Ch23 HA Textbook(KLM)

What imaginary lines define the four abdominal quadrants, and where do they intersect?

A vertical midline from xiphoid process to symphysis pubis bisected perpendicularly by a lateral line through the umbilicus.

Which major organs are located in the Right Upper Quadrant (RUQ) of the abdomen?

Liver, gallbladder, duodenum, head of pancreas, right kidney (upper pole), hepatic flexure of colon, ascending and transverse colon.

Which major organs are located in the Left Upper Quadrant (LUQ) of the abdomen?

Stomach, spleen, body and tail of pancreas, left kidney (upper pole), splenic flexure of colon, transverse and descending colon.

Which major organs are situated in the Right Lower Quadrant (RLQ) and Left Lower Quadrant (LLQ)?

RLQ: Cecum, appendix, ascending colon, right kidney (lower pole), right ovary/tube or spermatic cord; LLQ: Sigmoid colon, descending colon, left kidney (lower pole), left ovary/tube or spermatic cord.

What is the primary functional difference between solid viscera and hollow viscera, and what are examples of each?

Solid viscera maintain consistent shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus); hollow viscera change shape based on contents (stomach, gallbladder, small intestine, colon, bladder).

What structure forms the vertical midline white line where abdominal muscle aponeuroses join from xiphoid process to symphysis pubis?

Linea alba.

At what anatomical landmark is renal tenderness best assessed during blunt percussion?

Costovertebral angle (CVA) over the 12th rib.

Differentiate between visceral pain, parietal pain, and referred pain in terms of cause and characteristics.

Visceral pain arises from hollow organ distention or solid organ capsule stretching (dull, aching, burning, poorly localized); Parietal pain arises from parietal peritoneum inflammation (severe, steady, well-localized); Referred pain occurs at a distant site innervated by the same spinal level.

What is pyrosis, and what common digestive condition does it typically indicate?

Pyrosis is heartburn (acid indigestion), a burning sensation in lower mid-chest/epigastrium; it typically indicates Gastroesophageal Reflux Disease (GERD).

What does bright red hematemesis indicate versus dark tarry stools (melena)?

Bright red hematemesis indicates upper GI bleeding (esophageal varices, gastric ulcers); dark tarry stools (melena) indicate digested blood from gastric or duodenal ulcers.

What do clay-colored, fatty stools or dark tea-colored urine signify?

Malabsorption syndromes or liver/biliary disease (absence of bile in stool, excess bilirubin in urine).

What major bacterial pathogen and class of OTC medications are the primary causes of Peptic Ulcer Disease (PUD)?

Helicobacter pylori (H. pylori) infection and chronic use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like aspirin or ibuprofen.

How does timing of pain differ between a gastric ulcer and a duodenal ulcer?

Gastric ulcer pain occurs when stomach is empty or right after eating; duodenal ulcer pain occurs 2 to 3 hours post-meal and is relieved by food or antacids.

How do age-related physiological changes affect abdominal pain perception and bowel elimination in older adults?

Pain sensitivity diminishes (masking acute conditions), appetite decreases, protective urinary bacteria decline (higher UTI risk), and diarrhea rapidly causes dehydration due to higher fat-to-lean muscle ratio.

What is the correct clinical sequence for performing an abdominal physical examination, and why is this order used?

Inspection, Auscultation, Percussion, Palpation. Auscultation is performed second so percussion/palpation do not alter natural bowel sound patterns.

What steps should the nurse take to prepare the client and promote abdominal muscle relaxation prior to the exam?

Have client empty bladder, lie supine with arms across chest or at sides, flex knees slightly with pillow support, warm hands/stethoscope, and breathe slowly through mouth.

Why should tender or painful abdominal areas be examined last?

Examining tender areas first produces pain and muscle spasms (voluntary guarding) that interfere with the remaining examination.

What physical positioning error causes the client's abdominal muscles to tighten during assessment?

Raising arms above or folding them behind the head.

Differentiate between Gray Turner sign and Cullen sign, including their clinical significance.

Gray Turner sign is purplish discoloration of the flanks; Cullen sign is bluish/purple discoloration around the umbilicus. Both indicate intra-abdominal bleeding (e.g., pancreatitis, trauma).

What do pink/bluish striae versus dark bluish-pink striae indicate on abdominal inspection?

Pink or bluish striae indicate new stretch marks (pregnancy, weight gain); dark bluish-pink striae indicate Cushing syndrome.

What are the '6 Fs' that represent the major causes of abdominal distention?

Fat, feces, fetus, fibroids, flatulence, and fluid.

Differentiate an epigastric hernia from an incisional hernia and diastasis recti.

Epigastric hernia is bowel protruding through linea alba between xiphoid and umbilicus; Incisional hernia occurs through a surgical scar defect; Diastasis recti is a midline ridge bulge from rectus abdominis separation.

What do vigorous, wide, exaggerated abdominal aortic pulsations visible in the epigastrium suggest?

Abdominal Aortic Aneurysm (AAA).

What is the normal rate of bowel sounds per minute, and what are hyperactive bowel sounds called?

Normal rate is 5 to 30 per minute; hyperactive, loud, prolonged gurgling sounds are called borborygmus.

How long must the nurse listen to the abdomen before confirming that bowel sounds are completely absent?

At least 5 minutes total (minimum of 1 minute per quadrant).

What do high-pitched, rushing, tinkling bowel sounds accompanied by abdominal cramping suggest?

Early mechanical bowel obstruction.

What vascular sound is assessed using the stethoscope bell over the abdominal aorta, renal, iliac, and femoral arteries?

Bruit (a low-pitched, whooshing murmur-like sound indicating turbulent or obstructed blood flow).

What rare auscultatory finding produces a high-pitched, rough grating sound over the liver or spleen during respiration?

Friction rub (caused by inflammation of peritoneal surface rubbing against liver or spleen).

What percussion tone normally predominates over most of the abdomen, and where is dullness expected?

Tympany predominates over air-filled stomach/intestines; dullness is expected over solid organs (liver, spleen), distended bladder, or feces.

What is the normal liver span along the midclavicular line (MCL) and midsternal line (MSL)?

Normal liver span is 6 to 12 cm at the MCL and 4 to 8 cm at the MSL.

How is the scratch test performed to locate the lower border of the liver?

Place stethoscope diaphragm over liver at MCL (2nd-to-last intercostal space), lightly stroke skin horizontally starting at umbilicus moving upward toward costal margin until sound suddenly intensifies.

What finding during blunt percussion at the costovertebral angle (CVA) indicates a positive result?

Severe tenderness or sharp pain, suggesting kidney infection (pyelonephritis) or renal calculi.

What depth is used for light palpation versus deep palpation, and what is the goal of each?

Light palpation compresses 1 cm to assess superficial tenderness/resistance; deep palpation compresses 5 to 6 cm to delineate abdominal organs and detect deeper masses.

Differentiate voluntary guarding from involuntary reflex guarding.

Voluntary guarding is temporary muscle tensing from anxiety/cold hands; Involuntary reflex guarding is persistent peritoneal rigidity that fails to relax on expiration, reflecting peritoneal irritation.

What caution must the nurse exercise when palpating an enlarged spleen or a pulsating midline abdominal mass?

Use extreme gentleness with enlarged spleen to prevent rupture; avoid deep palpation over pulsating midline mass to avoid rupturing an aortic aneurysm.

How are the Shifting Dullness and Fluid Wave tests performed to detect ascites?

Shifting dullness percusses tone changes from tympany to dullness supine vs. side-lying; Fluid wave test taps one flank while feeling for transmitted wave on opposite flank with assistant pressing midline.

How is testing for Rebound Tenderness (Blumberg sign) performed, and what does a positive result indicate?

Compress deeply at 90 degrees into abdomen at McBurney point and release suddenly; sharp stabbing pain upon release indicates peritoneal irritation (e.g., appendicitis).

Describe Rovsing sign and its clinical significance.

Palpating deeply in Left Lower Quadrant (LLQ) causes referred pain in Right Lower Quadrant (RLQ), indicating acute appendicitis.

Describe the Psoas sign and Obturator sign tests for appendicitis.

Psoas sign: hyperextend right leg backward while lying on left side (pain in RLQ = positive); Obturator sign: flex right hip/knee and internally/externally rotate leg (pain in RLQ = positive).

What is Murphy sign, how is it tested, and what condition does it assess?

Press fingertips under right costal margin at liver border and have client inhale deeply; sharp pain causing sudden breath holding (inspiratory arrest) is a positive Murphy sign indicating acute cholecystitis.