HA EXAM 3 Abdomen, Anus, Rectal

Liver

largest organ in body

clotting factors

absorption

Spleen

removes waste

Gallbladder

stores bile produced in liver

Pancreas

insulin

fat breakdown

RUQ Organs

• liver

• kidney

• diaphragm

• gallbladder

• ascending colon

• right renal artery

• vena cava

RLQ Organs

• Appendix

• Right Ovary

• Cecum

• right illac artery

• right femoral artery

LUQ Organs

• Stomach

• body of pancreas

• Adrenal glands

• Descending colon

• spleen

• diaphragm

• aorta

• left renal artery

LLQ Organs

• sigmoid colon

• left ovary

• left uretur

• descending colon

• left iliac artery

• left femoral artery

Examining Abdomen Steps

Inspect, Auscultate, Palpate, Percuss

Abdomen Expected Findings

color, surface, venous patterns, surface movements

• flat

• symmetrical

• no distention

• no glistening

• light skin has pulsations

• umbilicus should be centrally located

Hypoactive Auscultate

1-4/min = very little

• ex. constipation, post-op

Active Auscultate

5-30/min

Hyperactive Auscultate

>30/min = take meds to slow it down

How long should you listen to the abdomen before you say it is absent?

5 mins

Where should you auscultate first?

RLQ

Who might have slower bowel sounds?

Elderly pt

Who might have a distended abdomen?

Pregnant women

Light Palpation

Superficial

assessing muscle tone

pads of fingers

Deep Palpation

Fingers

assess for masses and pain

Rebound Tenderness

90% angle press down on abdomen, pain after you release press

• ex. appendicitis

Bruits

swishing in vascular

• blood vessels narrowed

• over aorta = aneurism

• Turbulent blood flow

Infants Variations

• umbilical hernia

• organs easier to feel and see peristalsis

• Newborns = first stool (can’t be discharged till they have poop)

peristalsis

involuntary muscle contractions that move food, fluids, and waste through your digestive tract

Older Adult Variations

constipation common

GERD

chronic digestive condition where stomach acid or non acidic fluid flows backward into esophagus

most common

OTC meds

heartburn

difficulty swallowing

Hiatal Hernia

upper part of the stomach pushes up through hiatus in the diaphragm

bulges on stomach

heartburn

simular to GERD

Peptic Ulcer Disease

ulcer in lower end of esophagus or diaphragm after eating

What diseases can be treated but NOT cured?

Crohn’s disease

Ulcerative Colitis

Diverticulitis

Crohn’s disease

chronic inflammatory bowel disease

• causes long-term inflammation of the digestive tract

• give iv fluids

• redness, irritation, edema

Ulcerative Colitis

chronic inflammatory bowel disease

• causes long-term inflammation

• ulcers in the innermost lining of colon and rectum

Diverticulitis

inflammation or infection of one or more small, bulging pouches (diverticula) that form in the wall of colon

Colorectal Cancer

disease that starts when cells in the colon or rectum grow out of control

• unexplained weightloss

• dark stool

Viral Hepatitis

inflammation of the liver caused by a viral infection

• anorexia

• abdominal pain

• N/V/D

• dark urine

• jaundice

• large liver

Cirrhosis

late-stage chronic liver failure

• healthy liver tissue replaced by scar tissue

• can be from alc.

Cholecystitis with cholelithiasis

gallstones (cholelithiasis) caused inflammation of the gallbladder (cholecystitis)

• stone gets stuck in the cystic duct and blocks the flow of bile

• N/V/D

• greasy food

• can assess acute from Murphy Sign

Murphy’s Sign

pt lays supine, palpate RUQ with hand, pain when inhale = +

should request ultrasound

Pancreatitis

inflammation of the pancreas

• severe pain

• pt NPO

• increase in amylase + lipase

Urinary Tract Calculi (Kidney Stones)

hard mineral and salt deposits that form inside the kidneys

• very painful esp. w/ uretur

• pain in lower abdomen

UTI

bacterial infection that affects any part of your urinary system

• painful urination

• cloudy odur urine

• pain in lower back

Internal Hemorrhoids

above anal sphincter

• painless

• bright red rectal bleeding

• tender lump

External Hemorrhoids

below anal sphincter

• itching burning swollen pain

• less likely bright red rectal bleeding

• tender lump

Hemorrhoids Risk Factors

• straining w/ bowel movements

• constipation

• pregnancy

• prolonged sitting

Bright Red Stool

Hemorrhoidal or lower rectal bleeding

Tarry Black Stool

upper intestinal tract bleeding

excessive iron

bismuth ingestion

Light Tan or gray stool

obstruction of biliary tract (obstructive jaundice)

Pale yellow stool

malabsorption syndrome

Pt Positioning for Rectal Exam

left lateral or SIMS position

Knee-chest position

Standing position

DRE (Digital Rectal Exam)

• check sphincter tone, masses, tenderness

• for males prostate = smooth, firm, non-tender

• can be for rectal bleeding, prostate evaluation

Anal Fissure

small tear in lining of anal canal

Anal Fissure Symptoms

• sharp pain w/ bowel movements

• bright red bleeding

• burning, itching

Anal Fissure Causes

• constipation

• straining w/ bowel movements

• trauma

Benign Prostatic Hyperplasia

noncancerous enlargement of prostate gland

• can use lasers to treat

Benign Prostatic Hyperplasia Symptoms

• weak urine stream

• hesitancy or difficulty urinating

• nocturia

• incomplete bladder emptying

• dribbling

Benign Prostatic Hyperplasia Risk Factors

• family history

• older age (>50 yrs)

Prostate Cancer

malignant growth in prostate gland

Prostate Cancer Symptoms

• asymptomatic in early stages

• urinary symptoms similar to BPH

Prostate Cancer Risk Factors

• older age (>50 yrs)

• family history (first-degree)

• genetics (BRCA mutations)