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105 Cards in this Set
- Front
- Back
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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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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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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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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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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Liver Span - normal findings
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6-12cm in midclavicular line (mean for man = 10.5, woman = 7)
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Liver Descent - Normal Findings
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lower border dullness descends 2-3cm
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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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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 - deep
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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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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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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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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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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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Possible causes of muscle guarding
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peritonitis
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