NURS 3016 Chapter 20

Sickle cell (si/sx)

• Splenomegaly

• jaundice

• acute pain

• vomiting

Chronic liver disease (risk factors)

• Alcoholism

• obesity

• hepatitis B/C

Colorectal cancer

• A common cancer of the colon or rectum with risk factors including age, diet, obesity, and family history

• Long-standing ulcerative colitis

• Intestinal polyps

Crohn disease

• Malnutrition

• short bowel syndrome

Mononucleosis

• Hepatosplenomegaly (Enlargement of liver and spleen)

Quadrant Method

• A system dividing the abdomen into four sections (RUQ, LUQ, RLQ, LLQ)

• Vertical and horizontal lines through the umbilicus

Nine-Region Method

• A system dividing the abdomen into nine regions using midclavicular and horizontal lines for more precise localization of findings

Hepatitis

• Inflammation of the liver caused by viruses, drugs, or toxins

• Symptoms include nausea, fever, and jaundice

Hepatitis A

• A viral infection spread via the fecal–oral route that usually resolves within a year

Hepatitis B

• A viral infection spread through blood/body fluids that can lead to chronic disease and is preventable by vaccination

Hepatitis C

• A blood-borne viral infection with no vaccine that often becomes chronic and can lead to liver damage

Key abdominal landmarks

• Umbilicus

• Costal margins

• Iliac crests

• Pubic symphysis

Right upper quadrant (landmarks)

• liver

• gallbladder

Left upper quadrant (landmarks)

• stomach

• spleen

Right lower quadrant (landmarks)

• appendix

Left lower quadrant (landmarks)

• sigmoid colon

Health Promotion/Risk Reduction

• Diet: high fiber, low fat, adequate hydration

• Avoid alcohol/drug misuse

• Screening:

  • Colonoscopy (colon cancer)

  • PSA (prostate)

• Infection prevention (UTIs, hepatitis)

• Safe medication use (avoid NSAID overuse → ulcers)

• Hygiene & sexual health practices

Distention

• obstruction

• ascites

Ileus

• Absent bowel sounds

Peritonitis

• Rebound tenderness

Hyperthyroidism

• Overactive T3 & T4 production

• sped up metabolism

• restless or jittery

Hypothyroidism

• Minimal production of T3 & T4

• slowed metabolism

• Sluggish

Polyphagia

• Excessive hunger or increased appetite

• eating more than normal

Polydipsia

• Excessive thirst

• increased fluid intake

Diabetic gastroparesis

• Delayed stomach emptying due to nerve damage (usually the vagus nerve) from diabetes

• nausea

• vomiting

• bloating

• erratic/irregular blood glucose levels

Anorexia

• loss of appetite and can be related to stress

• difficulty with ingestion

• socioeconomic issues

• age-related issues

• dementia

Bulimia nervosa

• deliberately vomits after eating

Visceral Pain

• Pain from distention, stretching, or forceful contraction of hollow organs

• Poorly localized

• gnawing, burning, cramping, or aching

• sweating, pallor, nausea, vomiting, or restlessness

Parietal Pain

• Pain from inflammation of the peritoneum

• severe and well localized

• steady, aching, or sharp

• worsens with movement

Referred Pain

• Pain felt at a distant site that shares the same spinal nerve level as the affected organ

Hematemesis

• Vomiting of blood

• bleeding in the upper gastrointestinal tract

Odynophagia

• Painful swallowing

Jaundice/Icterus

• Yellow discoloration of the skin, sclera, and mucous membranes

• elevated bilirubin levels in the blood

Kidney Pain

• Pain in the side or back between the ribs and hip

• often related to kidney issues

Ureteral Colic

• Severe cramping pain caused by obstruction (often a kidney stone) moving through the ureter

Borborygmi

• Increased bowel sounds

• occur with diarrhea and early intestinal obstruction

Bruits

• Swishing sounds that indicate turbulent blood flow resulting from constriction or dilation of a tortuous vessel

• hepatic area indicate liver cancer or alcoholic hepatitis

• over the aorta or renal arteries indicate partial obstruction of the aorta or renal artery

Venous Hums

• soft-pitched humming noises with systolic and diastolic components

• indicate partial obstruction of an artery and reduced blood flow to the organ

Friction Rubs

• grating sounds that increase with inspiration and occur with liver tumors, splenic infarction, or peritoneal inflammation

Bladder Scan

• identify the volume in the bladder and ability to void and empty the bladder

Cirrhosis

• Chronic liver disease characterized by irreversible scarring (fibrosis) of liver tissue,

• impaired liver function

Esophagogastroduodenoscopy (EGD)

• A procedure using a flexible endoscope to visualize the esophagus, stomach, and duodenum

Computed Tomography (CT) scan

• An imaging test that uses X-rays and computer processing to create detailed cross-sectional images of the body

Magnetic Resonance Imaging

• An imaging technique that uses strong magnetic fields and radio waves to produce detailed images of internal body structures

Endoscopic Retrograde Cholangiopancreatography

• A procedure combining endoscopy and X-ray imaging to visualize and treat problems in the bile ducts and pancreatic ducts

Barium Enema

• a diagnostic X-ray procedure used to examine the lower gastrointestinal (GI) tract—the colon and rectum

Vascular Sounds

• Audible sounds (such as bruits) produced by turbulent blood flow within blood vessels, often heard with a stethoscope

Light Palpation

• Gentle, superficial pressing of the abdomen (about 1 cm) to assess tenderness, muscle tone, and surface abnormalities

Deep Palpation

• Firm, deeper pressing (about 4–5 cm) to assess organs, masses, and deeper areas of tenderness

Blumberg sign

• Rebound tenderness (pain upon release of pressure on the abdomen)

• indicating peritoneal irritation

Murphy Sign (Inspiratory Arrest)

• Sudden stop in inspiration due to pain when the examiner palpates the right upper abdomen

• indicating gallbladder inflammation (cholecystitis)

iliopsoas muscle test

• Pain elicited when the patient flexes the hip against resistance or when the hip is passively extended

• suggesting irritation of the iliopsoas muscle

• often seen in appendicitis