PA abdomen
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| Chief complaints | abdominal pain, indigestion, vomiting, diarrhea, constipation, flatus, melena, fecal incontinence, jaundice, dysuria, hematuria, radiating pain, etc
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| PMH | allergies, substances, preventatives, trauma, illness/surgeries, mental health, environmental exposures
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| personal/social history | ADLs, nutrition (increased fat, acid, gas formation, intolerances, cultural/ethnic foods, wt loss or gain), stresses, coping, values/beliefs, relationships, economics
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| family hx | gallbladder disease, kidney disease, malabsorption syndrome, hirschsprung disease, colon cancer
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| hirschsprung disease | part of the colon is missing nerves and cannot contract, so obstruction occurs
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| alimentary tract | 27 foot tube from mouth to anus
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| esophagus | 10 inch collapsible tube, connect pharynx to stomach, in chest and abdominal cavities
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| stomach | in left upper quadrant below diaphragm. 3 sections are fundus, body, and pylorus. Secrete HCl/enzymes to break down fats/proteins
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| small intestine | connects stomach to large intestine, 3 sections are duodenum, jejunum, and ileum. complete digestion, nutrients absorbed throguh wall into body
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| large intestine (colon) | connects small intestine to anus. 4 sections are cecum, ascending colon, transverse colon, descending colon. Functions include water absorption, lubrication, and putrefication
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| functions of alimentary tract | ingest and digest food, absorb nutrients/electrolytes/water, excretes watses, peristalsis
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| peristalsis | moves food along tract
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| liver (location) | four lobes in right upper quadrant
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| liver (major functions) | metabolizes fats and carbs, converts amino acids to glucose, synthesizes fats from carbs/proteins, stores vitamins and iron, detoxifies harmful substances, produces antibodies/blood coagulants, synthesizes bile, converts waste from fat to water soluble
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| gallbladder | pear shaped organ recessed in liver, concentrate and store bile
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| pancreas | • Located behind/beneath stomach
• Function: produces digestive juices and insulin/glucagon
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| spleen | positioned in LUQ below kidney; 2 tissues- white pulp (filters blood, produces wbcs), red pulp (stores/releases blood)
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| kidneys | retroperitoneal, connected to bladder via ureters, rid body of wastes, produces renin, erythropoetin, vitamin D, synthesizes prostaglandins
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| order of abdominal exam | inspect, auscultate, percuss, palpate
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| Four Quadrants of abdomen | right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant
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| Inspection of abdomen | surface characteristics, contour (flat, round, scaphoid, protuberant), location of umbilicus, symmetry, surface motion (pulsations), distention
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| abdominal aortic aneurysm | bruit, wide aorta, decreased femoral pulses, 50% asymptomatic
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| 9 causes of distention (9 F's) | fat, fluid, feces, fetus, flatus, fibroid, full bladder, false pregnancy, fatal tumor
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| causes of increased bowel sounds | gastroenteritis, early obstruction, hunger
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| borborygmi | loud gurgling
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| high pitched tinkling upon auscultation | early obstruction
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| decreased bowel sounds | late obstruction, peritonitis, paralytic ileus
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| absence of bowel sounds | must listen for 2-5 minutes
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| bruit | sounds like murmur, turbulent flow (use bell)
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| friction rub | check over spleen and liver, high pitched sound associated with respiration (use diaphragm)
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| percussion of liver | percuss at R MCL, go from tympany or resonance to dullness.
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| average span of liver | 6-12 cm
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| when is liver displaced downward? | lung disease
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| when is liver displaced upward? | pregnancy
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| percussion of spleen | o Percuss along left anterior axillary line- should be no dullness
o May be area of dullness between 6th and 11th rib just posterior to left midaxillary line (not >7cm)
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| percussion of kidneys | CVA tenderness (kidney punch)
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| light palpation | 1 hand, <1 cm depth
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| deep palpation | 2 hands, dominant hand down
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| palpation of liver | normal liver edge should be soft to moderately firm, smooth, distinct margins, non tender
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| palpation of spleen | not normally felt, enlarges toward midline
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| palpation of kidneys | press both hands together
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| palpation of abdominal aorta | palpate deeply, just above umbilicus, normal aortic pulse may be felt, but should be anterior in direction (lateral pulsation suggests abdominal aortic aneurysm)
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| signs of advanced liver disease | hyperbilirubinemia (icterus, jaundice, bilirubinuria), ascites, increased estrogen levels, lower extremity edema, varices
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| icterus | yellowing of the eyes
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| jaundice | yellowing of the skin
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| bilirubinuria | bilirubin in urine, dark color
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| detection of ascites | percuss for dullness/shifting of dullness
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| signs of increased estrogen levels | gynecomastia, spider angiomata, testicular atrophy
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| rebound tenderness | pain or tenderness upon removing pressure, not placing pressure
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| appendicitis | inflammation/rupture of appendix
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| cholecystitis | inflammation of gallbladder
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| pancreatitis | inflammation of pancreas
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| diverticulitis | inflammation of diverticula
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| volvulus | twisting of intestines
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| salpingitis | inflammation of fallopian tube
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| PID | pelvic inflammatory disease
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| renal calculi | kidney stones
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| peritonitis | inflammation of peritoneum, most commonly due to ruptured appendix
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| misc. causes of abdominal pain | perforated ulcer, intestinal obstruction, ectopic pregnancy, ruptured ovarian cyst, splenic rupture
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