Chapter 21Review: AnatomySlide 3Slide 4Alimentary Canal: Hollow tube from the mouth to the anusSlide 6Structure and Function (cont.)Slide 8Slide 9Slide 10Slide 11Slide 12Slide 13Referred Abdominal PainAssessing Abdominal PainSubjective DataPhysical Exam: PreparationInspectionSlide 19Slide 20Slide 21Causes of Distension: 6 F’sAuscultationPattern of AuscultationPhysical Examination: AuscultationBowel SoundsAbnormal BSPhysical Exam: PercussionPercussing for Liver SpanLiver Span cont’d.PercussionPercussing the SpleenPercussion of BladderPalpationSlide 35Palpation cont’d.Slide 37Palpation of LiverPalpate Liver cont’d.Physical Exam: Rebound TendernessRebound Tenderness cont’d. (Blumberg’s Sign)Assessing for AppendicitisPhysical Exam: RectumAge ConsiderationsAge Considerations: PregnancyAge Considerations: Aging AdultCommon GI AbnormalitiesAbnormalitiesAbnormal FindingsSlide 50GI DisordersIBS vs. DiverticulosisAbdominal Nursing Diagnoses:TerminologyDocumentation Example: Abdominal PainNsg 326 Clinical AssessmentAbdominal Tubes and DrainsChapter 21Chapter 21The AbdomenThe AbdomenReview: AnatomyReview: AnatomySurface landmarksSurface landmarksReview: AnatomyReview: AnatomyInternal AnatomyInternal AnatomyReview: AnatomyReview: AnatomyPeritoneumPeritoneum–Serous membraneSerous membrane–ParietalParietalCovers the entire abdominal wallCovers the entire abdominal wall–VisceralVisceralCovers the organs of the abdomenCovers the organs of the abdomen–Peritoneum cavityPeritoneum cavityThe space b/t the two layersThe space b/t the two layers–Gender differencesGender differencesClosed in malesClosed in malesOpenings in females (for fallopian tubes)Openings in females (for fallopian tubes)Alimentary Canal: Alimentary Canal: Hollow tube from the mouth to the Hollow tube from the mouth to the anusanusEsophagusEsophagusStomachStomachSmall intestineSmall intestineLarge intestineLarge intestineStructure and FunctionStructure and Function (cont.)(cont.)RUQRUQ–LiverLiver–GallbladderGallbladder–DuodenumDuodenum–Head of pancreasHead of pancreas–Right kidney and Right kidney and adrenal glandadrenal gland–Hepatic flexure of Hepatic flexure of coloncolon–Part of ascending and Part of ascending and transverse colontransverse colonLUQLUQ–StomachStomach–SpleenSpleen–Left lobe of liverLeft lobe of liver–Body of pancreasBody of pancreas–Left kidney and Left kidney and adrenal glandadrenal gland–Splenic flexure of Splenic flexure of coloncolon–Part of transverse and Part of transverse and descending colondescending colonSlide 21-Slide 21-77Structure and FunctionStructure and Function (cont.)(cont.)Right lower Right lower quadrantquadrant(RLQ)(RLQ)–CecumCecum–AppendixAppendix–Right ovary and tubeRight ovary and tube–Right ureterRight ureter–Right spermatic cordRight spermatic cordLeft lower quadrantLeft lower quadrant(LLQ)(LLQ)–Part of descending Part of descending coloncolon–Sigmoid colonSigmoid colon–Left ovary and tubeLeft ovary and tube–Left ureterLeft ureter–Left spermatic cordLeft spermatic cordSlide 21-Slide 21-88Structure and FunctionStructure and Function (cont.)(cont.)MidlineMidline–AortaAorta–Uterus, if enlargedUterus, if enlarged–Bladder, if distendedBladder, if distendedSlide 21-Slide 21-99Review: AnatomyReview: AnatomyInternal AnatomyInternal AnatomyReview: AnatomyReview: AnatomyAccessory Digestive Organs: functionsAccessory Digestive Organs: functions–Liver Liver Produces bileProduces bileMetabolizes proteins, fats and carbsMetabolizes proteins, fats and carbsStores some vitaminsStores some vitaminsProduces substances for blood clotting, antibodies Produces substances for blood clotting, antibodies Detoxifies harmful substancesDetoxifies harmful substances–GallbladderGallbladderStores bileStores bileReleases bileReleases bile–SpleenSpleenFilters & rids body of old/deformed RBC’s and Filters & rids body of old/deformed RBC’s and plateletsplateletsStores and contributesStores and contributesReview: AnatomyReview: AnatomyRetroperitoneal organsRetroperitoneal organs–Located behind the peritoneum and no Located behind the peritoneum and no mesenteric attachmentmesenteric attachmentPancreasPancreasKidneysKidneysUretersUretersBladderBladderReferred Abdominal PainReferred Abdominal PainAssessing Abdominal PainAssessing Abdominal PainType of PainType of PainPossible CausePossible Cause BurningBurning Peptic ulcerPeptic ulcer CrampingCramping Biliary colicBiliary colic Severe crampingSevere cramping AppendicitisAppendicitis StabbingStabbing PancreatitisPancreatitisOnset of PainOnset of PainPossible CausePossible Cause Gradual Gradual InfectionInfection Acute; awakens patientAcute; awakens patient Duodenal infectionDuodenal infection Loss of consciousnessLoss of consciousness Acute pancreatitis, Acute pancreatitis, per-per- forated ulcer, ruptured forated ulcer, ruptured ectopic pregnancy, ectopic pregnancy, intestinal obstructionintestinal obstructionSubjective DataSubjective DataAppetiteAppetiteDysphagiaDysphagiaFood intoleranceFood intoleranceAbdominal painAbdominal painNausea/vomitingNausea/vomitingBowel habitsBowel habitsPast abdominal Past abdominal historyhistoryMedicationsMedicationsNutritional Nutritional assessmentassessmentPhysical Exam: PreparationPhysical Exam: PreparationPositioning:Positioning:–Expose abdomenExpose abdomen SequenceSequence–InspectionInspection–AuscultationAuscultation–PercussionPercussion–PalpationPalpationEquipmentEquipment–Small pillow for Small pillow for under kneesunder knees–Tape measure (to Tape measure (to measure girth)measure girth)–StethoscopeStethoscopeInspectionInspectionEnsure adequate lighting:Ensure adequate lighting:–Use “tangential” lighting, if necessaryUse “tangential” lighting, if necessary–Position self on a horizontal plane Position self on a horizontal plane looking across patient’s abdomenlooking across patient’s abdomenStand on Pt’s rightStand on Pt’s rightInspectionInspectionContour and shapeContour and shapeInspectionInspectionSymmetrySymmetryUmbilicus (navel)Umbilicus (navel)Bulge(s) Bulge(s) Color, pigmentationColor, pigmentationScarsScarsPulsation below xiphoid processPulsation below xiphoid processProminent veinsProminent