what type of palpation?
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Moderate palpation
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Why use the side of your hand to palpate?
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to assess organs that move with respiration (LIVER & SPLEEN)
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When palpating the LIVER, where is your left hand?
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under the 11th and 12th Ribs, pushing the liver up towards abdominal wall
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Whene palpating the LIVER where is your RIGHT hand?
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Either on the abdomen at MCL facing up/vertical - or - along the costal margin
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Which direction does you right hand push when palpating the liver?
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In and UP
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When would u use fist percussion of the liver?
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To check for liver tenderness when the liver is not palpable - should not be tender with this either
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Where do you palpate the gall bladder?
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at the lateral border of the rectus abdomninus muscle
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Palpable, tender GB =
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cholecystitis
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Palpable, NON-tender GB =
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Commonm bile duct obstruction
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Murphy's Sign is used for
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GALL BLADDER
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Percussion over...
Spleen = Kidney = |
Dull - b/c the spleen displaces bowel. Dullness is increased downward adn toward midline
Resonant - b/c kidney is deeply situated behind the bowel |
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Prominent LATERAL pulsation of the AORTA =
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Aortic Aneurysm
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Protuberant abdomen or flanks that bulge in the supine position is a sign of
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Ascites
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Why test for shifting dullness?
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To see if there's fluid inside/to check for ascites
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Puddle sign is used to look for....
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Ascites
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Where is Renin, and EPO made?
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Kidney
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Where is body's active form of Vitamin D made?
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Kidney
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Where is the body's main production of Proteins?
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Liver
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Where is Glucagon produced?
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Pancreas: ALPHA cells
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Where does gluconeogenesis occur?
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Liverr
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What organ stores and concentrates Bile?
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Gall Bladder
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What is Diastasis Rectis?
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Separation of the rectus abdominis that occurs AFTER preganancy.
After pregnancy, the abd. mucles regain tone, but separation of the rectus abdomini may still persist. Normal finding :) |
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What is Fecal Incontinence Associated with?
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Cancer
IBD Diverticulitis Colitis Proctitis Diabetic Neuropathy |
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A baby that has a birth weight less than 1500g is at an increased risk for what?
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Necrotizing enterocolitis
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What should you always make the pt. do before you do an abdominal exam?
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Empty their bladder
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How should the pt. breathe during the abd. exam?
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Slowly thru the mouth
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Is a fine, venous network, that's visible on the abdomen at inspection normal or abnormal?
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Normal
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A glistening, taut appearance of the abdomen =
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Ascites
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Bluish periumbilical discoloration =
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Cullen's sign
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What does Cullen's sign indicate?
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Intraabdominal bleeding
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A man comes in with MVA, how would he present?
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Bluish discoloration around periumbilical area
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If a pt. has cirrhosis of the liver, what venous pattern would you expect to see on his abdomen??
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Veins with blood running away from the umbilicus in all directions
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Person has a protrusion in the midline of the epigastrium, that consists of some fat and is felt as a small, *tender* nodule,
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Hernia of the Linea Alba
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What is an INCARCERATED Hernia?
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*It won't go away*
A nonreducible hernia,meaning that the contents of the hernial sac are not easily replaced |
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What is a STRANGULATED Hernia?
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*It is becoming Dusky*
A nonreducible hernia, where blood supply to the protruded contents is obstructed |
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Which one requires immediate surgical intervention?
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STRANGULATED Hernia!
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Pt. comes in whose abd. is really disdended, w/ hypoactiveabsent bowel sounds. There is no particular pain, and no masses felt. Reflexes: hypoactive. Pt. is on diuretics for HTN tx. What's wrong with them?
|
HYPOKALEMIA!!!!
Think: Diuretics/Distention/Deficienct of K+ |
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What else can cause this?
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Steroids
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Marked pulsation in the upper midline may indicate what?
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Increased pulse pressure
or abdominal aortic aneurysm |
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What is borborygmi?
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Stomach growling
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What does High-pitched tinkling on auscultation of the abdomen indicate?
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Intestinal fluid adn air under pressure, like in early obstruction
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Increased bowel sounds indicate ---
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Gastroenteritis
Early Intestinal obstruction Hunger |
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Decreased bowel sounds indicate ---
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Peritonitis
Paralytic Ileus |
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How long do you have to listen for, to establish that bowel sounds are absent?
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5 minutes
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What is percussion used for?
|
to asses size and density of the organs in the abdomen and to detect the presence of fluid, air, and fluid-filled solid masses
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Where is air usually present?
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In the stomach and intestines
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How would a distended bladder present on percussion?
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DULLNESS in the SUPRAPUBIC area :)
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The lower liver border should be how far below the costal margin?
So greater than what value is considered enlargement of the liver? |
2 -3 cm
i.e. 3/4 - 1 inch |
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What is normal Liver span?!?
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6 -12 cm
i.e. 2.5 - 4.5 inches |
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How much should the liver descend when testing liver descent?
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2 - 3 cm
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Where is liver dullness usu detected?
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5th - 7th intercostal space
Dullness beyond these boundaries suggests a problem |
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What's the normal liver span at the MidSTERNAL line?
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4 - 8 cm
i.e. 1.5 - 3 cm |
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Where do you percuss the spleen?
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Posterior to the Mid-AXILLARY line on left
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Where may you hear "splenic dullness"
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rib 6-10
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What can mimic splenic fullness/enlargement
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Full stomach
Feces-full intestine |
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Where do you percuss the lowest IC space?
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Left ANTERIOR axillary line
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How does the spleen move with INSPIRATION?
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Forward and downward
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How does percussion of the gastric bubble sound?
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Tympany of it is LOWER pitched than the tympany of the intestine
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When doing Light palpation, how far down should you push?
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1 cm max
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What is board-like hardness of the abdominal wall overwaying areas of peritoneal irritation?
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Rigidity
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What kind of resistance is present when you put a pillow under the pt's knees, ask them to take a deep breath in and out, but you still feel tenseness during expiration?
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Involuntary Resistance
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What part of your hand do you use for moderate palpation?
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the side of your hand
helpful to use with organs that move with inspiration: liver, spleen |
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*** How do you determine whether a mass is superficial (in the abdominal wall) or intraabdominal?
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*** Have the pt. lift his head
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How would know differentiate between the two?
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Superficial masses in the abd. wall will still be palpable when the pt. lifts his head.
If it disappears when the pt. lifts his head, then its deeper in the abdominal cavity |
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An incomplete umbilicus that is soft in the center suggests what?
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Potential for herniation
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On Bimanual Technique what is the top hand doing?
what about the Bottom hand? |
Top hand exerts pressure
Bottom hand concentrates on sensation |
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How would you determine the lower liver border, if the abdomen is disdended, or the abdominal muscles are tense?
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Scratch Test:
With one hand, put the stetho ON the liver. With the OTHER hand, scratch on ABDOMEN, and slowly move the scratch towards the liver. Sound will be intensified when scratch reaches liver. |
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A palpable notch along the medial border of the left costal margin =
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Enlarged spleen
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During the abdominal exam, when do you move to the LEFT side of the pt?
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To capture the kidney
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What direction SHOULD the abdominal aortic pulse be?
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in an ANTERIOR direction
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What is a NORMAL abdominal reflex response?
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Umbilicus moves TOWARDS the stroked side
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When do you have a DIMINISHED abdominal reflex?
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Obese
Prev. Pregnant |
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Absent abdominal reflex =
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Pyramidal tract lesion
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What signs do you test for Ascites?
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Shifting Dullness
Fluid Wave Auscultatory Percussion Puddle Sign |
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Protuberant abd. or flanks that bulge when supine =
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Ascites
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With shifting dullness, where does the dullness shift to?
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The "dependent" side, meaning, the side on the bottom, closest to gravity
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What does a Fluid wave suggest?
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Ascites
* However, fluid wave is not confirmatory, it can happen in normal person too, and, a person w/ascites can present with no fluid wave * |
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When doing the puddle sign, you percuss and find tympany at teh umbilical area, what does the person have?
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Nothing, its normal
If there was fluid, like in ascites, it would be DULL |
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A pt. comes in with abdominal pain, what would you ask her to identify if her pain is infectious in origin?
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" Would you like something to eat?"
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A pt. comes int with sudden onset of Continuous, unrelieved, radiating pain to the groin and back. What could it be?
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Acute Pancreatitis
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Vomit that smells FETID =
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GI Obstruction
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Vomit that smells like KEROSINE =
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Hydrocarbon ingestion
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Vomit that smells like VIOLETS =
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Turpentine
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Vomit that smells like GARLIC =
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Arsenic
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A negative response to "Do you want something to eat?" suggests what?
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and organic cause of abdominal pain such as:
Appendicitis or Intraabdominal Infection |
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The farther from the navel that the pain is, the more likely it is organic in origin =
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Apley Rule
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What if when you tell the patient to point to their area of pain, and they go directly to the navel?
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Consider psychogenic causes in the differential
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Which pts close their eyes more during the exam? Which pts keep their eyes open?
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Pts with non-specific pain keep eyes closed
Pts with Organic disease keep eyes Open |
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What are the features of PERITONITIS?
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Pain: front, back, sides, shoulders
Electrolytes: fall --> shock Rigidity or Rebound of anterior abdominal wall Immobile abdomen & pt. Tenderness (rebound) Obstruction N & V Increasing pulse, decreasing BP Temperature falls then rises Increasing girth of abdomen Silent obdomen (no bowel sounds) |
