Chapter 21

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