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What are the anterior surface landmarks of the abdomen?
Extends from the diaphragm to symphysis pubis
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What are the posterior border surface landmarks of the abdomen?
vertebral column and paravetebral muscles
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What is the linea alba?
The white line extending down the middle of the ABD. It joins the abdominal wall muscles from either side.
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What are the exterior wall muscles of the abdomen?
rectus abdominis and external oblique
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What are the underlying muscles of the abdomen?
internal oblique and transversus
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What is in the RUQ?
- liver
- gallbladder
- pylorus
- duodenum
- head of pancreas
- part of right Kidney and adrenal gland
- hepatic flexture of colon
- part of ascending and transverse colon
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What is in the LUQ?
- Stomach
- spleen
- left lobe of liver
- body of pancreas
- par tof left kidney and adrenal gland
- splenic flexture of oclon
- part of transverse and descending colon
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What is in the RLQ?
- Cecum
- sppendix
- part of ascending colon
- right ovary and fallopian tube
- lower pole of right kidney
- right ureter
- right spermatic cord
- bladder
- uterus
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Waht is in the LLQ?
- Part of descending colon
- sigmoid colon
- left ovary and fallopian tube
- lower pole of left kidney
- left ureter
- left spermatic cord
- bladder
- uterus
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Where is the epigastric region?
midline, between costal margins
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Where is the umbilical region?
Around the umbilicus :)
makes sense, right???
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Where is the suprapubic region?
above the pubic bone....
for example, a full bladder gives suprapubic distention.
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What is on the midline of the ABD?
- Uterus/bladder
- Aorta (slightly left of midline in upper ABD)
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Where does the aorta bifurcate?
- Bifurcates into R and L renal arteries at costal margin
- Bifurcates into R and L iliac arteries 2 cm below umbilicus
- Branches into femoral arteries at groin
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Where are the kidneys located?
they are retroperitoneal-- posterior to ABD at costovetebral wall. R kidney is a little lower than L.
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Where is the spleen located?
Lays oblique and parallel with 10th rib, lateral to MAL
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What are the solid organs that might be palpable??
- liver
- pancreas
- spleen
- kidneys
- adrenal glands
- ovaries (usually only palpable by bimanual pelvic exam)
- uterus
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What are the hollow organs (that are usually not palpable)?
- stomach
- gallbladder
- small intestine
- colon
- bladder
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What does the right ribcage protect?
- liver
- gallbladder
- right kidney
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What does the left rib cage protect?
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What is the umbilical cord composed of?
2 arteries and 1 vein
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What are the developmental considerations of infant and children (in concern to the abdomen)?
- umbilical cord
- liver takes up more space in ABD
- bladder lies higher in ABD cavity (between symphysis pubis and umbilicus)
- Organs easier to palpate (less muscular ABD wall)
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What is morning sickness r/t (related to)?
increased HCG [Human chorionis gonadotropin]- occurs in 1st trimester in 50-75% of individuals. Starts in 4th -6th week
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What are the ABD concerns with pregnancy?
- Morning sickness
- Heartburn (r/t increased esophageal reflux 2 degree increased pressure from displaced ABD organs)
- Decreased GI motility (constipation)
- Increase pressure on venous system (hemmorrhoids, varicosities)
- Enlarging uterus (decreased bowel sounds r/t displacement of intestines upward and posterior)
- ABD skin changes
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What developmental considerations do we see with Aging Adults in regards to their ABD?
- Increased adipose tissue on ABD
- Decreased salvation and taste
- Delayed gastric emptying (increases risk for aspiration with supine)
- Decreased gastric acid secretion (may cause altered B12 absorption, Fe deficiency anemia and calcium malabsorption)
- Increased incidence of gallstones
- Decreased liver size (impaired drug metabolism)
- Increased constipation
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What does "start low, go slow mean?"
Start with lowest dose of a drug and advance slowly
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Dysphagia
difficulty swallowing indicating a problem with throat or esophagus
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Odynophagia
pain upon swallowing
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Lactose Intolerance
gastric bloating r/t decreased lactase (enzyme for digesting lactose). This is not an allergic, histamine, response, but rather an intolerance; subsequent exposure will not be harmful.
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What is a potential side affect with use of NSAIDS (particularily in the elderly?)
Even low doses may be harmful fr the elderly; risk of GI bleed. Always take with food to decrease this risk.
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If they have N/V, what do you want to consider?
- Consider potential med side effects
- presence of fever/chills (infection)
- tiem of last meal (food poisioning)
- Hematemesis (blood)
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Melena
black tarry stool= upper GI bleed (ulcer)
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Black stools
Fe, bismuth (peptobismal)
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Hematochezia
maroon stools; usually lower GI bleeding; may be UGI bleed if rapid GI motility present.
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BRBPR
bright red blood per rectum.
Means lower GI bleed, e.g. hemmorrhoids
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Clay colored stools
biliary obstruction
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Decreased caliber of stool-- pencil thin
Obstruction (cancer), or decreased fiber
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What are fissures (linear creacks in rectal mucosa) related to?
may be related to constipation adn hemmorrhoids
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Destention (7 Fs)
- fluid
- feces
- flatus (gas in GI)
- fat
- fetus
- fibroid
- fatal mass
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What are problems that ETOH (alcohol) can cause in the GI system?
GI ulceration, liver problems
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What is a problem that nicotine can cause in the GI tract?
increased incidence of peptic ulcers
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How will you position the patient for an ABD exam?
increase the HOB, patient's arms at side, full exposure of ABD, empty bladder, use good lighting, examiners nails should be short
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What is accentuated when the patient does a little sit up for us?
accentuates ventral (ABD) hernias
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What is diatis recti?
Linear bulge
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What are you looking for when you examine the umbilicus?
should be midline with no sign of discoloration, inflammation or hernia
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Are pulsations from the aorta in the ABD normal?
yes, we may see some pulsations, but marked pulsations may indicate an aneurysm
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What does peristalsis indicate?
Well, it can be normal to see in a thin person, or it may indicate an early bowel obstruction
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What could an everted umbilicus mean?
- acites or underlying mass
- pregnancy
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What are striae?
stretch marks; color initially pink or blue, then white
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What are purple striae related to?
cushing's syndrome (excess adrenocortical hormone)
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What are acites associated with?
liver disease
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What are cutaneous angiomas
spider nevi
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What can petechia and cutaneous angiomas signify?
liver disease (just an example)
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What is a cause of prominent dialated veins?
Portal HTN (cirrhosis, ascites) or inderior vena cava obstruction
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What is borborygmi
growling sounds -- can mean hunger
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What is the normal frequency of bowel sounds?
5-30 per minute, listen up to 5 minutes until they are heard
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What can greater than 30 bowel sounds per minute indicate?
hyperactive bowel-- rushing, tinkling. may indicate early bowel obstruction
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What are the causes of hypoactive or absent bowel sounds?
- *abdominal surgery results in a paralytic ileus (absence of GI motility and BS)- mat take up to 48 hours for BS to return
- *peritoniris
- *bowel obstruction
- *hypokalemia
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What are the vascular sounds that we listen to in the ABD?
- *listen with the bell of the stethoscope
- Aortic
- Renal
- Iliac
- Femoral
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What does percussion detect?
distention, fluid, masses
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What is the normal sound for percussion in most of the abd?
tympany
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Where will you hear dullness while percussing the abd?
liver, distended bladder, adipose tissue, fluid, feces, mass
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When will you find hyperresonance while percussing?
present with gaseous distention
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What are the normal findings for liver span?
- RMCL- 6-12 cm. 5th ICS to R costal margin
- midsternal line (4-8cm) usually not measured
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Hepatomegaly
enlargement of the liver. greater than 12 cm at RMCL
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COPD may........
displace the liver downwards
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How large is the spleen normally?
Less than 7 cm while percussing
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Enlarged spleen
extends medial to MAL-- mononucleosis, trauma, leukemia
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CVAT test
indicates kidney infection. Over 12th rib
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What is a good position for palpation of the ABD?
bend knees, have patient relax ABD muscles
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what is muscle guarding?
tightening abd muscles
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What is rigidity?
hardness decondary to inflammation
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How far down do you depress for light palpation?
- 1cm
- watch for involuntary guarding(board-like hardness)
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what is deep palpation?
greater than 1 cm
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What do you write down if you find a palpable mass?
describe location, size, shape, consistency, surface, mobility, pulsatility, tenderness
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How do you palpate the liver border?
- feel edge at RUQ with deep inspiration; usually non-palpable.
- Abnormal if greater than 1-2 cm below right costal margin.
- inferior border should be smooth. If it is not, may indicate a heptoma
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Function of Spleen
- Forms monocytes and lymphocytes
- Stores RBC adn releases into circulation if needed
- Filters old RBCs from blood
***Must be 3x normal size to palpate. But stop palpation if enlarged-- may rupture!! May extend to LLQ
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If the aortic pulsation is far to the left, what may that indicate?
an AAA (abd aortic anneurysm)
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What is the test for peritoneal inflammation (ruptured appendix, PID)?
- Rebound tenderness----
- deep palpation with quick withdrawl (hand at 90 degrees)
- Positive test (pain with quick release)
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What is Murphy's sign?
- Cholecystitis
- Positive test (inspiratory arrest with deep palpation under liver)
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Considerations for infant/child exam
- *normally has protruberant contour until age 4
- *umbilical hernia:
- - may appear in 2-3 weekds
- - reaches max size by one month (2.5cm)
- - disappears by 1 year
- *Diastasis recti (separation of rectus ABD muscles causing bulge along midline)
- *ABD breathing until age 7 (normal)
- *Stool differences
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In an infant, what is the stool of the 1st 24 hours?
sticky, greenish black meconium
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By the 4th day, what is an infant's stool like?
- - breast fed (golden yellow, pasty)
- - formula fed (brown-yellow, firmer)
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What are abnormal findings of the abdominal exam?
- hepatomegaly
- splenomegaly
- enlarged kidney
- bruits
- aortic aneurysm
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