3016: CHAPTER 20 (EXAM #3)

Stomach changes in elderly?

↓ acid + ↓ saliva → poor swallowing + digestion

What happens to GI motility with aging?

↓ peristalsis → bloating, distention, constipation

Pain presentation in elderly?

LESS obvious (vague, diffuse abdominal pain) so less likely to present w/ acute rebound tenderness even in SEVERE

Subcutaneous fat changes in older adults?

FAT accumulates in the lower abdomen + waist → assessment LESS accurate

Liver/kidney changes in older adults?

• ↓ liver size/function → reduced metabolism

• ↓ renal function → meds accumulate

Fluid intake changes in older adults?

lower sense of thirst (higher risk of UTIS + constipation)

Abdominal Assessment Correct Order? And why?

INSPECT → AUSCULTATE → PERCUSS → PALPATE

WHY?

• Palpation/percussion can change bowel sounds

How to prepare for IPPA?

Have patient empty bladder + examine PAINFUL areas last (prevent guarding)

Inspection

Normal contour? (Inspection)

Flat, symmetric

Umbilicus? (Inspection)

Midline, inverted

Skin? (Inspection)

No scars, lesions, or veins

Normal bowel sounds? (Auscultation)

5–30 per minute (high pitch gurgles/clicks)

Hyperactive bowel sounds are called? (Auscultation)

Borborygmi (loud rushing sounds)

Hyperactive bowel sounds = ? (Auscultation)

• Diarrhea

• Early obstruction

Hypoactive Bowel Sounds (Auscultation)

Decreased sounds

Hypoactive sounds = ? (Auscultation)

• Ileus

• Peritonitis

• Post-op

ABSENT sounds are (Auscultation)

No sounds after listening for a full 5 minutes

ABSENT sounds = ? (Auscultation)

Paralytic ileus (EMERGENCY)

Normal vascular sounds? (Auscultation)

• NO bruits

• NO venous hums

Normal aortic pulsations visible in what pts? (Auscultation)

In thin patients (epigastric area); aorta is 2 cm

Abnormal vascularity findings in abdomen (Ausculation)

• Bruits

• Venous Hum

What is a bruit? (Abnormal Vascularity)

Abnormal swishing → vessel narrowing

Whast is a Venous Hum? (Abnormal Vascularity)

Soft humming in epigastric/umbilical caused by portal hypertension

Normal Abdominal Findings (Percussion)

• Tympany (Gas)

Tympany (Percussion)

predominant sound over most of the abdomen due to the presence of gas

Abnormal Abdominal Findings (Percussion)

Dullness

Dullness = ? (Normal Percussion)

• normal over solid organs like liver (RUQ) + full bladder

Dullness indicates? (Abnormal Percussion)

• Fluid (ascites)

• Mass/tumor

• Enlarged organ

• Pregnant Uterus

Normal palpation?

• Soft abdomen

• No tenderness

• No masses

Abnormal palpation?

• Involuntary Guarding

• Board-like rigidity

Guarding indicates? (Abnormal palpation)

Peritoneal inflammation

Rebound tenderness (Blumberg)?

Peritoneal irritation

Board-like abdomen? (Abnormal palpation)

Surgical emergency!!!!

Localized tenderness in RUQ =? (Abnormal palpation)

RUQ (cholecystitis)

Localized tenderness in RLQ =? (Abnormal palpation)

RLQ (appendicitis)

Localized tenderness in LLQ=? (Abnormal palpation)

LLQ (diverticulitis)

RUQ organs?

• Liver (bile, detoxifies)

• Gallbladder (stores bile)

LUQ organs?

• Stomach (mechanical/chemical digestion)

• Spleen (stores RBCs)

• Pancreas (insulin/enzymes)

RLQ organs?

• Cecum

• Appendix

LLQ organs?

Sigmoid colon

NINE REGIONS

4 Regions

• Epigastric

• Umbilical

• Hypogastric

• Suprapubic

Epigastric region =?

top midline (stomach)

Umbilical region = ?

At CENTER

Hypogastric/suprapubic = ?

above the pubic bone (bladder)

What is ascites?

Fluid in abdomen (cirrhosis)

Finding for ascites tested via?

Shifting dullness / fluid wave

**What is ileus?

No bowel movement (no peristalsis)

**Key sign for ileus?

ABSENT bowel sounds

Hernia = ?

Protrusions through the abdominal wall

When is hernia worse?

Straining / standing

Which hernia has highest risk for?

Strangulation

Classic symptom for aortic aneurysm (AAA)?

Tearing abdominal/back pain; pulsations >3 cm

Finding of aortic aneurysm (AAA)

Pulsating mass (DO NOT PALPATE!!!)

UCLERS

Gastric ulcer pain?

Worse with food

Duodenal ulcer pain?

Better with food, worse later

Normal spleen?

NOT palpable

Splenomegaly = ?

Spleen tip is palpable (mononucleosis)

***Key signs of Hepatic Disease?

• Ascites

• Jaundice

• Enlarged liver

Pain progression for Appendicitis?

Pain starts at Umbilicus → McBurney’s point (RLQ)

Key sign for Appendicitis?

McBurney’s point tenderness

******Appendicitis positive for?

Blumberg (rebound tenderness), Psoas, and Obturator signs

***Malnutrition = ?

Signs of Malnutrition?

• Weight loss

• Weakness

• poor skin/hair

Upper GI bleed signs?

• Hematemesis (vomiting blood)

• Coffee ground emesis (digested blood)

• Melena (black stool)

Lower GI bleed signs?

• Bright red blood in stool (hematochezia OR hemeroids)

Normal stool?

Soft, light brown

Abnormal Stools

• Black

• Red

• Pale

• Foul diarrhea

Black Abnormal Stool

Upper GI bleed (digsested)

Red Abnormal Stool

Lower GI Bleed

Pale Gray/Tan Abnormal Stool

Obstructive jaundice/lack of bile

Foul smelling/Liquid = ? (Abnormal Stool)

Infection (C. diff)

What is peritonitis?

Inflammation of abdominal lining

What is peritonitis?

Inflammation of abdominal lining

Key signs for Peritonitis?

• Fever/Nausea

• Board-like Rigid abdomen

• Guarding

• Positive Rebound pain

Key differences for VS for Elderly?

• Lower baseline temp

• Blunted response to infection

Athlete VS

LOW resting HR (bradycardia)

How to assess VS?

How to document VS

T: 98.6°F, HR: 72, RR: 16, BP: 120/80, SpO₂: 98% RA

Visceral pain?

Dull, hard to localize (organs)

Parietal pain?

Sharp, localized (peritoneum)

Referred pain?

Felt elsewhere

What tool for pain assessment?

OPQRST

OPQRST

Pain Signs?

• Grimacing

• ↑ HR/BP

• Restlessness

• Muscle tension