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156 Cards in this Set
- Front
- Back
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Upper border of abdominal cavity
Lower border of abdominal cavity |
U - diaphragm
L - symphysis pubis |
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Muscles of the abdomen
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rectus abdominus
transversus abdominus external oblique internal oblique |
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What is the linea alba? Where is it?
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tendinous tissue
extends from sternum to symphysis pubis in midline of abdomen between rectus abdominus muscles |
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Layers of the peritoneum
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parietal - outer, lines walls of cavity
visceral - inner, covers organs peritoneal cavity = space in between |
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Is peritoneal cavity open or closed?
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closed in males, openings for fallopian tubes in females
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What are the intraperitoneal organs?
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spleen
gall bladder stomach liver bile duct small intestine large intestine |
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What are the retroperitoneal organs?
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pancreas
kidneys ureters bladder |
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What are the blood vessels in the abdomen? Where are they located?
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Abdominal Aorta - below diaphragm
arterial vessels - supply abdominal wall and gastrointestinal organs R+L common iliac arteries - 4th lumbar vertebrae |
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2 ways the abdominal cavity can be divided
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1) quadrants
2) 9 regions |
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Organs in RUQ
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liver, gall bladder, pylorus, duodenum, pancreas (head), portion of right kidney and adrenal gland, hepatic flexure of colon, section of ascending and transverse colons
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Organs of LUQ
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left lobe of liver, stomach, spleen, pancreas (body), portion of L kidney and adrenal gland, splenic flexure of colon, sections of transverse and descending colons
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Organs of RLQ
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appendix, cecum, lower pole of right kidney, right ureter, right ovary (F), right spermatic cord (M)
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Organs of LLQ
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sigmoid colon, section of descending colon, lower pole of left kidney, left ureter, left ovary (F), left spermatic cord (M)
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Where do the imaginary lines dividing the quadrants intersect?
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umbilicus
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Common pathologies of RUQ
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biliary stone
cholecystitis cholelithiasis duodenal ulcer gastric ulcer hepatic abscess hepatitis hepatomegaly pancreatitis pneumonia |
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Common pathologies of epigastrium
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AAA
appendicitis (early) biliary stone cholecystitis diverticulitis gastroesophageal reflux disease hiatal hernia |
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Common pathologies of LUQ
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gastric ulcer
gastritis MI pneumonia splenic enlargement splenic rupture |
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Common pathologies of periumbilical region
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AAA
appendicitis (early) diverticulitis intestinal obstruction IBS pancreatitis peptic ulcer recurrent abdominal pain (children) volvulus |
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Common pathologies of RLQ
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appendicitis
crohn's disease diverticulitis ectopic pregnancy (ruptured) endometriosis hernia (strangulated) IBS Mittelschmerz ovarian cyst PID renal calculi salpingitis |
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Common pathologies of LLQ
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diverticulitis
ectopic pregnancy (ruptured) endometriosis hernia (strangulated) IBS Mittelschmerz ovarian cyst PID renal calculi salpingitis ulcerative colitis |
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Common diffuse pathologies
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gastroenteritis
paritonitis |
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9 abdominal regions
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From top right (like reading a book)
R hypochondriac region Epigastric region L hypochondriac region R Lumbar region Umbilical region L lumbar region R iliac region hypogastric region L iliac region |
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Abdominal assessment landmarks
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xiphoid process
costal margin abdominal midline umbilicus rectus abdominus muscle anterior superior iliac spine inguinal ligament (poupart's) symphysis pubis epigastrium midline |
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Position of the stomach
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LUQ
beneath diaphragm to right of spleen partially covered by liver |
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Purpose of stomach
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resevoir for mechanical and chemical digestion - liquifies into chyme which is released into SI
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secretions of stomach
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HCl
enzymes |
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Capacity of stomach
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1-1.5L
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where is the SI located?
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pyloric sphincter to opening of large intestine
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purpose of SI
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digestion and absorption of food
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length of SI
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3-9m
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Role of duodenum
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releases hormonal secretions, where common bile duct and main pancreatic ducts open into
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Role of jejunum
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provides SA for nutrient absorption
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Role of ileum
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absorbs bile salts and vitamin B12
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location of LI
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ileocecal valve to anus
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general length of LI
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1.5m
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segments of LI
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ascending, transverse, descending, sigmoid
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What is the cecum?
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blind pouch that is continuous with the ascending colon
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Role of LI
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-form stool from cellulose, indigestible fibres, fat, bacteria, debris, inorganic material and carry to end of GI tract
-absorption of water and electrolytes |
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2 possible causes of hematemesis
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GI ulcers
esophogeal varices |
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What should be assessed in a vomiting patient at risk for fluid imbalance?
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skin turgor
mucous membranes orthostatic BP |
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Symptoms of C difficile
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watery diarrhea
fever loss of appetite nausea abdominal pain/tenderness |
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location of liver
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below diaphragm
mostly RUQ, superior aspect at 5th rib (nipples), lower border 1-2cm below costal margin |
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Functions of liver
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-storage (carbs, AA, vitamins, minerals, blood)
-detoxification and filtration (drugs, hormones, bacteria) -metabolism (carbs, proteins, fats, ammonia to urea) -synthesis and secretion (bile production (600-1000mL/day, formation of lymph, bile salts, plasma proteins, fibrinogen, blood-clotting substances, antibodies) |
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location of gallbladder
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pear-shaped, RUQ, attached to inferior surface of liver
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role of gallbladder
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store and concentrate bile (30-50mL) - released through cystic duct into common bile duct
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cause of flatulence
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bacterial gas formation in LI
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Location of pancreas
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transverse position along posterior abdominal wall
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role of pancreas
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exocrine - secretes bicarbonate and pancreatic enzymes
endocrine- insulin, glucagon, gastrin |
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composition of spleen
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lymph organ
white pulpy lymphoid tissue, red pulp containing capillaries and venous sinuses |
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location of spleen
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behind fundus of stomach, below diaphragm, above left kidney and splenic flexure
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role of spleen
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filter and resevoir for RBC mass - contributes needed blood to circulation during vasoconstriction and rids body of old/deformed RBCs and platelets
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location of appendix
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extends off lower cecum
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role of appendix
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fills with digestive materials - infection occurs when it doesn't empty completely
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location of kidneys
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against posterior abdominal wall, R kidney hangs 1.25cm lower than left because of liver (T12-T13)
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function of kidney
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rid body of waste products and maintain homeostasis ny regulating acid-base balance, fluid and electrolyte balance, arterial BP
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normal amount of urine held in bladder
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200-400 mL
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location of superficial lymph node chains
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superior - horizontal near inguinal ligament
inferior - vertical below junction of saphenous and femoral veins |
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Health History: age related
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recurrent abdominal pain (2-15)
appendicitis (young child-30) peptic ulcer disease (>30) cholecystitis (40-50) type 2 diabetes (>45) colonic diverticulosis (>50) bladder cancer (50-70) pancreatic cancer (60-70s) mesenteric arterial insufficiency or infarct (more in elderly) |
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Health History: female
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gallbladder disease
mittelschmerz |
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Health History: male
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pancreatic, gastric, kidney and bladder cancer, cirrhosis, duodenal ulcer, diverticulosis
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Health History: ethnicity
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stomach cancer - latin america
primary liver cancer - E + SE Asia, men esophageal cancer - china, india, japan, england Hep A - Africa, Asia, central and south america Hep B - immigrant populations, inuit, first nations |
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Health History: Common issues/concerns
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nausea
vomiting diarrhea constipation hematemesis indigestion hemorrhoids heartburn abdominal distention abdominal pain increased eructation increased flatulence dysuria nocturia jaundice flank pain urinary incontinence uretal colic |
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Health History: medications
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histamine-2 antagonists, PPI, antibiotics, lactulose, antacids, vitamins, antiparasitics, anticholinergics, tranquilizers, steroids, antidiarrheals, electrolytes, laxatives, stool softeners, insulin, antiemetics, antiflatulants, pancreatic enzymes, chemotherapeutics, antiflatulents
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Health History: communicable diseases
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STI
HIV hepatitis TB infectious mono intestinal parasites |
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Health History: allergies
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foods, medications, lactose intolerance
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Health History: family history
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malignancies of stomach, liver, pancreas, colon, peptic ulcer disease, diabetes, IBS, polycystic kidney disease, colitis, malabsorption syndromes, GERD
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Health History: travel
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poor sanitation, foreign bacteria (drinking water)
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Health History: home environment
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water source, lead paint
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Health History: leisure
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sports associated with traumatic injuries
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Health History: stress
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can have stress ulcers
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Health History: SES
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infections from poor sanitation
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Health History: sleep
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some pain at night
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Health History: diet
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gallbladder attacks after fatty meals
caffeinated drinks, coffee, tea, alcohol exacerbate GERD |
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Origin, Cause, Characteristics - Visceral pain
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O - abdominal organs
C - hollow structures painful when they contract forcefully or become distended, solid painful when stretched C - deep, dull, poorly localized, when intense associated with nausea, vomiting, pallor, diaphoresis |
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Origin, Cause, Characteristics - Parietal Pain
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O - parietal peritoneum
C - inflammation C - sharp, precisely localized, usually severe from onset and intensifies with movement |
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Origin, Cause, Characteristics - Referred pain
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O - abdominal organs to non abdominal locations
C - nerve innervation C - well localized, pain from disorder in another site (duodenal - back and right shoulder, pancreatic - back and left shoulder) |
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Order of abdominal assessment
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inspection, auscultation, percussion, palpation
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7 Fs of abdominal distention
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fat
fluid (ascites) flatus feces fetus fatal growth fibroid tumour |
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Components of abdominal inspection
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Contour
Rectus abdominis muscles Pigmentation and colour Scars Striae Respiratory Movement Masses or Nodules Visible Peristalsis Pulsation Umbilicus |
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Different types of abdominal contours
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flat
rounded scaphoid portuberant |
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Normal contour in adult
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flat or rounded
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Where should symmetry of abdomen be checked from?
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right side, feet
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Normal symmetry
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bilateral symmetry
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How are the rectus abdominis muscles inspected?
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pt raises head and shoulders off the table - observe for separation
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Normal rectus abdominis
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symmetrical, no visible ridge parallel to umbilicus or between rectus abdominis muscles
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Normal pigmentation and colour
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uniform in colour and pigmentation
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Normal - scars
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no scars
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What are striae? what is normal?
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stretch marks
none |
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Normal - respiratory movement
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no respiratory retractions
abdomen rises with inspiration, falls with expiration |
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Normal - peristalsis
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ripples of peristalsis may be observed in thin patients - slowly transverses abdomen in slanting downward direction
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Normal - pulsation
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may see non-exaggerated pulsation of abdominal aorta in epigastric area
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Inspecting for umbilicus
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observe umbilicus in relation to abdominal surface, ask patient to flex neck, perform valsalva manoeuvre, observe for protrusion of the intestine through umbilicus
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Normal - umbilicus
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umbilicus is depressed and beneath abdominal surface
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What do you auscultate for?
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Bowel sounds
Vascular sounds Venous Hum Friction Rubs |
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Auscultating Bowel Sounds - Process
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1) diaphragm on abdominal wall beginning at RLQ
2) listen for frequency and character - listen for 5 mins before concluding bowel sound absent 3) repeat on LUQ, RLQ, LLQ |
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Normal - Bowel Sounds
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intermittent gurgling sounds in all quadrants, usually 5-30 times/min - result from movement of air and fluid through GI tract, and normally always present at ileocecal valve area (RLQ)
-normal hyperactive bowel sounds = borborygmi due to hyperperistalsis or sound of flatus in intestines |
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Auscultating Vascular Sounds - Process
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1) place bell on abdominal aorta, renal arteries, iliac arteries, femoral arteries
2) listen for bruits (should be none) |
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Auscultation - Venous Hum method
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use bell to listen for venous hum in all quadrants - should be none
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Auscultation - Friction Rubs
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use diaphragm to listen on right and left costal margins, over liver, spleen, and in all 4 quadrants
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What do you percuss in abdominal assessment?
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general - all quadrants
liver span liver descent spleen stomach Fist percussion - kidney, liver, bladder |
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General Percussion - Normal Findings
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tympany sound - high-pitched, long duration (especially stomach and intestines)
dullness heard over liver, distended bladder |
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Percussion - Liver Span
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1) stand right of patient
2) begin at midclavicular line below umbilicus, percuss upward to determine lower border of liver (where changes from tympany to dullness) 3) percuss down from midclavicular line from lung resonance to dullness 4) measure distance between |
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Liver Span - normal findings
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6-12cm in midclavicular line (mean for man = 10.5, woman = 7)
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Risk factors for stomach cancer
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diet high in smoked foods, lacking in significant qualities of fruit and vegetables
pernicious anemia possible hereditary factors chronic stomach inflammation |
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Percussion technique - Liver descent
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1) ask pt to take deep breath and hold
2) percuss lower border of liver at midclavicular line, have pt exhale 3) repeat with liver-lung border 4) mark difference in cm of lower border |
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Liver Descent - Normal Findings
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lower border dullness descends 2-3cm
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Percussion technique - spleen
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percuss lower level of left lung posterior to midaxillary line and continue down until dullness
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Percussion of Spleen - Normal Findings
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upper border of dullness 6-8cm above the left costal margin; dullness may be heard 6-10th rib
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Percussion of stomach
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percuss for gastric air bubble in LUQ at left lower anterior rib cage and epigastric region
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Percussion of stomach - normal findings
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tympany of gastric air bubble lowe in pitch than the tympany of the intestine
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Risk factors for ascites
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increased vascular resistance to hepatic outflow
increased hepatic lymph flow and extravasation of fluid into the peritoneal cavity portal hypertension and increased capillary filtration pressure hypoalbuminemia and decreased colloid osmotic pressure of the serum disordered kidney function hyperaldosteronism excessive secretion of ADH |
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Fist percussion - kidneys
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1) pt sitting
2) strike costovertebral angle with closed fist or place palmar surface of one hand over the costovertebral angle and strike that hand with ulnar surface of fist of other hand 3) ask pt what was felt and observe reaction |
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Fist percussion - kidneys - normal findings
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no tenderness
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Fist percussion - liver
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1) pt supine
2) indirect fist percussion at lower right rib cage should be no tenderness |
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Fist percussion - bladder
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1) percuss up from symphysis pubis to umbilicus
2) note where sound changes from dull to tympany |
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Fist percussion - bladder - normal findings
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urine filled bladder - dull
empty - should not be percussable above symphysis pubis |
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Palpations performed in abdominal assessment
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light
abdominal muscle guarding deep liver spleen kidneys aorta bladder inguinal lymph nodes |
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Palpation - light
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1) hands and forearm on horizontal plane
2) use pads of fingers to depress abdominal wall 1cm 3) lightly palpate all quadrants should be smooth with consistent softness |
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Palpation - abdominal muscle guarding
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light palpation of rectus muscles during expiration
should be no muscle guarding, abdomen soft, no muscle tension |
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Palpation - deep
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1) use palmar surface of extended fingers, depress 5-8cm in RLQ
- can use 2 hands - dominant under nondominant 2) identify masses and note characteristics 3) repeat in all quadrants normal: no organ enlargement, masses, bulges, swelling, can only palpate aorta and edge of liver -may feel LI or bladder if they are full |
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Signs of encephalopathy
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slowed mentation or mental confusion
asterixis uncoordinated muscle movements elevated values for serum BUN, ammonia, liver enzymes, osmolarity |
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Risk factors for liver cancer
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cirrhosis
hep B, C cigarette smoking alcohol exposure to toxic substances Primary malignancy |
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Palpation - Liver
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Bimanual
- stand at right side facing pt's head - place L hand under pt's right flank at bottom (11th or 12th rib) - press up with L hand to elevate liver - place R hand parallel to midline at R midclavicular line below R costal margin - tell pt to take deep breath - push deeply and under costal margin with right fingers - note size, shape, consistency, level, any masses of liver Hook method -pt's right, facing feet - place hands side by side on R costal margin and ask pt to take deep breath and hold - palpate liver's edge as it descends Normal - edge is firm, sharp, regular ridge with a smooth surface - normally liver not palpable |
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Palpation - Spleen
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-use bimanual technique
-stand on right and place L hand beneath pt and over L costovertebral angle, press up to lift - use right hand to press in along L costal margin while asking pt to take deep breath -could also do with pt lying on right side - note shape, consistency, size, masses NORMAL: should not be palpable |
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Palpation - kidneys
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-stand on right side
-one hand on costovertebral angle on back, other below and parallel to costal margin - press hands together as pt takes deep breath - at peak of inspiration press fingers together with greater pressure from above -ask pt to exhale and hold breath briefly - release pressure of fingers (and see if feel kidney being released) -note size, shape, consistency - repeat on other side NORMAL: kidneys not palpable but possible to feel the lower pole of R kidney -more palpable in elderly |
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Palpation - Aorta
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-press upper abdomen with one hand on each side of abdominal aorta, slightly left of midline
NORMAL - width 2.5-4cm and pulsates in anterior direction |
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Rebound Tenderness Test
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assess if pain during palpation or pt reports pain
-apply several seconds of firm pressure to abdomen with hand at 90 degrees to abdomen and fingers extended, quickly release NORMAL: no pain when pain in RLQ may be appendicitis |
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Iliopsoas Muscle Test
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to distinguish perforated appendix via irritation of iliopsoas muscle
-place hand over right thigh and push down as pt raises leg NORMAL: no pain pain - inflammation of iliopsoas muscle = inflamed appendix |
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Obturator Muscle Test
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flex R leg at hip and knee at right angle
rotate leg internally and externally NORMAL: no pain pain - ruptured appendix or pelvic abscess |
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Palpation - Bladder
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1) deep palpation - palpate at abdomen starting at symphysis pubis toward umbilicus
2) note size, shape, consistency NORMAL - empty bladder not palpable, moderately full is smooth and round, palpable about symphysis pubis. Full - palpated above symphysis pubis and may be close to the umbilicus |
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Types of Urinary Incontinence
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Stress
Urge Overflow Functional |
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Cutaneous Hypersensitivity Test
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1) lift fold of skin away from underlying muscle or jab with pin
NORMAL: no pain |
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Definition and possible causes of stress incontinence
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-involuntary loss of urine with activities that increase abdominal pressure
-childbirth, previous abdominal surgery, prostate surgery, radiation therapy |
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Definition and possible causes of urge incontinence
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-involuntary loss of urine due to detrusor hyperactivity - usually associated with a strong desire to void with a larger volume of urine
-stroke, dementia, MS, parkinson's, brain tumour, urinary tract tumours |
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Definition and possible causes of overflow incontinence
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-involuntary loss of urine due to an overextended bladder - incontinence occurs when bladder pressure exceeds urethral pressure - usually small amount of urine occurs during dribbling, may be some hesitancy and frequency
-fecal impaction, diabetic neuropathy, obstruction of bladder or urethra (due to prostate cancer, benign prostatic hypertrophy) |
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Definition and possible causes of functional incontinence
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-involuntary loss of urine due to the inability to reach the toilet because of physical, cognitive, environmental impairments
-immobility, dementia, inaccessible toilet, inappropriate lighting, physical restraints |
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Palpation of Inguinal Lymph Nodes
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1) supine with knees slightly flexed
2) use finger pads of 2nd, 3rd, 4th fingers to apply pressure and palpate with a rotary motion in right inguinal area 3) repeat left NORMAL: small, movable nodes less than 1cm in diameter, non-tender |
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Gerontological Changes of Abdomen
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-muscle diminishes in mass and tone, fat content increases
-mucosal lining of GI tract less elastic - changes in digestion and absorption and decrease in secretion of acid -constipation - changes in bowel habits, malignancies -jaundice due to obstruction of biliary system |
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Abdominal region contains organs of which systems?
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Digestive
Genitourinary Reproductive Lymphatic |
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Characteristics of upper GI bleeding
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hematemesis - coffee grounds, frank bleeding
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Characteristics of lower GI bleeding
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stool colour, frank bleeding
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Possible causes of hypoactive bowel sounds
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decreased motility, possible obstruction
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Possible causes of hyperactive bowel sounds
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increased motility, possible diarrhea, gastroenteritis
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What do peritoneal friction rubs sound like? Where do you hear them?
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coarse sand paper
over liver and spleen - R&L costal margins, increases with inspiration |
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What do pleural friction rubs sound like? Where do you hear them?
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cracking, grating
continuous with inspiration and expiration |
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What do pericardial friction rubs sound like? Where do you hear them?
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leather rubbing together
3-5th LICS, best heard while holding inspiration/expiration |
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What is a possible cause of ability to percuss recently emptied bladder?
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urinary retention
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What is a possible cause of costovertebral angle tenderness?
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pyelonephritis
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When should you not palpate the aorta or spleen?
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when auscultation/percussion suggest enlarged spleen or AAA
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Possible causes of muscle guarding
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peritonitis
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Possible causes of tenderness on palpation
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inflammation, masses, enlarged organs
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possible causes of masses, bulges, swelling
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enlarged organs, tumors, cholecytitis, hepatitis, cirrhosis
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possible causes or large aorta width
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AAA
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posible causes of palpable inguinal lymph nodes (large or tender)
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systemic infections, cancer
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possible causes of palpable spleen
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inflammation, CHF, cirrhosis, mono
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possible causes of palpable kidneys
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hydronephrosis, neoplasms, polycystic kidney disease
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