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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
Muscles of the abdomen
rectus abdominus
transversus abdominus
external oblique
internal oblique
What is the linea alba? Where is it?
tendinous tissue
extends from sternum to symphysis pubis in midline of abdomen between rectus abdominus muscles
Layers of the peritoneum
parietal - outer, lines walls of cavity
visceral - inner, covers organs

peritoneal cavity = space in between
Is peritoneal cavity open or closed?
closed in males, openings for fallopian tubes in females
What are the intraperitoneal organs?
spleen
gall bladder
stomach
liver
bile duct
small intestine
large intestine
What are the retroperitoneal organs?
pancreas
kidneys
ureters
bladder
What are the blood vessels in the abdomen? Where are they located?
Abdominal Aorta - below diaphragm
arterial vessels - supply abdominal wall and gastrointestinal organs
R+L common iliac arteries - 4th lumbar vertebrae
2 ways the abdominal cavity can be divided
1) quadrants
2) 9 regions
Organs in RUQ
liver, gall bladder, pylorus, duodenum, pancreas (head), portion of right kidney and adrenal gland, hepatic flexure of colon, section of ascending and transverse colons
Organs of LUQ
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
Organs of RLQ
appendix, cecum, lower pole of right kidney, right ureter, right ovary (F), right spermatic cord (M)
Organs of LLQ
sigmoid colon, section of descending colon, lower pole of left kidney, left ureter, left ovary (F), left spermatic cord (M)
Where do the imaginary lines dividing the quadrants intersect?
umbilicus
Common pathologies of RUQ
biliary stone
cholecystitis
cholelithiasis
duodenal ulcer
gastric ulcer
hepatic abscess
hepatitis
hepatomegaly
pancreatitis
pneumonia
Common pathologies of epigastrium
AAA
appendicitis (early)
biliary stone
cholecystitis
diverticulitis
gastroesophageal reflux disease
hiatal hernia
Common pathologies of LUQ
gastric ulcer
gastritis
MI
pneumonia
splenic enlargement
splenic rupture
Common pathologies of periumbilical region
AAA
appendicitis (early)
diverticulitis
intestinal obstruction
IBS
pancreatitis
peptic ulcer
recurrent abdominal pain (children)
volvulus
Common pathologies of RLQ
appendicitis
crohn's disease
diverticulitis
ectopic pregnancy (ruptured)
endometriosis
hernia (strangulated)
IBS
Mittelschmerz
ovarian cyst
PID
renal calculi
salpingitis
Common pathologies of LLQ
diverticulitis
ectopic pregnancy (ruptured)
endometriosis
hernia (strangulated)
IBS
Mittelschmerz
ovarian cyst
PID
renal calculi
salpingitis
ulcerative colitis
Common diffuse pathologies
gastroenteritis
paritonitis
9 abdominal regions
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
Abdominal assessment landmarks
xiphoid process
costal margin
abdominal midline
umbilicus
rectus abdominus muscle
anterior superior iliac spine
inguinal ligament (poupart's)
symphysis pubis
epigastrium
midline
Position of the stomach
LUQ
beneath diaphragm
to right of spleen
partially covered by liver
Purpose of stomach
resevoir for mechanical and chemical digestion - liquifies into chyme which is released into SI
secretions of stomach
HCl
enzymes
Capacity of stomach
1-1.5L
where is the SI located?
pyloric sphincter to opening of large intestine
purpose of SI
digestion and absorption of food
length of SI
3-9m
Role of duodenum
releases hormonal secretions, where common bile duct and main pancreatic ducts open into
Role of jejunum
provides SA for nutrient absorption
Role of ileum
absorbs bile salts and vitamin B12
location of LI
ileocecal valve to anus
general length of LI
1.5m
segments of LI
ascending, transverse, descending, sigmoid
What is the cecum?
blind pouch that is continuous with the ascending colon
Role of LI
-form stool from cellulose, indigestible fibres, fat, bacteria, debris, inorganic material and carry to end of GI tract
-absorption of water and electrolytes
2 possible causes of hematemesis
GI ulcers
esophogeal varices
What should be assessed in a vomiting patient at risk for fluid imbalance?
skin turgor
mucous membranes
orthostatic BP
Symptoms of C difficile
watery diarrhea
fever
loss of appetite
nausea
abdominal pain/tenderness
location of liver
below diaphragm
mostly RUQ, superior aspect at 5th rib (nipples), lower border 1-2cm below costal margin
Functions of liver
-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)
location of gallbladder
pear-shaped, RUQ, attached to inferior surface of liver
role of gallbladder
store and concentrate bile (30-50mL) - released through cystic duct into common bile duct
cause of flatulence
bacterial gas formation in LI
Location of pancreas
transverse position along posterior abdominal wall
role of pancreas
exocrine - secretes bicarbonate and pancreatic enzymes
endocrine- insulin, glucagon, gastrin
composition of spleen
lymph organ
white pulpy lymphoid tissue, red pulp containing capillaries and venous sinuses
location of spleen
behind fundus of stomach, below diaphragm, above left kidney and splenic flexure
role of spleen
filter and resevoir for RBC mass - contributes needed blood to circulation during vasoconstriction and rids body of old/deformed RBCs and platelets
location of appendix
extends off lower cecum
role of appendix
fills with digestive materials - infection occurs when it doesn't empty completely
location of kidneys
against posterior abdominal wall, R kidney hangs 1.25cm lower than left because of liver (T12-T13)
function of kidney
rid body of waste products and maintain homeostasis ny regulating acid-base balance, fluid and electrolyte balance, arterial BP
normal amount of urine held in bladder
200-400 mL
location of superficial lymph node chains
superior - horizontal near inguinal ligament
inferior - vertical below junction of saphenous and femoral veins
Origin, Cause, Characteristics - Visceral pain
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
Origin, Cause, Characteristics - Parietal Pain
O - parietal peritoneum
C - inflammation
C - sharp, precisely localized, usually severe from onset and intensifies with movement
Origin, Cause, Characteristics - Referred pain
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)
Order of abdominal assessment
inspection, auscultation, percussion, palpation
7 Fs of abdominal distention
fat
fluid (ascites)
flatus
feces
fetus
fatal growth
fibroid tumour
Components of abdominal inspection
Contour
Rectus abdominis muscles
Pigmentation and colour
Scars
Striae
Respiratory Movement
Masses or Nodules
Visible Peristalsis
Pulsation
Umbilicus
Different types of abdominal contours
flat
rounded
scaphoid
portuberant
Normal contour in adult
flat or rounded
Where should symmetry of abdomen be checked from?
right side, feet
How are the rectus abdominis muscles inspected?
pt raises head and shoulders off the table - observe for separation
Normal rectus abdominis
symmetrical, no visible ridge parallel to umbilicus or between rectus abdominis muscles
Normal pigmentation and colour
uniform in colour and pigmentation
Normal - scars
no scars
Normal - peristalsis
ripples of peristalsis may be observed in thin patients - slowly transverses abdomen in slanting downward direction
Normal - pulsation
may see non-exaggerated pulsation of abdominal aorta in epigastric area
Inspecting for umbilicus
observe umbilicus in relation to abdominal surface, ask patient to flex neck, perform valsalva manoeuvre, observe for protrusion of the intestine through umbilicus
Normal - umbilicus
umbilicus is depressed and beneath abdominal surface
What do you auscultate for?
Bowel sounds
Vascular sounds
Venous Hum
Friction Rubs
Normal - Bowel Sounds
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
Auscultating Vascular Sounds - Process
1) place bell on abdominal aorta, renal arteries, iliac arteries, femoral arteries
2) listen for bruits (should be none)
Auscultation - Venous Hum method
use bell to listen for venous hum in all quadrants - should be none
Auscultation - Friction Rubs
use diaphragm to listen on right and left costal margins, over liver, spleen, and in all 4 quadrants
What do you percuss in abdominal assessment?
general - all quadrants
liver span
liver descent
spleen
stomach
Fist percussion - kidney, liver, bladder
General Percussion - Normal Findings
tympany sound - high-pitched, long duration (especially stomach and intestines)
dullness heard over liver, distended bladder
Liver Span - normal findings
6-12cm in midclavicular line (mean for man = 10.5, woman = 7)
Liver Descent - Normal Findings
lower border dullness descends 2-3cm
Percussion of Spleen - Normal Findings
upper border of dullness 6-8cm above the left costal margin; dullness may be heard 6-10th rib
Percussion of stomach
percuss for gastric air bubble in LUQ at left lower anterior rib cage and epigastric region
Percussion of stomach - normal findings
tympany of gastric air bubble lowe in pitch than the tympany of the intestine
Fist percussion - bladder - normal findings
urine filled bladder - dull
empty - should not be percussable above symphysis pubis
Palpations performed in abdominal assessment
light
abdominal muscle guarding
deep
liver
spleen
kidneys
aorta
bladder
inguinal lymph nodes
Palpation - deep
normal: no organ enlargement, masses, bulges, swelling, can only palpate aorta and edge of liver
-may feel LI or bladder if they are full
Palpation - Aorta
-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
Rebound Tenderness Test
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
Iliopsoas Muscle Test
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
Obturator Muscle Test
flex R leg at hip and knee at right angle
rotate leg internally and externally

NORMAL: no pain
pain - ruptured appendix or pelvic abscess
Palpation - Bladder
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
Types of Urinary Incontinence
Stress
Urge
Overflow
Functional
Cutaneous Hypersensitivity Test
1) lift fold of skin away from underlying muscle or jab with pin

NORMAL: no pain
Gerontological Changes of Abdomen
-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
Abdominal region contains organs of which systems?
Digestive
Genitourinary
Reproductive
Lymphatic
Characteristics of upper GI bleeding
hematemesis - coffee grounds, frank bleeding
Characteristics of lower GI bleeding
stool colour, frank bleeding
What do peritoneal friction rubs sound like? Where do you hear them?
coarse sand paper

over liver and spleen - R&L costal margins, increases with inspiration
What do pleural friction rubs sound like? Where do you hear them?
cracking, grating

continuous with inspiration and expiration
What do pericardial friction rubs sound like? Where do you hear them?
leather rubbing together

3-5th LICS, best heard while holding inspiration/expiration
What is a possible cause of ability to percuss recently emptied bladder?
urinary retention
Possible causes of muscle guarding
peritonitis