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Health Assessment
Jarvis: Ch 21 - Abdomen
105
Nursing
Graduate
11/15/2009

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Cards

Term

Structure & Function:

Linea Alba

Definition
Midline consisting of the joining of the 4 layers of large, flat muscles that form the abdominal wall
Term

Structure & Function:

Viscera

Definition
Internal Organs
Term

Structure & Function:

Solid Viscera

Definition

Maintain a characteristic shape

 

Ex: Liver, pancreas, spleen, adrenal glands, kidneys, ovaries and uterus

Term

Structure & Function:

Hollow Viscera

Definition

Depends on the contents

 

Ex: Stomach, gallbaldder, small intestine, colon, bladder

 

* Usually not palpable unelss distended with feces or bladder or inflammed

Term

Structure & Function:

Where is the stomach? Gallbladder? Small Intestines?

Definition

Stomach: Below the diaphgragm, between the liver and spleen

 

Gallballder: Under the posterior surface of teh liver, lateral to right midclavicular line

 

Small Intestine: Located in all 4 Quadrants (Extends from stomach's pyloric valve to the ileocecal valve in the RLQ, where it joins in the colon)

Term

Structure & Function:

Spleen

Where?

Definition

Spleen: Mass of Lymphatic tissue on the postlateral wall of the abdominal cativy, under the diaphgragm (LUQ) - 10th rib to the 11th rib

 

Normally not palpable -

If it becomes enlarged, its lower pole moves downward and toward the midline

Term

Structure & Function:

Aorta

Location?

Definition

Left of midline in Upper abdomen

Behind the peritoneum and 2cm below the umbilicus

 

Bifurcates to right & left iliac arteries

 

Iliac arteries become Left & Right femoral - Pulsations are easily palpated halfway between the anterior superior iliac spine and symphysis pubis

Term

Structure & Function:

Pancreas

Where?

Definition
Pancrease: Gland located behind the stomach
Term

Structure & Function:

Kidneys

Where?

Definition

Posterior to abdominal contents and peritoneal cavity

 

Protected by ribs

Term

Structure & Function:

Costovertebral Angle

Definition

12th rib forms an angle with the verebral column

 

Left kidney lies right there

 

Left kidney is 1-2 cm higher then the right kidney 

 

Left kidney is not palpable

Term

Structure & Function:

Four Quadrants: Right Upper Quadrant (RUQ)

Definition
Liver, Gall Bladder, Duodenum, Head of Pancreas, Right Kidney and Adrenal,
Term

Structure & Function:

Four Quadrants: Left Upper Quadrant (LUQ)

Definition

Stomach, Spleen, Pancrease, Left Lobe of Liver

Left Kidney and Adrenal

Term

Structure & Function:

Four Quadrants: Right Lower Quadrant (RLQ)

Definition
Cecum, Appendix, Right Ovary and Tube, Right Ureter, Right Spermatic Cord
Term

Structure & Function:

Four Quadrants: Left Lower Quadrant (LLQ)

Definition
Sigmoid Colon, Descending Colon, Left Ovary and Tube and Left Ureter, Spermatic Cord
Term

Structure & Function:

Four Quadrants: Midline

Definition

Aorta (Slightly to the Left)

Uterus (if enlarged)

Bladder (if distended)

Term

Developmental Care:

Infants and Children

Differences in Liver?

Bladder?

Umbilicus?

Abdominal Wall?

Definition

Liver: More proportionate and more space in the abdomen then later in life

 

Bladder: Higher in abdomen then in adults

 

Umbilicus: Contains 2 arteries and 1 Vein

 

Abdominal Wall: Less muscular so organs are easier to palpate

Term

Developmental Care:

Pregnant Female

Signs of Pregnancy

Definition

Nausea, Vomiting

 

Missed Periods: Due to hormonal changes such as the production of human chorionic gonadotropin (HcG)

 

Acid Indigestion or heartburn (pyrosis) caused by esophageal reflux

 

GI Motility decreases = prolongs gastric emptying time = causes more water to be reabsorbed from the colon = leads to constipation --> constipation increases venous pressure in lower pelvis which may led to hemorrhoids

Term

Developmental Care:

Pregnant Female

Changes in Uterus, Bowel, Appendix, Skin

Definition

Enlarged uterus displaces intestines upward

Bowel sounds diminish

Appendix displaced upward and to the right

Skin changes in abdomen (Sriae and linea nigra)

Term

Developmental Care:

Aging Adult Abdominal Normal Appearance Changes

Definition

Increased Fat

(Women due to decreased estrogen levels)

 

Adipose tissue redistributes away from face and extremities to the abdomen and hips

Term

Developmental Care:

Aging Adult

Are GI Changes Significant in an adult? Yes/No

Definition
GI Changes - Not significant unless disease is present
Term

Developmental Care:

Aging Adult

Salivation decreases causing ...

Definition

Dry Mouth

Decreased sense of taste

Term

Developmental Care:

Aging Adult

Esophageal emptying is ______

Definition
delayed
Term

Developmental Care:

Aging Adult

Gastric Acid secretion Decreases with age, causing

Definition
Pernicious Anemia (due to Vit B12 Deficiency), iron defiency anema and malabsorption of calcium
Term
Pyrosis
Definition
HeartBurn
Term

Developmental Care:

Aging Adult

Liver size decreases causing liver function to

Definition

REMAIN NORMAL

 

Unless it is impaired by pharmacological treatments, alcoholism, liver disease, etc.

Term

Cross Cultural Care

Lactose Intolerant

Definition

Lactase: Digestive enzyme necessary for absorption of carbs lactose (milk sugar)

 

Some racial groups, lactase is high at brith but declines in adulthood (called lactose intolerant)

 

Lactose intolerant have abdominal pain, bloatin and flaulence when milk is consumed

Term
What types of subjective abdominal data should be collected during an assessment? (pg 562-566) 
Definition

Appetite, Dysphagia (difficulty swallowing), Food intolerance, Abdominal Pain, Nausea, Vomiting, Bowel habits, Past Abdominal History, Medications, Nutritional Assessment

 

Infants and Children

Breast or Bottle feeding, Table foods introduced, Frequency of meals, Consitpation, Abdominal Pain, Overweight, Underweight

 

Adolescents

Regular meals, exercise, body requirements, activity patterns, over- or under- weight

 

Aging Adult

Acquire groceries, prepare snacks, eat alone, share meals, dificulty swallowing, bowel movements

Term

Inspect the Abdomen:

Contour, Symmetry, Umbilicus

Definition

Look down at abdomen with light; Should be symmetrical, flat or rounded; Assess stomach during inspiration and expiration

 

Umbilicus shoudl be midline and inverted, no discoloration or inflammation

Term

Inspect the Abdomen:

Symmetry abnormalities

Hernia

Definition
Hernia: Protursion of abdominal viscera through abnormal opening in muscle
Term

Inspect the Abdomen:

Umbilicus abnormal findings

Bluish periumbilical color occurs with ....

Definition
Intraabdominal Bleeding
Term

Inspect the Abdomen:

Umbilicus abnormal findings

Enlarged and enverted umbilicus with ...

Definition
a Hernia
Term

Inspect the Abdomen:

Umbilicus abnormal findings

Deeply sunken umbilicus found with

Definition
Obesity
Term

Inspect the Abdomen:

Umbilicus abnormal findings

Everted (Outward appearance) of Umbilicus with ...

Definition
Acites (Fluid accumulation) or Underlying mass
Term

Inspect the Abdomen:

Skin inspection notes

Definition

* Good area to judge pigment because it is protected from sun

 

*Striae (Lineae albicants) - change in pigmant

 

*Note pigmented nevi (moles)

 

*Veins are not usually seen, except in thin persons

 

* Skin turgor reflects healthy nutrition

Term
Striae
Definition
Form of scarring on the skin with an off-color hue. They are caused by tearing of the dermis, and over time can diminish but not disappear completely.
Term
Striae looks purple-blue with ____________, due to excess adrenocorticol hormone causing the skin to be fragile and easily broken from normal stretching
Definition
Cushings Syndrome
Term

Cutaneous angiomas are .... ?

They occur with ... ?

Definition

Skin, benign tumors

 

Occur with portal hypertension or liver disease

Term
Prominent, dilated veins occur with ...
Definition
Portal Hypertension, Cirrhosis, Ascites (fluid accumulation) or vena caval obstruction
Term
Veins are more visible with malnutrition due to ....
Definition
Thinned adipose tissue
Term
Poor turgor is a sign of __________ which accompanies GI Disease
Definition
Dehydration
Term
Pulsations of the aorta felt during palpations occur with widened pulse pressure, with ....
Definition
Hypertension, aortic insufficiency, thyrotoxicosis and aortic aneurysm
Term
Visible peristalsis with a distended abdomine indicate ....
Definition
intestingal obstruction
Term
Pubic hair on abdomen alter with __________ & _________ abnormalities
Definition
Endocrine or Hormonal abnormalities
Term
Signs of Colicky pain of Gastroenteritis or bowel obstruction include
Definition
Constant turning and restlessness
Term
Peritonitis
Definition

Stillness, Resisting any movement

 

An inflammation of the peritonium. Peritonitis may be localised or generalised, and may result from an infection (often due to rupture of a hollow organ as may occur in abdominal trauma or appendicitis) or from a non-infectious process.

Term
What is unusual about the sequence of the abdominal exam?
Definition
Auscultating is the 2nd step as opposed to percussion and palapting in other exams
Term
First auscultate the ...
Definition
Start in the Right Lower Quadrant, then procede by listening to the LLQ, LUQ, RLQ (not sure about that order but I know the Right Light Quardrant is first)
Term
Normal bowel sounds while listening to the quadrants with the diaphgragm occur
Definition
5 - 30 times per minute
Term

Abnormal bowel sounds:

Hyperactive sounds

Definition
Loud, high-pitched, rushing, tinkling sounds that signal increased motility
Term

Abnormal bowel sounds:

Hypoactive/Absent Sounds

Definition
Follow abdominal surgery or with inflammation of the peritoneum
Term
Borborygmus
Definition

Type of hyperactive bowel sound (Common)

Stomach Growling

Term
How long must you listen to the abdomen to determine it is perfectly silent?
Definition
5 minutes in each quadrant
Term
After auscultating bowel sounds with the diaphgram, asucultate _____ sounds with the _____.
Definition

Vascular sounds

Bell

 

* Note any bruits

Term
What are the arteries that should be auscultated in an abdominal exam?
Definition

Aortic

Right & Left Renal Arteries

Right & Left Iliac Arteries

Right & Left Femoral Arteries

 

* House Shape *

Term
Bruit
Definition
Unusual sound that blood makes when it rushes past an obstruction (called turbulen flow) in an artery when the sound is auscultated with the bell portion of a stethoscope
Term
A systolic bruit is a ....
Definition
pulsatile blowing sound and occurs with stenosis or oclusion of an artery
Term
After Inspection and Auscultating, the next step of the abdominal exam is ...
Definition
Percussion
Term
The main percuss sound heard over all 4 quadrants is ...
Definition
Tympanic (because air in the intestines rise to the suface when the person is supine)
Term
Dullness is heard in the abdomen when percussing over ...
Definition
a distended bladder, adipose tissue, fluid or a mass
Term
Hyperresonance
Definition
Greater then normal pitch (low)
Term
Hyperresonance is present in the abdomen with ...
Definition
gaseous distention
Term
Dysphagia
Definition
Difficulty Swallowing
Term
How to measure the liver span by percussing?
Definition

Begin in the lung resonance area and percuss down the interspaces until the sound changes to dull quality. mark the spot.

 

Then find abdomen Tympany, Perucss upward and mark where the sound changes to dullness

 

Measure the distance between 2 marks: Normal liver span is 6-12 cm

 

Liver is direct correlation to persons actual height in a normal person with healthy liver functioning

Term
Enlarged liver span indicates ...
Definition
Liver enlargement or Hepatomegaly (enlarged liver due to infection, direct toxicity, hepatic tumors or metabolic disorder - may be present with jaundice)
Term
Liver span can be interfered with ..
Definition
Dullness heard in the lungs due to consolidation or dullness heard in the abdomen due to preganncy, gas distention, or ascites (fluid accumulation)
Term
Variation in liver span occurs with ...
Definition
Chronic emphysema, because the liver is displaced downward due to hyperinflated lungs
Term
What is the scratch test?
Definition
Help define the liver borders when abdomen is distended; Start scratching in RLQ and move up to the liver wall, scratching soundin the stehoscope become magnified as you reach the liver
Term
Is the Spleen palapable? If so, How?
Definition

Spleen is usually blocked by the stomach

 

Locate it by percussing from teh 9-11th intercostal space on the left side

Term
Enlarged spleens occur with ...
Definition
Mononucleosis (Abnormally large number of WBC), trauma or infection
Term

How to determine splenomegaly?

 

What is splenomegaly?

Definition

If site changes to dullness instead of tympany during inspiration, sign of splenomegaly.

 

Splenomegaly is an enlargement of the spleen

Term
What assessment should be performed to determine inflammation of the kidney or paranephric area (area next to the kidneys)?
Definition

Costovertebral Angle Tenderness - On the left side of back, by the 12 rib

 

Patients should feel a thud but no pain - if pain is present, represents inflammation of the kindeys or paranephric area.

Term
What are 2 tests that can be preformed to distinguish betweeen ascites (fluid inthe peritoneal cavity) or gaseious distention?
Definition

Fluid Wave Test

Shifting Dullness Test

Term
Fluid Wave Test
Definition

Stand on persons right side, place ulnder edge of patients hand firmly on abdomen midline; place your left hand on persons right flank. With right hand give the left flank a firm strike

 

If ascites is present: a fluid wave through the abdomen will occur (positive test)

 

If gas, not change will occur

Term
Shifting Dullness
Definition

Step 1: In supine position, fluid settles by gravity while air rises. Percuss the abdomen; if fluid is present, the note will change from tymphany to dull

 

Step 2: Turn the person towards you, fluid will gravitate; Percuss the upperside of abdomen and move downward, the sound changes from tymphany to dull as you reach fluid level; but this time the level of dullness is higher towards the umbilicus (shifiting level of dullness indicates presence of fluids)

 

* Note: Shifting dullness will not detect volumes less then 500 mL

Term
Light Palpations
Definition

Small circles about 1 cm deep over abdomen

 

Looking for muscle guarding, rigidty, large masses, tenderness

Term
Voluntary guarding vs. Involuntary Rigidity
Definition

Voluntary Guarding: Occurs when the person is cold, tense or ticklish; bilater; you will feel msucles relax slightly during exhalation; use relaxation techniques to eliminate guarding or it will interfere with deep palpation

 

Involuntary Rigidity: Constant broadlike hardness of muscles; Protective mechanism accompanying acute inflammation of the peritoneum; could be unilateral; same area is painful when person increases pressure (ex: doing a sit up)

Term
Deep Palpation
Definition

Push down 5 - 8 cm - Move counter clockwise & explore the abdoment

 

To overcome reistance of large abdomens, use a bimanual technique

Term
Tenderness occurs in deep palpation with ...
Definition
local inflammation, inflammation of peritoneum or underlying organ or with an elarged organ whose capsules is over stretched
Term
What are the 3 organs that are palpable in the abdomen?
Definition

Liver, Spleen, Kidneys

 

(Sometimes the Aorta as well)

Term
How to Palpate the Liver?
Definition

1. Hooking Technique

2. Or place hand on persons back and push down deeply below the 11th and 12th ribs; Ask patient to take a deep breath; It is normal to feel the edge of the liver bump your fingertips as the diaphgragm pushes down during inhalation

Term
How to search for the spleen?
Definition

Put left hand on the left side/back and lift body up slightly; Push your right hand obliquely on the LUQ with the fingers pointing toward the left axilla; Ask the person to take a deep breath

 

* Shoudl feel nothing firm

 

* If an enlarged spleen is felt, do not continue to palpate because an enlarged spleen is friable (easily crumbled) and can rupture easily with overpalpation

 

*Enlarged spleens are due to trauma or increased number of WBC

Term
How to palpate kidneys?
Definition
Duck-bill position
Term

True or false:

The Left kidney is palpable, but not the right.

Definition

False

 

Right kidney is palpable becaue it sits 1-2 cm lower then the left kidney - the left kidney is up higher and surrounded more by the ribs

Term

True or False

To palpate the Aorta, put your thumb and fingers slightly to the right of the midline.

Definition
False, put your thumbs and fingers slightly to the LEFT of the midline
Term
Widen aorta may be caused by ...
Definition
An aneurysm
Term

Special Procedures & Findings:

Blumberg's Sign (Rebound tenderness)

Definition

Hod hand @ 90 deg perpendicular to abdomen, push down slowly, then life quickly;

 

Negative response is No Pain

 

*Pain or relase of pressure confirms rebound ternerness, which is a sign of peritoneal inflammation and/or appendicitis

Term

Special Procedures & Findings:

Inspiratory Arrest (Murphy's Sign)

Definition
While palpating the liver, ask the client to take a deep breath; if pain occurs, inflammation of teh gallbladder could be present
Term

Special Procedures & Findings:

Iliopsoas Muscle Test

Definition

Perform when appendicitis is suspected; Lift leg straight up, flexing at the hip; push over the lower right thigh; the person should feel no pain

 

* When iliopsoas is inflamed (appendicitis), pain is felt in LRQ

Term

Special Procedures & Findings:

Obturator Test

Definition

Performed when appenditis is expected; Lift the right leg, flex at hip and 90 deg at knee; Hold ankle and rotate the leg

 

Negative response is no pain

Positive response irritates the obturator muscle and produces pain (appendicitis)

Term

Abnormalities on Palpation of Enlarged Organs:

Enlarged Gallbladder

Definition

Suggest acute cholecystitis (blockage of the cystic duct causing gallbaldder inflammation)

 

Felt behind the liver as smooth and firm mass (like a sausage); Difficult to palpate b/c of involuntary rigidty of abdominal muscles

 

Area is PAINFUL to percuss and Murphy's sign is present

Term

Abnormalities on Palpation of Enlarged Organs:

Enlarged Spleen

Definition

Spleen enlarges downward and to midline because it is blocked by the diaphragm

 

Retains the splenic notch;

 

Splenomegaly occurs with acute infections (mononucleosis (too much WBC)); soft;

 

Chronic cause results in a firm, hard spleen with sharp edges

 

Enlarged spleens are not usually tender in palpations; only if the peritoneum is also inflammed

Term
Acute Cholecystisis
Definition
Inflammation of the gall bladder due to blockage of the cystic ducts
Term

Abnormalities on Palpation of Enlarged Organs:

Enlarged Kidney

Definition

Enlarged with hydronephrosis (usually caused by obstruction of the free flow of urine from the kidney, leading to progressive atrophy of the kidney), cyst (closed sac having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material) or neoplasm (new growth)

 

Difficult to distinguish between enlarged spleen and kidney; however, spleen has sharp edges whereas kidneys never do

 

Spleen retains splenic notch, where as the kidney has no palpable notch

 

Percussion over spleen is dull, where as over the kidney it is tympanitic b/c of the overriding bowel

Term

Abnormalities on Palpation of Enlarged Organs:

Aortic Aneurysm

Definition

More then 95% are located below the renal arteries and extend to the umbilicus

 

80% are palapble during routine exam

 

Feel like a pulsating mass in upper abdomen to the left of the midline

 

Hear a bruit

 

Femoral pulses will decrease in strength

Term

Abnormalities on Palpation of Enlarged Organs:

Enlarged Liver

Definition

Occurs with fatty infiltration, portal obstruction or cirrhosis (A chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue and the loss of functional liver cells. It can result from alcohol abuse, nutritional deprivation, or infection especially by the hepatitis virus), high obstruction of inferior vena cava and lymphocytic leukemia (type of leukemia affecting circulating lymphocyte cells).

 

Liver feels enlarged and smooth, but is tender to palpate with early CHF, acute hepatits or hepatic abscess

Term

Abnormalities on Palpation of Enlarged Organs:

Enlarged Nodular Liver

Definition
Occurs with Late protal cirrhosis, metastiatic cancer or tertiary syphilis
Term

Peritoneal Friction Rub

Liver vs. Spleen

Definition

Liver: Friction rub over Lower Right rib cage from abscess or metastict tumor

 

Spleen: Friction rub over lower left rib cage from abscess, infection or tumor

Term

Venous Hum

(occurs rarely)

Definition

Heard in periumbilical region; originates from inferior vena cava;

 

Medium pitch, continuous sound, pressure on bell; occurs with portal hypertension and cirrhotic liver

Term
Memorize common sites of referred abdominal Pain
Definition
[image]
Term
Succussion Splash
Definition

Loud splash ausculated over the upper abdomen when the infant is rocked side to side

 

Indicates increased air and fluid in the stomach (pyloric obstruction or hiatus hernia (the protrusion of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm))

Term
Marked peristalsis together with projectile vomiting in a newborn suggests .....
Definition
pyloric stenosis (obstruction of the stomachs pyloric valve)
Term
Diastasis Recti
Definition

Midline ridge, separation of abdominal rectus muscles

Ridge is revealed when intraabdominal pressure is increased by raising head while suppine

 

Occurs because of prolonged distention or a decrease in muscle tone

 

Not clinically significant

Term
Incisional Hernia
Definition
Bulge near an old operative scar that may not show when a person is supine, but it is apparent when the person increases intraabdominal pressure by a situp, stand or Valsalva Maneuvar (by forcible exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut)
Term
Epigastric Hernia
Definition

Small, Nodule at epigastrium in midline through the linea alba

 

One can feel rather then observe

 

Only palpable when standing

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