Physical Diagnosis II Exam 1 - (part 1) Abdomen Anatomy & History

What is the core examination skills in the particular sequence for the abdominal exam?

1) Inspection

2) Auscultation

3) Percussion

4) Palpation

NOTE: least to most invasive!

What structure of the abdomen forms a protective cover for many of the abdominal structures?

Peritoneum

Which of the two layers of the serous membrane lines the abdominal cavity? Which lines the organs?

Parietal peritoneum

Visceral peritoneum

What is contained within the peritoneal cavity?

Lubricating fluid

Double folds of peritoneum around the stomach constitute what two structures?

Greater & Lesser Omentum

What is a fan-shaped fold of peritoneum, covering most of the small intestine and anchoring it to the posterior abdominal wall?

Mesentery

What side of the abdomen is the liver located? Gallbladder? Stomach? Spleen?

Liver = Right Upper quadrant

Gallbladder = Right upper quadrant

Stomach = Left upper quadrant

Spleen = Left upper quadrant

What is the 27 food tube from mouth to anus? What are the 4 parts of this?

Alimentary Tract

1) Esophagus

2) Stomach

3) SI

4) LI (colon)

What is the length of the SI? LI (colon)?

21 ft

5 ft

What are the 3 functions of the Alimentary Tract?

1) Ingest & digest food

2) absorb nutrients, electrolytes, water

3) excrete waste

What moves food along the tract under autonomic nervous system control?

Peristalsis

The esophagus is the ______ inch collapsible tube that connects the pharynx to the stomach, _________to the trachea, and descends through the __________ cavity, through the diaphragm, and enters the stomach at the ___________?

10 inch

posterior

mediastinal cavity

cardiac orifice

What organ is flask-shaped, lying transversely in the upper abdomen below the diaphragm? What are the 3 sections of this?

Stomach

Sections: Fundus, Body, Pylorus

The stomach secretes _____ & ______ to break down ______ & _______.

HCl & enzymes

Fats & Proteins

T/F: Little absorption takes place in the stomach

TRUE

What organ connects the stomach to the large intestine? What are the 3 sections coiled in the abdominal cavity? Which section has openings for bile and pancreatic ducts?

Small intestine

Sections: Duodenum, Jejunum, Ileum

Duodenum has openings for bile & pancreatic duct

What is the length of the duodenum? Jejunum? Ileum?

Duodenum = 12 inches

Jejunum = 8 feet

Ileum = 12 feet

T/F: The small intestine does not participate in digestion, with its major function being absorption through the mucosa

FALSE

Completes digestion through pancreatic enzymes, bile, and other enzymes

Nutrients absorbed through mucosa

Why are the circular folds and villi important in the small intestine?

Surface area enormously increased

What is between the ileum and large intestine, preventing backflow?

Ileocecal valve

What organ connects the small intestine to the anus? What are the 4 sections of this structure? From which section does the vermiform appendix extend from?

Large intestine

Sections: Cecum, Ascending colon, Transverse colon, Descending colon

Vermiform appendix extends from base of Cecum!

What are the 3 concluding parts of the descending colon?

Sigmoid colon, Rectum, and Anal canal

What is the major function of the large intestine?

Water absorption & transport waste

-- alkaline mucus lubricates the contents & neutralize acids formed from intestinal bacteria

What is the process in the LI by which live bacteria decompose undigested food, unabsorbed amino acids, cell debris, and dead bacteria?

Putrefaction

What are the major functions of the liver? (8)

1) Metabolize fat & carbs

2) Convert AA to glucose

3) Synthesize fats from carbs & proteins

4) Store Vitamins & Fe

5) Detoxify harmful substances

6) Produce antibodies & blood coagulants

7) Synthesize bile

8) Convert waste from fat to water soluble

What is the pear-shaped, saclike organ that is about 4 inches long recessed in liver? What is its major function?

Gallbladder

Concentrates & Stores bile

What 3 things is bile made up of? What is the pathway that bile follows from the gallbladder until it enters the SI? (3)

Bile = Cholesterol, Bile salts, Pigments

Released into cystic duct --> common bile duct --> duodenum

Bile maintains a __________ pH of the SI to permit emulsification of fats for absorption?

Alkaline pH

What organ is located behind and beneath the stomach?

Pancreas

What is the exocrine function of Pancreas? Endocrine function?

Exocrine = produces digestive juices

Endocrine = Produces hormones to regulate body's level of glucose (Insulin & Glucagon)

T/F: Glucagon is the major anabolic hormone

FALSE

Insulin is the major anabolic hormone

What organ is located in the left upper quadrant above the kidney?

Spleen

What is the function of the WHITE pulp of the spleen? RED pulp?

White = LYMPHOID tissue

1) filters blood

2) produces WBCs (lymphocytes & monocytes)

Red = Storage & release of BLOOD

NOTE: Red thing blood, white think immune

The kidneys are located bilaterally in the _______________ space and are connected to the bladder via ________. Each kidney extends from about _____ - _____

Retroperitoneal space

Ureters

T12-L3

What are the 3 functions of the kidneys, ureters, and bladder collectively?

1) Rid body of water-soluble waste

2) Produce (endocrine) renin, erythropoietin, biologically active Vit D

3) Synthesize prostaglandins

What two muscles form and protect the abdominal cavity?

1) Rectus abdominis

2) Internal and external obliques

What connective tissue contains the umbilicus? What connective tissue is also known as the Poupart ligament?

Linea alba (contains umbilicus)

Inguinal ligament (Poupart ligament)

The descending aorta is located just _____ of midline.

Left

At the level of the umbilicus, the aorta branches into what 2 arteries? What are the other two branches of the descending aorta?

2 common iliac arteries

Splenic artery & Renal artery

The pancreatic buds, liver, and gallbladder all begin to form during _________ of gestation. _______ already exists as a single tube.

week 4

Intestine

What is the end product of fecal metabolism? When is it produced?

Meconium

Week 17

By what weeks is the GI tract capable of adapting to extrauterine life?

36-38 weeks

Elasticity, musculature, and control mechanism continue to develop, reaching adult levels of function at ____ to ____ years of age

2-3 years of age

T/F: The liver is smaller than adult size at birth, but still remains the heaviest organ in the body.

FALSE

- Liver is very LARGE at birth, remains heaviest organ in the body

What is the organ of metabolic and glycogen storage?

Liver

Pancreatic islet cells are developed by _____ of gestation, beginning to produce _______/

12 weeks

Producing insulin

The spleen is active in ______________ during fetal development and first year of life. After, the spleen aids in _______________ and functions as a ____________ organ for immunological response.

Blood formation

Destruction of blood cells

Lymphatic organ

Nephrogenesis begins during the ________ embryologic month. By week 12, the kidneys are able to ________________. Development of new nephrons will cease by 36 weeks of gestation and after birth, the kidney size __________.

Second

produce urine

Increase (because enlargement of existing nephrons and adjoining tubules)

During pregnancy, the abdominal wall muscles stretch and lose tone, which may lead to ___________ persisting

Diastasis recti

(belly sticks out because the space between your left and right belly muscles has widened)

In pregnancy, organs are displaced and affect functions. What are 5 possible results of this? Which two conditions is MC in the 2nd and 3rd trimesters?

1) Heartburn - (alkaline reflux from duodenal contents into stomach; 2nd/3rd tri)

2) Gallstones - (produce cholesterol crystals; 2nd/3rd tri)

3) Urinary stasis/urgency

4) Constipation or flatus (GI transit time prolonged)

5) Hemorrhoids (later in pregnancy)

What distinctly appears in the 3rd trimester of pregnancy?

Linea nigra

In what 3 ways is the GI tract of older adults affected?

1) Motility slows

2) Secretion and absorption may slow

3) Impair digestive ability (may result in food intolerances)

In older adults, the liver loses some ability to metabolize ______, may be a ______ of biliary lipids which can result in the formation of _______________. The pancreases has _______ physiologic changes.

Certain drugs

Increase

NO significant

T/F: Abdominal pain is common

TRUE

Summary: History considerations

Pain Assessment

- How bad is pain?

- Recent trauma?

- Willingness to move (or pain too severe)?

- N/V with pain?

- Areas of localized tenderness?

- Facial expressions during palpation?

Summary: History considerations

Abdominal pain

- onset/duration

- character

- location

- associated symptoms

- relationship factors

- stool & urine characteristics

- medications (high doses of aspirin, steroids, NSAIDs)

Summary: History considerations

Ingestion

- character

- location

- relationship to amount, type, timing of food intake

- onset of symptoms

- symptoms relieved by antacids, rest, activity

- medications (antacids)

Summary: History considerations

Nausea & Vomiting

Nausea

- associated with vomiting

- particular stimuli (odor, activity, time of day, food intake)

- date of last menstrual period

- medications (antiemetics)

Vomiting

- character (nature, color, quantity, duration, frequency)

- relationship to meals, appetite, diarrhea, constipation

- medications (antiemetics)

Summary: History considerations

Diarrhea

- character

- associated symptoms

- relationship to food intake & stressors

- travel history

- medications (laxatives, stool softeners, antidiarrheals)

Summary: History considerations

Constipation & Fecal incontinence

Constipation

- character

- pattern

- diet

- medications (laxatives, stool softeners, iron, diuretics)

Fecal incontinence

- character

-associated symptoms

- related factors

- medications (laxatives, stool softeners, iron, diuretics)

Fecal incontinence generally occurs in in what population? History of what can make fecal incontinence more likely?

older population

History of constipation

Summary: History considerations

Jaundice

- onset and duration

- color of stools and urine

- associated with abdominal pain, chills, fever

- exposure to hepatitis, use of illicit drugs, high-risk sexual activity

- medications (high doses of acetaminophen, antipileptics)

Summary: History considerations

Dysuria (painful urination)

- character

- location (suprapubic or distal urethra)

- associated fever or other systemic signs of illness

- increased frequency of sexual intercourse

- amount of daily fluid intake

Summary: History considerations

Urinary Frequency & Incontinence

Urinary frequency

- change in pattern or volume

- dysuria or other urinary characteristics (urgency, hematuria, incontinence, nocturia)

- change in urinary stream, dribbling

- medications (diuretics)

Urinary incontinence

- character, amount, frequency

- associated w/ urgency, previous surgery, coughing, sneezing, walking up stairs, nocturia, menopause

- medications (diuretics)

Summary: History considerations

Hematuria

- character, color, timing

- associated symptoms (flank or costovertebral pain)

- alternate possibilities (ingestion of food containing red vegetable dyes, ingestion of laxatives containing phenolphthalein)

- medications (aspirin, NSAIDs, anticoagulants, diuretics, antibiotics)

Summary: Past Medical History

- GI disorders

- Hepatitis or cirrhosis of liver

- Abdominal or urinary tract surgery or injuyr

- UTI

- major illnesses

- blood transfusions

- immunization status (Hep A & B)

- colorectal or related cancers

- STI

Summary: Family History

- Colorectal cancer/familial colorectal cancer syndromes

- Gallbladder disease

- Kidney disease

- Malabsorption syndrome

- Hirschsprung disease (AKA agonglionic megacolon)

- Familial Mediterranean fever (periodic peritonitis)

Summary: Personal and Social History

- Nutrition

- LMP

- Alcohol intake (frequency, type, amounts)

- Stressful life events, physical and psychologic changes

- Exposure to infectious diseases

- Travel history

- Trauma

- Illicit/intravenous drugs

- Tobacco use

Summary: Infants History

- Gestational age and birth weight

- Passage of first meconium stool within 24 hours

- Jaundice

- Vomiting, frequency, projectile

- Diarrhea, colic, failure to gain weight, weight loss, or steatorrhea (malabsorption syndrome)

- Apparent enlargement of abdomen (with or without pain), constipation, or diarrhea

Summary: Children History

- Constipation (toilet training methods, diet, soiling, diarrhea, distention, pica, size, shape, consistency, time of last stool, rectal bleeding, painful passage of stool)

- Dietary habits (lack of fiber in diet, change in appetite, daily fluid intake; pica)

- Abdominal pain (splinting of abdominal movement, resists movement, keeps knees flexed)

- Psychosocial stressors (home, school, and peers)

Summary: Pregnant Women History

- Urinary symptoms (frequency, urgency, burning, dysuria; odor)

- Abdominal pain

- Fetal movement

- Contractions (onset, frequency, duration, intensity, accompanying symptoms, back pain, leakage of fluid, vaginal bleeding)

Summary: Older Adults History

- Urinary symptoms (nocturia, change in stream, incontinence)

- Change in bowel patterns (constipation, diarrhea, fecal incontinence)

- Dietary habits (fiber in diet, food intolerances, change in appetite, daily fluid intake)