Abdominal Assessment

Question 1

Right Upper Quadrant

Answer 1

liver
gallbladder
right kidney
part of ascending colon
head of pancreas

Question 2

Right Lower Quadrant

Answer 2

appendix
cecum
right ureter

Question 3

Left Upper Quadrant

Answer 3

stomach
spleen
left lobe of liver
body of pancreas
left kidney
part of descending colon

Question 4

Left Lower Quadrant

Answer 4

part of descending colon
sigmoid colon
left ureter

Question 5

Midline

Answer 5

aorta
uterus (if enlarged)
bladder (if distended)

Question 6

three region of the abdomen

Answer 6

epigastric - between costal margins
umbilical - around umbilicus
hypogastric/suprapubic - area above pubic bone

Question 7

rectus abdominus

Answer 7

strip of muscle that extends the length of the midline

Question 8

linea alba

Answer 8

where the four layers of large, flat muscles join

Question 9

External obliques
Internal obliques
Transversus

Answer 9

three anterolateral abdominal wall muscles

Question 10

aponeurosis

Answer 10

sheet of pearly-white fibrous tissue that attach sheet0like muscles

Question 11

parietal peritoneum

visceral peritoneum

Answer 11

parietal - outer layer touching abdo wall

visceral - inner layer touching internal organs

Question 12

solid viscera

Answer 12

maintains shape

• liver
• pancreas
• spleen
• adrenal glands
• kidneys
• ovaries
• uterus
• aorta

Question 13

hollow viscera

Answer 13

shape depends on content
(not palpable unless full)

• stomach
• gallbladder
• small intestines
• colon
• bladder

Question 14

Dev Considerations - infants and children

Answer 14

• larger liver
• bladder is higher (closer to umbilicus)
• abdo wall less muscular
• increased risk for GI illness (immune system not fully developed until 5-6 years of old)

Question 15

Dev Considerations - pregnancy

Answer 15

• nausea/vomiting
• acid indigestion
• constipation
• diminished bowel sounds (decreased motility and peristalsis, displaced upwards and back)
• skin changes (striae, linea nigra)

Question 16

Dev Consideration - older adults

Answer 16

• adipose tissue redistribution to abdo and hips
• abdo muscles relax
• decreased gastric acid secretion
• decreased liver size
• decreased renal function
• increased incidence of gallstones and colorectal cancer

Question 17

Subjective Assessment

Answer 17

a. appetite
b. dysphagia
c. food intolerance (pyrosis)
d. abdominal pain
e. nausea/vomiting (hematemesis - blood present)
f. bowel habits
melena stool
- black and tarry stool, upper GI tract bleeding
frank blood
- bright red blood, lower GI tract bleeding
g. past abdominal history
(IBD - increase risk of colon cancer, IBS - does not cause lasting damage, colorectal cancer, FAP)
h. medications
i. alcohol/tobacco
j. nutritional assessment

Question 18

pyrosis

Answer 18

heartburn caused by reflux of gastric content

Question 19

visceral pain

Answer 19

Pain from organ

• usually contracting
• difficult to localize
• aching, burning, cramping
• mark pallor and sweating when severe

Question 20

parietal pain

Answer 20

Inflammation in parietal peritoneum, usually originats from specific organ

• precisely localized pain
• sharp, severe, stabbing
• unable to move, guarding

Question 21

referred pain

Answer 21

Referring to another region but originates from abdomen

• precisely localized and consistent
• structures innervated at same spinal level

Question 22

Familial adenomatous polyposis (FAP)

Answer 22

polyp forming mainly in the epithelium of large intestine

- untreated can develop into colon cancer

Question 23

Objective Assessment - Inspection

Answer 23

a. contour (flat, rounded, scaphoid, protuberant - ascites)
b. symmetry
c. umbilicus (inverted, midline, everted - mass underneath)
d. skin
e. pulsations or movement (aorta or peristalsis)
f. hair distribution
g. demeanor (in pain, relaxed)

Question 24

hernia

Answer 24

umbilical hernia - at umbilicus
incisional hernia - from incision
inguinal hernia

Question 25

diastasis recti

Answer 25

separation of abdominal wall muscles as abdomen expands - in pregnancy

Question 26

Objective Assessment - Auscultation

Answer 26

a. bowel sounds (hypoactive, hyperactive, absent) - all four quadrant b. vascular sounds (if bruit, do not palpate) - aorta - renal arteries - iliac arteries - femoral arteries

Question 27

borborygmus

Answer 27

hyperactive sounds heard when hungry

Question 28

Objective Assessment - Percussion

Answer 28

a. all four quadrant - general tympany should be heard (dullness - distended bladder, fluid, mass) (hyperresonance - gaseous distension)

Question 29

Special Percussion Tests

Answer 29

- to detect hepatomegaly Liver Span Scratch Test ``` - to detect splenomegaly Splenic dullness (percuss 9th-11th intercostal space) ``` - inflammation of the kidney Costovertebral angle tenderness (percuss angle between spine and rib)

Question 30

Objective Assessment - Palpation

Answer 30

a. masses, enlargement of an organ, tenderness b. light palpation depress in 1 cm using all 4 fingers c. deep palpation depress in 5-8 cm using one hand or two - location, size, consistency, mobility, masses, enlargement of organs, tenderness

Question 31

Normally palpable structures

Answer 31

a. Xiphoid process b. Normal liver edge - deep palpation c. Pulsatile aorta - relaxed abdominal muscles - using thumb and forefinger, 2.5-4cm d. Rectus muscles e. Uterus (gravid) f. Full bladder

Question 32

When can the spleen be felt?

Answer 32

enlarged to three times its size left hand across to back between 11th and 12th rib, right hand just under rib margin toward axilla

Question 33

aortic aneurysm

Answer 33

abnormal bulge in aorta

Question 34

Special Tests

Answer 34

a. Appendicitis Blumberg's sign (rebound tenderness) Iliopsoas muscle test (supine, light right leg straight up flexing at hip, push down over lower thigh while person tried to hold leg up) b. Gallbladder inflammation Murphy's sign (deep breath with holing fingers under liver border) c. Ascites Fluid Wave (ulnar edge of hand down midline, place one hand on one side and strike firmly with other hand on other side) Shifting Dullness