liver, gallbladder, duodenum, head of pancreas, right kidney and andrenal , hepatic flexure of colon, part of ascending and transverse colon
What organs are found in the right upper quadrant
stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal, splenic flexure of colon, parts of transverse and asending colon
What organs are found in the left upper quandrant
Cecum, appendix, right ovary and tube, right ureter, right spermatic cord
What organs are found in right lower quadrant
Parts of descending colon, sigmoid colon, left ovary and tube, left ureter, and left spermatic cord
What organs are found in left lower quadrant
dysphagia
difficulty in swallowing
decreased
Pregnant women have __________ gastrointestinal motility that causes constipation and may lead to hemorrhoids
Diminished
in pregnant women, enlarging uterus displaces intestines upward and posteriorly. bowel sounds are _________
decreases, increases
in aging adult, salivation , gastric acid and liver size secreation _________ gallstone incidence _________
Anorexia
loss of appetitte from gastrointestinal disease , as a side affect of medications
African americans
Lactose intolerance is highest in
pyrosis
heartburn - burning sensation in esophagus and stomach from reflux of gastric acid
Dull sound
What type of sound should you hear when percussing the liver?
GI Bleeding
Black tarry stools indicate occult blood from
hepatitis
Gray stools occur with
NSAIDS non steroidal anti inflammatory drugs
peptic ulcer disease occurs with frequent use of
pica
condition where people eat objects that are not food or edible
Scaphoid
Abdomen cave in
protuberant
abdomen distends
hernia
protrusion of abdominal viscera through abdominal opening in muscle wall
normal
Pulsations from aorta beneath skin in epigastric area is
they can increase peristalsis and give false interpretation of bowel sounds
Auscultation is done before percussion and palpation because
right lower quadrant at ilececal valve
Where should you
start auscultation
Bowel sounds
high pitched gurgling cascading sounds occurring irregularly anyhere from 5-30 times per minute
hyperactive bowel sounds
loud high pitched rushing tinkling sounds that signal increased motility
hypoactive bowel sounds
usually follow abdominal surgery or with inflammation of peritoneum
Systolic bruit
pulsitle blowing sound that occurs with stenosis or occlusion of artery
Tympany
when percussing the abdomen ______should be predominate because air in the intestines rises to surface when person is supine
enlarged liver span
indicates liver enlargerment or hepatomegaly
Liver span
Percuss down the interspaces until sound changes to dull quality, mark spot, then find abdominal typany and percuss up in midclavicular line mark where sound changes measure between 2 spots, this is the_________. It is normally 6-12 cm in adults
Enlarged spleen
Dull note forward of midaxillary line indicates__________occurs with mononucleosis, trauma and infection
Splenic dullness
percuss from 9th to 11th interspace, just behind midaxillary line will hear ___________. is not usually wider than 7 cm
Fluid wave test
test for fluid in the peritoneal cavity by standing on person's side , place ulnar edge of another examiners hand on patient's own hand firmly on abdomen in midline. Place your hand on person's right flank and reach across abdomen and give flank a firm st
Shifting dullness
supine position, will hear tympanic note as you percuss over top of abdomen but dull on sides of abdomen, turn person on right. Percuss upper right side and move downward. Sounds change from tympany to dull sound as reach fluid level, but level of dullnes
last
When palpating, if a patient complains of tenderness when should you palpate this area
light palpation
Depress skin about 1 cm make gentle rotary motion sliding fingers and skin together. move clockwise to next location around abdoment. Tender areas last
Deep palpation
Depress skin about 5-8 cm make gentle rotary motion sliding fingers and skin together. move clockwise to next location around abdoment. note size , location, consistency and mobility of palpable organs
Voluntary guarding
occurs when person is cold tense or ticklish, bilateral feel muscles relax during exhalation.
involuntary rigidity
constant boardlike hardness of muscles. It is a protective mechanism accompanying acute inflammation of peritoneum. May be unilateral
Umbilical hernia
protrusion of the intestine through a weakness or incomplete closure of umbilical ring. usually resolves within a year
Epigastric hernia
small fatty nodule at epigastrium in midline through linea alba may be palpable when standing
Diastasis Recti
midline longitudinal ridge, separation of abdominal rectus muscles. Ridge is revealed when intra-abdominal pressure is increased by raising head when supine
location, size, shape, consistency, surface, mobility, pulsatility, tenderness
If a mass is found in abdominal area what do you need to note
Rebound tenderness (blumberg sign)
assess ________when person reports abdominal pain or when you elicit tenderness during palpation. Hold had at 90degress to abdomen, push down slowly and deeply, lift up quickly . normal response is no pain
appendicitis
Pain on release of pressure confirms rebound tenderness. this accompanies
murphy's sign (inspiratory arrest)
Hold fingers under liver ask person to take a breath. Complete breath with no pain is normal. pain idicates inflammation of the gallbalnder
dehydration
Scaphoid shape of abdomen in infant indicates
10-14 days
Umbilical stump dries up within a week, hardens and falls off by
aging adults
abdominal musculature is thinner and has less tone and depostits of subcutaneous fat on abdomen and hips occurs in
Obesity
uniformly rounded abdomen, umbilicus sunken, have normal bowel sounds, may be hard to palpate due to thick abdomeinal wall
Air or gas
single round curve, hyperactive bowel sounds with obstruction, decreased bowel sounds with ileus, typany is heard with percussion
Ascites
single curve, umbilicus bulgin flanks when supine, increase in abdominal girth
normal bowel sounds present, typany is head at top and dull over fluid,
Ovarian cyst
curve in lower half of abdomen, everted umbilicus. normal bowel sounds. top dull over fluid, intestines pushed superiorly, large may produce fluid wave and shifting dullness. palpations transmits arotic pulsation
Succusion splash
unrelated to peristalsis, very loud splash auscultated over upper abdomen when infant is rocked side to side. Indicates increased air and fluid in stomach as seen with pyloric obstruction or large hiatus hernia
pyloric stenosis
Marked peristalsis together with projectile vomiting in the newborn suggests ________ obstruction of stomachs pyloric valve. Appears in 2nd 3rd week of life. After feeding, pronounced peristaltic waves cross from left to right leading to projectile vomiti
Hyperactive bowel sounds
Loud gurglingg sounds, borborygmi, signal increased motility. Occur with early mechanical bowel obstruction, gastroenteritis, brisk diarrhea, laxative use and paralytic ileus
Hypoactive bowel sounds
Diminished or absent bowel sounds signal decreased motility as a result of inflammation as seen with peritonitis, from paralytic ileus as following abdominal surgery or from late bowel obstruction. Also occurs with pneumonia.
Aortic aneurysm
located below renal arteries and extend to umbilicus. Focal bulging is palpable ins 80% of cases, feels like pulsating mass in upper abdomen just left of midline. Bruit present, femoral pulses are present but diminished.
enlarged kidney
enlarged with hydronephrosis cyst or neoplasm. Enlarged kidney never has sharp edges. Percussion is tympanic because overriding bowel
enlarged spleen
enlarges down and to midline. Splenomegaly occurs with acute infections (mononucleosis), moderately enlarged and soft with round edges, chronic cause - enlargement is firm with sharp edges. Usually not tender to palpation
enlarged tender gallblader
suggests acute cholecystitis. Murphy's sign is present
enlarged nontender gallbladder
occurs when gallbladder is filled with stones, common bile duct obstruction
enlarged nodular liver
- occurs with late portal cirrhosis, metastatic cancer or tertiary syphilis
enlarged smooth nontender liver
- occurs with fatty infiltration, portal obstruction cirrhosis, high obstruction of inferior vena cava, and hyphocytic leukemia
Enlarged smooth tender liver-
occurs with early heart failure, acute hepatitis, hepatic abscess