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75 Cards in this Set
- Front
- Back
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borders of the abdominal cavity
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TOP: diaphragm
BOTTOM: brim of pelvis BACK: spine & paravertebral muscles FRONT: lower rib cage & abdominal muscles |
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musculature of the abdomen (name and describe)
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abdomen has 4 layers of large, flat muscles that form ventral abdominal wall:
1. external oblique 2. internal oblique 3. transversus muscles 4. rectus abdominis - all muscles joined at the midline by linea alba |
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What is the linea alba?
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linea alba = a tendon seam at the midline of the abdomen where all of the abdominal muscles are joined
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Which muscles tend to get in the way when palpating the abdomen?
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the rectus abdominis muscles
(need to get over oblique muscles for palpation) |
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viscera in right lower quadrant
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- most of ascending colon
- cecum - appendix - right ovary & spermatic cord - right ureter |
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viscera in right upper quadrant
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- most of liver
- gall bladder (just lateral to midclavicular line) - duodenum - head of pancreas - right kidney (primarily posterior) -- slightly lower than L kidney because of liver - parts of both ascending and transverse colon |
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viscera in left upper quadrant
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- stomach
- spleen (very far up - usually nonpalpable) - left lobe of liver - body of pancreas - left kidney (primarily posterior) - parts of both transverse and descending colon |
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viscera in left lower quadrant
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- most of descending colon
- sigmoid colon - left ovary & spermatic cord - left ureter |
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viscera located midline
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- uterus & bladder when enlarged (these are pelvic organs and only rise into abdomen when enlarged/during pregnancy)
- abdominal aorta |
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How are ovaries usually felt?
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generally only palpable with bimanual palpation (w/ one hand in vagina pushing up)
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health hx questions for abdomen
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- appetite
- dysphagia (liquids or solids or both) - food intolerance - abdominal pain - N/V - bowel habits (how often do you poop) - past abdominal hx (any surgery) - medications - nutritional assessment |
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3 types of abdominal pain
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1. visceral pain
2. parietal pain 3. referred pain |
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describe visceral pain
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pain from an internal organ; is generally dull & poorly localized
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describe parietal pain
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pain from inflammation of the overlying peritoneum (lining of abdomen); feels sharp, precisely localized, aggravated by movement
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describe referred pain
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a type of abdominal pain that is felt in an area that is not directly where organ is located --> the pain is REFERRED from where the organ was located during fetal development (one hypothesis)
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Where is pancreatitis felt?
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pain from pancreatitis is referred to left shoulder as well as in the abdomen (front and back)
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Where is appendicitis usually felt?
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usually felt in R lower quadrant but can also be felt in epigastric area
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Where is kidney stone pain usually referred to?
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kidney stones often felt in groin or middle of back
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Where is pain from the liver referred to?
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right shoulder
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How must the patient be laying for an abdominal assessment?
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- supine position w/ knees bent
- arms at sides or folded over chest (NOT over head) - they should have an empty bladder |
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What should you be inspecting for in the abdominal assessment?
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- demeanor (are they writhing around in pain or are they very stiff/rigid?)
- contour of abdomen (flat, protuberant, scaffoid [concave]) - skin (look out for abdominal scars!!) - hair distribution - pulsations or movement - umbilicus (any bulges or lipoma) |
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What is a lipoma?
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a fatty tumor
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What could a bulge in the abdomen indicate?
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a hernia
bulges around umbilicus = umbilical hernia (indicates weakening in abdominal wall, allowing intestines to push through) |
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What should the hair distribution for men & women be?
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men --> diamond shaped projecting up towards umbilicus
women --> triangle-shaped |
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What is an incisional hernia?
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when the incision from abdominal surgery doesn't heal properly & intestines begin pushing through the incision
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How should you note character & frequency of bowel sounds?
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- should be high pitched
- if normal write "bowel sounds present at all 4 quadrants" - normal is 5-30/min - could also be hyperactive (sounds like tinkling) or hypoactive |
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What could hypoactive bowel sounds indicate? What about hyperactive?
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HYPOACTIVE:
- common after abdominal surgery - could indicate peritoneal inflammation (i.e., appendicitis) HYPERACTIVE: - diarrhea - early intestinal obstruction |
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What is borborygmi?
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gurgling of intestines that can be heard w/o stethoscope
(often indicates hunger) |
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REVIEW: why do you listen for bruits?
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- bruits are the sound of turbulent blood flow
- you would hear them w/ stenosis of blood vessels |
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What kind of bruit in the abdominal area might be normal?
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epigastric systolic bruits
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What kind of bruit in the abdominal area is really bad?
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arterial bruits w/ both systolic & diastolic noises ("whooshes") --> suggests partial occlusion of aorta or large arteries
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What could dullness w/ percussion indicate?
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1. fluid
2. feces 3. fetus 4. fibroid 5. masses or enlarged organs |
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Why might the liver become enlarged?
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- early alcoholism
- hepatitis |
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Expected range for percussion of liver at
a) midclavicular line b) right sternal border |
a) 6-12 cms
b) 4-8 cms |
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liver scratch test
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Done when abdomen is distended or muscles tense (i.e., when someone is pregnant or really heavy & it's hard to hear percussion).
1. Place stethoscope over liver 2. Using finger or tip of tongue blade, start in RLQ and scratch upward 3. When you hear change in sound (sound magnifies), you've crossed the liver edge |
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How does Desjardens say to percuss the spleen?
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- percuss in lowest intercostal space along left mid-axillary line (should hear tympany)
- Ask pt to take deep breath and keep percussing in this spot - Tympany should remain throughout inspiration, but if it changes to dullness that's a (+) splenic percussion sign (indicates splenomegaly) |
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Why might you have splenomegaly?
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- mono
- malaria - cirrhosis of liver |
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What does CVA stand for and how do you check it?
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CVA = costovertebral
you check CVA tenderness during thoracic exam --> test for kidney inflammation/infection |
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solid organs of abdomen
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(keep their shape when you feel them)
- liver - spleen - kidneys - ovaries |
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fluid-filled organs of abdomen
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- gall bladder
- urinary bladder - aorta |
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hollow organs of abdomen
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(normally not palpable unless distended w/ gas or fluid)
- stomach - intestines - colon |
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How do you do deep palpation of abdomen?
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dominant hand on bottom, non-dominant hand above it pressing down
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normally palpable structures in the abdomen
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- ribs
- xiphoid process - liver edge - right kidney on a thin person - ascending & descending colon when filled with stool - maybe the sacrum on a thin person |
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Where is mild tenderness normal in the abdomen?
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over sigmoid colon - lower left quadrant
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What is voluntary muscle guarding?
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normal muscle tensing in a ticklish person
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What is involuntary rigidity?
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uncontrollable, board-like hardness of muscles (protective mechanism) --> this is an abnormal finding
- indicates peritonitis - asking pt to cough could help localize the pain of peritoneal irritation - also testing rebound tenderness for peritoneal irritation |
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How do you test rebound irritation?
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push firmly & slowly into abdomen and then release, seeing if the rebound causes more irritation than pushing in
(this indicates peritoneal irritation) |
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How should the liver feel when palpated?
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- soft
- regular (non-nodular) - "sharp" (coming to a point) - non-tender - should be felt no more than 2 cms below ribcage |
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2 methods of liver palpation
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1. normal method (1 hand below pushing up & the other hand pressing underneath ribcage with fingers or side of hand)
2. hook method (hooking both hands under ribcage (good for pts w/ CHF, colitis, or who are pregnant) |
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How big would the spleen have to be to be palpable?
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3x the normal size
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How to palpate kidneys?
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**must be lateral to rectus muscles!!!
duckbill technique below ribs |
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What is the normal pulsation width of the abdominal aorta? When are we concerned about it?
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normal = 2-3 cms wide
concerned about wider pulsations in pts w/ HTN, PVD, and smokers |
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Where are most aortic aneurysms?
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98% are between renal arteries and belly button (and most are palpable!)
(you would hear bruits & femoral pulses would be weak) |
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Which is more painful - gall bladder peritonitis or liver peritonitis?
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gall bladder inflammation is much more painful
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iliopsoas muscle test
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(test for appendicitis)
when pt lies flat and you ask them to raise right leg against pressure & it hurts in RLQ |
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obturator muscle test
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(another test for appendicitis)
- flex pt's right knee and rotate inward & outward at hip - this stretches the obturator muscle & would irritate where the muscle meets the abdominal quadrants - pain in RLQ = a positive obturator sign, suggesting inflamed appendix |
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rovsing's sign
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(test for appendicitis)
doing palpation tests on the left purposefully & pt feels it on the right |
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What are all the tests you could perform if ? appendicitis
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- rebound tenderness
- rovsing's sign - psoas sign (iliopsoas muscle test) - obturator test |
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Murphy's sign
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when you palpate for the liver and when they breathe in it's EXTREMELY painful (they will jump & gasp)
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What is acute cholecystitis and how do you assess for it?
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inflamed gall bladder
test for it with murphy's test/sign |
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When does the GI system fully develop in a child?
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it's fully developed at 2 years of life
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pediatric stomach
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- pediatric stomach lies more horizontally until 2 years of age
- also stomach capacity increases greatly (neonates have a capacity of 6-30 mL & adults have a capacity of 2000-3000 mL) |
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pediatric kidneys
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- kidneys are proportionally larger in infants & small children
- thus, more susceptible to trauma b/c of their size |
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Which is faster - gastric emptying after ingestion of breast milk or ingestion of formula?
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gastric emptying is more rapid after ingestion of breast milk
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assessment of pediatric abdomen
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- best to inspect when infant is calm/not crying --> assessment of tenderness is hard to assess in crying infants
- child can sit in parents lap directly facing examiner - assess for facial grimacing, higher pitched cry, inability to console, drawing the knees up toward chest - use diaphragm of stethoscope to gently press & assess for tenderness |
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Is it normal to see pulsations in epigastric area of a young infant or very thin child?
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yes
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AP dimension of infants/young children
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- infants & children have lesser developed abdominal musculature so abdomen is more protuberant and round
- children up to 4 yrs will have potbellied appearance due to lordosis of spine |
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What might a scaphoid abdomen indicate in peds?
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- malnutrition
- displaced abdominal organs |
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What my a distended abdomen indicate in peds?
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- intestinal obstruction
- a mass - organomegaly - ascites |
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inspection of umbilicus in peds
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- observe for any signs of drainage, infection, hernia, or masses
- inspect for umbilical vessels in newborns (2 arteries & 1 vein) - umbilical cords usually detach by 10th day of life (can take up to 3 weeks though) |
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diastasis recti (peds)
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separation of rectus muscles with a visible bulge along midline
- not a functional problem - usually disappears by early childhood |
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normal bowel sounds in peds
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10-20/min
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pediatric liver
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- larger liver size in females until 3 yrs of age
(assessed by percussion) - should NOT be felt more than 3 cm below costal margin --> if so, indicates hepatomegaly |
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pediatric spleen
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- spleen can be felt in most children
- felt 1-2 cm below costal margin - shaped like tongue & projects downward w/ smooth, sharp edge - slightly mobile PALPATE GENTLY! highly vascular organ |
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pyloric stenosis (peds)
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- abnormal finding
- seen in infants b/w 3 - 8 weeks - hallmark sign: projectile, nonbilious vomiting |
