1. Where does the posterior abdomen extend from?
    Vertebral column and paravertebral muscles
  2. Where does the anterior aboment extend from?
    Extends from the diaphargm to symphysis pubis
  3. Th abd wall muscles are joined at the midline by what?
    Tendon seam (linea alba= white line)
  4. What are the exterior abd wal muscles?
    rectus abdominis and external oblique
  5. What are the underlying muscles of the abd wall?
    Internl oblique and transversus
  6. What is in the RUQ?
    • 1. Liver
    • 2. Gallbladder
    • 3. Pylorus
    • 4. Duodenum
    • 5. Head of pancreas
    • 6. Part of right kidney and adrenal gland
    • 7. Hepatic flexure of colon
    • 8. Part of ascending and transverse colon
  7. What is in the LUQ?
    • 1. Stomach
    • 2. Spleen
    • 3. Left lobe of the liver
    • 4. Body of the pancreas
    • 5. Part of left kidney and adrenal gland
    • 6. Spenic flexure of colon
    • 7. Part of transverse and descending colon
  8. What is in the RLQ?
    • 1. Cecum
    • 2. Appendix
    • 3. Part of ascending colon
    • 4. Right ovary and fallopian tube
    • 5. Lower pole of right kidney
    • 6. Right ureter
    • 7. Right spermatic cord
    • 8. Bladder
    • 9. Uterus
  9. What is in the LLQ?
    • 1. Part of descending colon
    • 2. Sigmoid colon
    • 3. Left ovary and fallopian tube
    • 4. Lower pole of left kidney
    • 5. Left ureter
    • 6. Left spermatic cord
    • 7. Badder
    • 8. Uterus
  10. Where is the epigastric region
    Midline, between costal margins
  11. Where is the umbilica region
    Around the umbilicus
  12. Where is the suprapubic region
    • Above the pubic bone
    • E.g. full bladder--> suprapubic distension
  13. Where is the aorta located?
    Slightly left of the midline in upper abd
  14. What does the aorta artery bifurcate into at the coastal margin?
    Right and left renal arteries
  15. What does the aorta artery bifurcate into 2cm below the umbilicus?
    Right and left iliac arteries
  16. What does the aortic artery branch into at the groin?
    Femoral arteries
  17. Where is the liver located?
    Fills RUQ and extends into left MCL. Lower border may be palpable
  18. Where is the spleen located?
    • Lays under the diaphargm on the postero-lateral abd wall.
    • ays oblique and parallel with the 10th rib, ateral to the MAL
    • Usually not palpable
  19. Where are the kidneys located?
    • Retroperitoneal, posterior to abd at costovertebral angle
    • Right kidney is apprx 2cm ower than the left kidney due to the liver
    • May be palpable
  20. What are solid organs?
    • Liver
    • Pancreas
    • Spleen
    • Kidneys
    • Adrenal glands
    • Ovaries
    • Uterus
  21. What are hallow organs?
    • Stomach (below left diaphargm behind rib cage)
    • Gallbladder (under liver, lateral to right MCL)
    • Small intestine (in all 4 quads)
    • Colon (in all 4 quads)
    • Bladder
  22. What does the right rib cage protect?
    liver, gallbladder, right kidney
  23. What does the left rib cage protect?
    Stomach, spleen, left kidneys
  24. How may arteries and veins are in a newborn umbilical cord and what does deviation indicate?
    • 2 arteries
    • 1 vein
    • congenital anomaly
  25. Does the liver take up more or less space in infants and newborns?
  26. Does the bladder lie higher or lower in the abd int he newborn and infant?
    Higher. Between the symphysis pubis and umbilicus
  27. What is morning sickness related to?
    When does it occur?
    And in what percentage of individuals?
    • Increase HCG (human chorionic gonadotropin)
    • First trimester
    • 50-75% individuals
  28. What is heartburn in the pregnant women related to?
    Increased esophageal reflux secondary to increased pressure from displaced abd
  29. Pregnancy: increased or decreased GI motiity?
    Decreased--> Constipation
  30. Pregnancy: Increased or decreased pressure on venous system?
    Increased--> Hemorrhoids, varicosities
  31. Effects of enlarging uterus on bowel sounds in pregnancy?
    Decreased BS r/t displacement of intestines upward and posterior
  32. Skin changes in the pregnant woman
    Striae and linea nigra
  33. Aging adult: increase or decrease adipose on abd
    increased (redistribution of fat)
  34. Aging adult: effect on salivation and taste
    decreased saliation and decreased taste
  35. Aging adult: effects of gastric emptying
    • Delayed, which increased risk for aspiration when supine
    • Also increased constipation
  36. Aging adult: effects of gastric acid secretion
    decreased, which may cause altered B12 absorption, Fe deficiency anemia and calcium malabsorption
  37. Aging adult: effects of gallstone incidences
  38. Aging adult: effects on liver
    decreased which may impair drug metabolism. Start slow and go slow
  39. Anorexia
    Decreased desire for food
  40. Dysphagia
    Difficulty swallowing indicating a problem with throat or esophagus
  41. Odynophagia
    Pain upon swallowing
  42. Lactose intolerane
    • Gastric bloating r/t decreased lactase.
    • This is not an allergic response, but rather an intolerance. Subsequent exposure will not be harmful
  43. Referred pain:
    1. Appendicitis
    2. Cholecystitis
    3. Diverticulitis
    • 1. Periumbilical to RLQ
    • 2. RUQ to right shoulder or right subscapular region
    • 3. LLQ
  44. Referred pain:
    4. Gastritis
    5. Gastric ulcer
    6. Gastroesophagal reflux
    • 4. epigastric
    • 5. LUQ
    • 6. midepigastric to jaw
  45. Referred pain:
    7. Hepatitis/hepatomegaly
    8. Leaking abd aneurysm
    9. Pancreatitis
    • 7. RUQ
    • 8. midline and penetrates to back
    • 9. LUQ and epigastric to left shoulder to lower back
  46. Referred pain:
    10. Perforated duodenal ulcer
    11. Renal/ureteral stone
    12. Salpingitis, ovarian cyst, ruptured ectopic pregnancy
    • 10. RUQ to shoulders
    • 11. RLW or LLQ to groin
    • 12. RLQ tor LLQ
  47. Meds in the older adult
    Even low doses may be harmful for the elderly. Increased risk for GI bleed. Always take with food to decrease risk for gastritis/GI bleed
  48. Melena
    • Black tarry stool--> UGI bleed
    • E.g. ulcer
  49. Black stools
    Fe, bismuth (peptobismal)
  50. Hematochezia
    Maroon stools, usually LGI bleed. May be UGI bleed if rapid motility present
  51. BRBPR
    • Bright red blood per rectum
    • Lower GIB
    • Ex: Hemorrhoids
  52. Clay colored stools
    Biliary obstruction
  53. Decreased caliber of stools
    Pencil thin--> obstruction (Ca), decreased fiber
  54. Distention (7 Fs)
    • Fluid
    • Feces
    • Flatus
    • Fat
    • Fetus
    • Fibroid
    • Fetal mass
  55. IMB
    • Inflammatory bowel disease
    • Colitis and Crohns disease (increased risk of colon cancer)
  56. Effects of nicotine
    increased incidence of peptic ulcer
  57. Diastis recti (linear buldge) with sit-up inspection
  58. Inspection: aortic pulsation
    May see some pulsation. Marked pulsations may indicate an aneurysm
  59. Inspection: peristalsis during inspection
    • Visible in thin person
    • May indicate early bowel obstruction
  60. Demeanor with colicky pain
  61. Demeanor with peritoneal pain
    Absolute stillness, knees flexed, grimaces, rapid uneven respirations
  62. What would an everted umbilicus mean?
    Ascites or underlying mass, pregnancy
  63. What would striae mean?
    • Stretch marks
    • Color initially pink or blue, then white.
    • Purple striae r/t Cushing syndrome (excess adrenocortical hormone)
  64. What is ascites associated with?
    Liver disease
  65. What may prominent dilated veins indicate?
    portal HTN (cirrhosis, ascites) or inferior vena cava obstruction
  66. Borborygmi
    Growling sounds indicating hunger
  67. Nml freq bowel sounds
    5-30 min. Listen up to 5 minutes until heard
  68. Tinkling bowel sounds
    may indicate early bowel obstruction
  69. Paralytic ileus (absence of GI motility and bowel sounds)
    May take up to 48 hours for BS to return
  70. Tympanny with percussion
    • generally predominates
    • r/t gas in small and large intestine
  71. Dullness with percussion
    liver, distended bladder, adipose tissue, fluid, feces, mass
  72. Hyperresonance with percussion
    present eith gaseous distention
  73. Liver span
    • RMCL (6-12cm)- 5th ICS to right costal margin
    • Mid sternal line (4-8cm) usually not measured
  74. Hepatomegaly
    • Enlargement. Greater than 12cm at RMCL
    • COPD may displace the liver downward
  75. Spleen percussion
    • Dull noted 9th to 11th ICS and lateral of left MAL.
    • Usually <7cm
    • Enlarged spleen (extends to MAL)- mononucleosis, trauma, leukemia
  76. CVAT percussion
    direct or indirect percussion over 12th rib elicits pain (may indicate kidney infection)
  77. Special tests: fluid wave (not reliable. need US)
    tap abd and feel wave on opposite side if ascites present
  78. Special tests: shifting dullness (not reliable, need US)
    • Percussion sounds change wil position change
    • Spine- Fluid dispersed to both sides
    • Lateral- Fluid drains to side causing shifting dullness
  79. Fxn of spleen
    • Forms monocytes and lymphocytes
    • Stores RBC and releases into circulation if needed
    • Filters old RBC from blood
  80. What to do is palpate spleen
    • Must be 3x nml size to palpate
    • Stop palpation if enlarged because you may rupture
    • May extend to LLQ
  81. Palpation: Prominent lateral pulsation of aorta
    • May indicate AAA
    • If >4cm AAA may be indicated
  82. Rebound tenderness
    • Tests for peritoneal inflammation
    • Deep palpation with quick withdrawal (hand at 90 degree angle)
    • Positive test (pain with quick release)
  83. Iliopsoas muscle test
    • Assess with patient in supine position
    • Positive test (SLR with resistance causes RLQ pain)
  84. Obturator test
    Positive test (pain occurs with passive internal/external roation of the leg when the leg is flexed 90 degrees at the hip)
  85. Murphy's sign
    • Cholecystitis.
    • Positive test (inspiratory arrest with deep palpation under liver)
  86. Umbilical hernia in infant/child
    • may appear in 2-3wks
    • reseaches max size 1 month (2.5cm)
    • disappears by 1yo
  87. Diastasis recti
    Separation of rectus abd muscles causing buldge along midline
  88. Stool in infant/child
    • first 24h sticky, greenish black meconium
    • By 4th day:
    • - breast- golden/yellow, pasty
    • - formula- brown-yellow, firmer
  89. Hepatomegaly
    • Nontender smooth liver (fatty infiltration, portal obstruction or cirrhosis, high onstruction of IVC and lymphocytic leukemia)
    • Tender enlargment (CHF, acute hepatitis or hepatic abscess)
    • Nodular liver (late cirrhosis, metastatic cancer, tertiary syphylis)
    • Small liver (end stage liver disease)
  90. Enlarged kidney
    • Hydronephrosis (back up fluid in kidney r/t distal obstruction)
    • Cyst or neoplasm
  91. Aortic aneurysm
    95% located near renal arteries
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