Exam 3 - Abdomen- Examination and Findings, Anatomy and Physiology, Additional Procedures

When inspecting the abdomen what side do you stand on?

Right

What is important with patient placement when doing palpation of the abdomen

KNEE FLEXED FOR PALPATION

What surface characteristics do you look for with inspection?

Skin

Venous return

Lesions and scars

Tautness and striae

What do you check for with contour inspection of the abdomen?

Abdominal profile from rib margin to the pubis, viewed on horizontal plane

Symmetry

Surface motion

What type of movement of the abdomen should occur with respiration

Smoooth, even movement

Limited movement may indicate?

Peritonitis

How is peristalsis seen as a surface motion?

Rippling movement across section of the abdomen

When can you see peristalsis?

Thin patients

Or sign of intestinal obstruction

How do you typically hear bowel sounds?

Clicks and gurgles

How often should you hear bowel sounds

5-35 per minute

What are loud prolonged gurgles?

borborygmi (stomach growling)

When may increased bowl sounds occur?

Gastroenteritis

Early intestinal obstruction

Hunger

High pitched tinkling sounds suggest?

intestinal fluid and air under pressure, as in early obstruction

Decreased bowel sounds occur with?

Peritonitis

Paralytic ileus

What is paralytic ileus

Intestines aren't moving from a cause that is outside the intestines

When is it considered absent bowel sounds?

Inability to hear any bowel sounds after 5 minutes of continuous listening

What is absent bowl sounds associated with?

Surgical emergency

What are high-pitched sounds that are head in association with respiration?

Friction rubs

How do you hear friction rubs?

Diaphragm of stethoscope

TRUE or FALSE

It's rare to hear friction rubs in the abdomen

TRUE

What do friction rubs indicate?

Inflammation of the peritoneal surface

If you do hear friction rubs in the abdomen, where are some common places they can be heard?

Liver

Spleen

What are harsh auscultatory sounds that may reflect blood flow turbulence and indicate vascular diseases?

Bruits

Bruits are best heard with?

Diaphragm of the stethoscope

Where do we auscultate for bruits?

3 sites down midline from xiphoid to umbilicus

3 sites down both iliac arteries

2 sites over renal arteries

Where can you auscultate the renal arteries

Right and left side of midline 1/2 way between xiphoid and umbilicus

What are soft, low pitched and continuous sounds that are best heard with the bell of the stethoscope

Venous hum

How does venous hum occur

Increased collateral circulation between portal and system venous systems

Where do you hear venous hum

Epigastric region and around umbilicus

Who would we hear a venous hum in?

Someone with portal hypertension

What is used to assess the size and density of organs?

Percussion

Percussion can be used to detect the presence of?

Fluid (ascites)

Air (gastric distention)

Fluid filled or solid masses

Where would we hear tympany?

Stomach (air bubble)

Where would we hear dullness?

Solid organ (liver)

Where would we hear resonance?

Occurs over intestines (everything but liver and stomach)

How do we do percussion?

Do a zig zag pattern of all 9 areas

Size of liver span?

6-12 cm (2.5-4.5 inches)

Spleen is located here?

6-9th intercostal space on left mid-axillary line

What can be noted during general percussion?

Gastric bubble

When do you do pro active percussion?

At the very end of the exam

What are the different type of palpation that we do?

Light palpation

Moderate palpation

Deep palpation

What is important to do during palpation?

WATCH THE PATIENTS FACE FOR PAIN DURING

What are some areas to feel fecal matter sometimes on palpation

Cecum

Sigmoid colon

You (should or should not) typically feel the bladder if the patient doesn't need to urinate

SHOULD NOT

The umbilical ring should be?

Round and free of irregularities

Where is a potential for herniation?

Umbilical ring

What specific organs and structures do we palpate for?

Liver

Gallbladder

Spleen

Left and right kidneys

Aorta

Urinary bladder

When palpating for the liver you should also say you are palpating?

The gallbladder

-SHOULD NOT FEEL GALLBLADDER IN HEALTHY PERSON

What organ is typically no palpable?

Spleen

How should the kidney feel?

Smooth and a little bit rounded

What is a serous membrane that lines the cavity and forms a protective cover for many of the abdominals structures

Peritoneum

What is a a fan shaped fold of the peritoneal that covers most of the small intestine and anchors it to the posterior abdominal wall

Mesentery

What is a 27 foot tube from the mouth to the anus

Alimentary tract

What are the parts of the alimentary tract?

Esophagus: 10 inches

Stomach

Small intestine: 21 feet

Large intestine (colon): 4.5-5 feet

Functions of alimentary tract

Ingest and digest food

Absorb nutrients, electrolytes and water

Excrete wastes

What connects the pharynx to the stomach

Esophagus

Where is the esophagus in relation to the trachea

Posterior to the trachea

Path of the esophagus

Descends through mediastinal cavity

Travels through diaphragm

Enters stomach at cardiac orifice

Where does the stomach lie?

Upper abdomen below diaphragm

What are the sections of the stomach

Fundus

Body

Pylorus

What does the stomach break down? How?

Secretes HCl and enzymes to break down fats and proteins

TRUE or FALSE

Little absorption takes place in the stomach

TRUE

What connects the stomach to the large intestine

Small intestine

What are the 3 sections of the small intestine

Duodenum: 12 inches

Jejunum: 8 feet

Ileum: 12 feet

The duodenum has openings for?

Bile and pancreatic ducts

What is between the ileum and large intestine that prevents backflow?

Ileocecal valve

What helps increase the surface area of the small intestine

Circular folds and villi

What connects the small intestine to the anus

Large intestine

What are the 4 sections of the large intestine

Cecum

Ascending colon

Transverse colon

Descending colon

What extends from the base of the cecum

Vermiform appendix

What are the parts of the descending colon

Sigmoid colon

Return and anal canal

Functions of large intestine

Water absorption

Putrefaction

Lubriction of contents

What is putrefaction in the large intestine

Live bacteria decompose undigested food, unabsorved amino acids, cell debris and dead bacteria

Where is the liver

Right upper quadrant

How many lobes does the liver have?

Four lobes

Major functions of the liver

Metabolize fats and carbs

Convert amino acids to glucose

Synthesize fats from carbohydrates and protein

Store vitamins and iron

Detoxify harmful substances

Produce antibodies and blood coagulants

Synthesize bile

Convert waste from fat to water soluble

What is a pear shaped, saclike organ about 4 inches long that is recessed in the liver?

Gallbladder

Function of gallbladder

Concentrates and stores bile

What maintains alkaline pH of small intestine to permit emulsification of fats for absorption

Bile

Where is the pancreas located

Behind and beneath stomach

Functions of pancreas

Produces digestive enzymes

Endocrine function produces hormones to regulate body`s level of glucose (insulin and glucagon)

Where is the spleen located

Left upper quadrant above kidney

Functions white pulp of spleen

Lymphoid tissue

-filters blood

-produces lymphocytes and monocytes

Functions of red pulp of spleen

Allows for storage and release of blood

What are located bilaterally in the retroperitoneum and connected to the bladder via uterus

Kidneys

Functions of the kidneys, ureters and bladder

Rids body of water-soluble waste

Produces (endocrine) renin, erythropoietin, and biologically active vitamin D

Synthesize prostaglandins

What are the musculature and connective tissues that form and protect the abdominal cavity

Rectors abdominis

Internal and external obliques

Linea alba

Inguinal ligament

What contains the umbilicus

Linea alba

What are the branches of the descending aorta

Iliac arteries

Splenic artery

Renal arteries

What form during about week 4 of gestation

Pancreatic buds

Liber

Gallbladder

What is produces at about 17 weeks

Meconium (end product of fetal metabolism)

When is the GI tract capable of adapting to extra uterine life?

36-38 weeks

What organ is very large at birth?

Liver

-metabolic and glycogen storage organ

When is the spleen active in blood formation?

During fetal development and first year of life

What is a pathological increase in fluid in the peritoneal cavity

Ascites

What do you percuss for with Ascites

Dullness and resonance

Shifting dullness

Fluid wave

How do you look for shifting dullness

Patient supine has typamny surrounded by dullness and then lays on their side and the side up is tympany and side down is dullness

How do you test for fluid wave

Patient supine with hand midline of abdomen, thumb side of their abdomen and watch for ripple

Red bound tenderness is present with?

Appendicitis and irritation of peritoneum

When do you do the iliospoas test

When you suspect appendicitis