Term
| What organ systems do you expect to find in the abdomen? |
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Definition
Digestive
Cardiovascular
Endocrine
Renal/Urinary
Musculoskeletal
Neurological |
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Term
| The abdomen is typically divided into ____ quadrants when doing the physical exam. |
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Definition
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Term
| Contents of the right upper quadrant: |
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Definition
Liver
Gallbladder
Pylorus
Duodenum
Head of pancreas
Right adrenal gland
Portion of right kidney
Hepatic flexure of colon
Portions of ascending and transverse colon |
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Term
| Contents of the left upper quadrant: |
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Definition
Left lobe of liver
Spleen
Stomach
Body of pancreas
Left adrenal gland
Portion of left kidney
Spleenic flexure of colon
Portions of transverse and descending colon |
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Term
| Contents of the right lower quadrant: |
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Definition
Lower pole of right kidney
Cecum and appendix
Portion of ascending colon
Bladder (especially if distended)
Ovary and salpinx
Uterus (if enlarged)
Right spermatic cord |
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Term
| Contents of the left lower quadrant: |
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Definition
Lower pole of left kidney
Sigmoid Colon
Portion of descending colon
Bladder (especially if distended)
Ovary and salpinx
Uterus (if enlarged)
Left spermatic cord
Left ureter |
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Term
| The ________ can occur anywhere in the abdomen; it is not necessarily always in the RLQ. |
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Definition
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Term
| Name the 9 regions of the abdomen. |
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Definition
Right and left hypochondriac
Epigastric
Right and left lumbar
Umbilical
Right and left iliac
Hypogastric |
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Term
| Contents of the right hypochondriac region: |
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Definition
Dome of the Liver
Part of Gallbladder
Part of Biliary tree
Hepatic flexure of ascending colon |
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Term
| Contents of the epigastric region: |
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Definition
Most of liver
Cardia, body and (+/-) pyloric region of stomach
Head and body of pancreas
Biliary tract |
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Term
| Contents of the left hypochondriac region: |
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Definition
Spleen
Tail of pancreas
Splenic flexure of descending colon |
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Term
| Contents of the right lumbar region: |
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Definition
Ascending colon
Rt Kidney/ureter |
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Term
| Contents of the umbilical region: |
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Definition
Small intestine (most)
Mesenteric circulation
Mesenteric lymphatics |
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Term
| Contents of the left lumbar region: |
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Definition
Descending colon
Lt Kidney/ureter |
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Term
| Contents of the right iliac region: |
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Definition
Cecum (+/-)
Appendix (+/-)
Rt inguinal canal
Rt Ureter |
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Term
| Contents of the hypogastric region: |
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Definition
Small intestines (some)
Cecum (+/-)
Appendix (+/-)
Sigmoid colon
Rectum |
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Term
| Contents of left iliac region: |
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Definition
Terminal descending colon
Sigmoid colon (some)
Lt inguinal canal
Lt Ureter |
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Term
Review the biliary system…
Body of the gall bladder is larger than the fundus, gall stones are typically found here. When the gall bladder contracts in response to a meal, the stone is “shoved” into the area of the fundus and then sometimes into the common bile duct. This backs up pancreatic fluids and can result in pancreatitis. |
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Definition
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Term
| Gall stones are typically found in the ____ of the gall bladder because the ____ is bigger than the _______. |
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Definition
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Term
| The musculature of the abdomen includes: |
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Definition
Rectus abdominis
Internal and external oblique
Transverse abdominis
Linea Alba Inguinal ligaments |
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Term
| The peritoneum of the abdomen includes: |
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Definition
Visceral peritoneum
Parietal peritoneum
Peritoneal cavity
Greater omentum
Lesser omentum |
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|
Term
SAD PUCKER can help you to remember what is INSIDE the peritoneal cavity in the abdomen.
S – adrenal glands
A – Aorta/IVC
D – Duodenum (Except first part)
P – Pancreas (except tail)
U – Ureters/Uterus
C – Colon (ascending and descending)
K – Kidneys
E – Esophagus (most)
R - Rectum |
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Definition
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Term
| The ___, duodenum, _______, ureters, ______, ______, and sigmoid colon are all ________________ organs. |
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Definition
IVC
kidneys
pancreas
aorta
retroperitoneal |
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Term
|
Definition
Stomach
Duodenum
Jejunum
Ileum
Cecum and appendix
Ascending colon
Transverse colon
Sigmoid colon
Rectum |
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Term
|
Definition
Kidneys
Ureters
Urinary bladder
Uterus
Ovaries
Prostate
Liver
Gallbladder
Pancreas
Spleen |
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Term
5 things that the examiner needs to do an abdominal exam:
Good _____ source
Full ________ of abdomen
Warm ____ and short __________
Warm _________, centimeter _____, water soluble ________ ____
Professional and sensitive attitude |
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Definition
light
exposure
hands, fingernails
stethoscope, ruler, marking pen |
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Term
4 things a patient needs for the abdominal exam:
An empty ________
Warm ____ with privacy
Comfortable _________
A _____ for warmth and modesty |
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Definition
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Term
| Inspect the abdomen for contour, symmetry, and surface motion with a tangential light source. Examples of contour are: |
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Definition
Scaphoid
Distended
Protuberant
Flat
Asymmetrical |
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Term
| Rounded, ____, or ________ are contours of the abdomen that you would expect to find in a normal exam. |
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Definition
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Term
| Localized bulges in the abdomen include __________, incisional, and _________ hernias, ________ _____ and lipomas. |
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Definition
umbilical, epigastric
diastasis recti |
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Term
| _______ is fluid in the abdomen that is often associated with liver disease. |
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Definition
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Term
| Common skin changes noted on abdomnal exam: |
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Definition
Scars
Striae-stretch marks
Rashes
Ecchymoses (Grey Turner, Cullen)
Prominent vessels (Caput Medusa) |
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Term
| purple striae are associated with ________ ________. |
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Definition
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Term
| Ecchymoses on the abdomen can be associated with ______ ______. |
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Definition
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Term
| A scar along McBurney's point indicates that the patient has had an __________. |
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Definition
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Term
| A median/midline hypogastric scar usually indicates that the patient has had a _____________. |
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Definition
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Term
| Visible peristalsis on the abdomen can indicate an __________ ___________. |
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Definition
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Term
| Prominent aortic pulsation can indicate an _______ __________. |
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Definition
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Term
| Abdominal movements that you should look for on the abdominal exam. |
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Definition
Visible peristalsis
Respiration
Prominent aortic pulsation |
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Term
| ____________ always preceeds percussion and _________. |
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Definition
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Term
| You should auscultate with the _______ in all 4 quadrants. |
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Definition
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Term
| Bowel sounds can be recorded as hyperactive, __________ , or hypoactive. |
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Definition
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Term
| You must auscultate for _ _____ before declaring bowel sounds as absent. This is a surgical emergency. |
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Definition
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Term
| You should listen with the ____ over these arteries (4) for abdominal bruits. |
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Definition
bell
aorta
right and left renal
right and left iliac
right and left femoral |
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Term
| Place your stethoscope in the __________ area and listen for a low pitched, continuous sound. A _____ ____ may be present with increased collateral circulation between portal and systemic venous systems. |
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Definition
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Term
| What is the purpose of percussion of the abdomen? |
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Definition
| to access size and density of organs and detect the presence of fluid (ascites) |
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Term
| When percussing over solid organs, full bladder and masses you will hear _________. |
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Definition
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Term
| When percussing over the abdomen, the predominant sound you will hear is ________ as the stomach and intestines are filled with air. |
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Definition
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Term
| A _______ is not necessary when percussing but make sure that you percuss a few times in each quadrant |
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Definition
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Term
| When percussing the liver, start at the ____________ _____ in an area of ________, mark with water soluble pen the area where _______ begins and ends. |
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Definition
midclavicular line
tympany
dullness |
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Term
| A normal liver span is ___ to ___ cm vertically. |
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Definition
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Term
| To percuss the spleen, percuss the area just ________ to the __________ line on the left side. |
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Definition
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Term
| When percussing the spleen you should hear a small area of _________ between the ____ and ____ rib. |
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Definition
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Term
| During ______ palpation you should depress the skin no more than __cm. Any irritation can indicate ____________. |
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Definition
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Term
| When you are palpating for irregularities such as a mass, always look for involuntary tightening of abdominal muscles that can occur with peritoneal irritation. |
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Definition
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Term
| The purpose of deep palpation is: |
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Definition
| to uncover abdominal masses and to delineate abdominal organs |
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Term
| _____ palpation may evoke discomfort over the cecum, sigmoid colon, _____ and midline near the _______ process in healthy individuals. |
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Definition
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Term
| Two techniques for palpating the liver: |
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Definition
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Term
| Two techniques for palpating the kidneys: |
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Definition
| anterior and posterior techniques |
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Term
| Rebound tenderness in the RLQ over ________ point indicates ____________. |
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Definition
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Term
| 5 signs that indicate peritoneal irritation: |
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Definition
Iliopsoas
Obturator
Rebound
Heel Jar
Rovsing |
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Term
| 6 signs that indicate appendicitis: |
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Definition
McBurney
Iliopsoas
Obturator
Rebound
Heel jar
Rovsing |
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Term
| _______ sign is when you do deep palpation in the LLQ and the patient feels pain in the RLQ. |
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Definition
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Term
| A ______ _______ sign is indicated when a distended gall bladder falls into your finger as the pt is breathing in deeply. They will immediately stop breathing in deeply because of the pain that it causes when the gall bladder hits your finger. |
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Definition
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Term
| ____ ____ and shifting dullness are used to detect _______ in the abdomen. The ______ ____ test is performed by placing your hand against one side of the abd and then pushing the other side of the abd. A positive sign will be that you feel the fluid shift from one side to the other. |
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Definition
fluid wave
ascites
fluid wave |
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Term
| A positive Murphy sign is indicative of ______________. |
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Definition
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Term
| Provocative maneuvers are used to detect ______, _________, and testicular hernias. |
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Definition
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Term
| Two common abdominal complaints with referred back pain are _____ _____ and _______ ______. |
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Definition
renal colic
duodenal ulcers |
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Term
| _________ often has referred back and shoulder pain. |
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Definition
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Term
| _______ _____ often has referred ipsilateral groin pain. |
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Definition
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Term
| Patients with __________ may often experience referred pain at the tip of the scapula. |
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Definition
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Term
| _________ can often present as referred pain at the umbilical area. |
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Definition
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Term
| Renal colic may present with referred pain in the back and __________. |
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Definition
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Term
| You should firmly percuss over the costovertebral angle to test for pain/tenderness in the __________. |
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Definition
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Term
| The iliopsoas test is performed with the patient laying supine and _____ leg at the hip. Pain with flexion indicates a _________ "psoas sign". |
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Definition
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Term
| For the obturator test have the patient lay supine, _____ the knee and hip, and rotate the knee laterally and ________. A positive sign is indicated by pain. |
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Definition
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Term
A thorough abdominal exam, especially in the presence of ____ or complaints, would include the following:
-Inspection of the ______ for icterus
-___________ of lungs and heart
-Possibly an ___
-______ exam in females
-______ exam with hemoccult testing |
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Definition
pain
sclera
auscultation
EKG
pelvic
rectal |
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Term
| Difference between rebound tenderness and McBurney’s sign is: |
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Definition
| tenderness at the point of palpation vs. tenderness on release. |
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Term
| 4 tonal qualities associated with percussion of the abdomen: |
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Definition
tympany
hyperresonance
resonance
dullness |
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