HA MIDTERM

• Right Upper Quadrant (RUQ)

  • Ascending and transverse colon
  • Duodenum
  • Gallbladder
  • Hepatic flexure of colon
  • Liver
  • Pancreas (head)
  • Pylorus (the small bowel—or ileum— traverses all quadrants)
  • Right adrenal gland
  • Right kidney (upper pole)
  • Right ureter
• Right Lower Quadrant (RLQ)

  • Appendix
  • Ascending colon
  • Cecum
  • Right kidney (lower pole)
  • Right ovary and tube
  • Right ureter
  • Right spermatic cord
• Left Upper Quadrant (LUQ)

  • Left adrenal gland
  • Left kidney (upper pole)
  • Left ureter
  • Pancreas (body and tail)
  • Spleen
  • Splenic flexure of colon
  • Stomach
  • Transverse descending colon
• Left Lower Quadrant (LLQ)

  • Left kidney (lower pole)
  • Left ovary and tube
  • Left ureter
  • Left spermatic cord
  • Descending and sigmoid colon
• Midline

  • Bladder
  • Uterus
  • Prostate gland
• Character


  Describe the sign or symptom (feeling, appearance, sound, smell, or taste if applicable)
• Onset


  When did it begin
• Location


  Where is it? Does it radiate? Does it occur anywhere else?
• Duration


  How long does it last? Does it recur?
• Severity


  How bad is it? Or how much does it bother you?
• Pattern


  What makes it better or worse?
• Associated factors/how it affects the client


  What other symptoms occur with it? How does it affect you?
• Abdominal Pain


  Abdominal pain occurs when specific digestive organs or structures are affected by chemical or mechanical factors such as inflammation, infection, distention, stretching, pressure, obstruction, or trauma.
• Indigestion


  Indigestion (pyrosis), often described as heartburn, may be an indication of acute or chronic gastric disorders including hyperacidity, gastroesophageal reflux disease (GERD), peptic ulcer disease, and stomach cancer.
• Nausea and Vomiting


  Nausea may also be precipitated by dietary intolerance, psychological triggers, or menstruation. Nausea may also occur at particular times such as early in the day with some pregnant clients ("morning sickness"), after meals with gastric disorders, or between meals with changes in blood glucose levels.
• Appetite


  Loss of appetite (anorexia) is a general complaint often associated with digestive disorders, chronic syndromes, cancers, and psychological disorders. Carefully correlate appetite changes with dietary history and weight monitoring.
• Bowel Elimination


  Changes in bowel patterns must be compared to usual patterns for the client. Normal frequency varies from 2–3 times per day to 3 times per week.
• Constipation


  is usually defined as a decrease in the frequency of bowel movements or the passage of hard and possibly painful stools. Signs and symptoms that accompany constipation may be a clue as to the cause of constipation, such as bleeding with malignancies or pencil-shaped stools with intestinal obstruction.
• Diarrhea


  is defined as frequency of bowel movements producing unformed or liquid stools. It is important to compare these stools to the client's usual bowel patterns. Bloody and mucoid stools are associated with inflammatory bowel diseases (e.g., ulcerative colitis, Crohn's disease); clay-colored, fatty stools may be from malabsorption syndromes. Associated symptoms or signs may suggest the disorder's origin. For example, fever and chills may result from an infection or weight loss and fatigue may result from a chronic intestinal disorder or a cancer.
• Visceral pain


  occurs when hollow abdominal organs—such as the intestines—become distended or contract forcefully, or when the capsules of solid organs such as the liver and spleen are stretched. Poorly defined or localized and intermittently timed, this type of pain is often characterized as dull, aching, burning, cramping, or colicky.

  (organs mismo yung masaket)
• Parietal pain


  occurs when the parietal peritoneum becomes inflamed, as in appendicitis or peritonitis. This type of pain tends to localize more to the source and is characterized as a more severe and steady pain.
• Referred pain(travel pain)


  occurs at distant sites that are innervated at approximately the same levels as the disrupted abdominal organ. This type of pain travels, or refers, from the primary site and becomes highly localized at the distant site.
• Inspection


  Observe the coloration of the skin, scars, lesions and rashes, umbilicus, and abdominal contour and symmetry.
• Auscultation


  Listen for bowel sounds.
• Percussion


  Not mentioned
• Palpation


  Not mentioned
• Mechanisms and sources of abdominal pain include visceral, parietal, and referred pain
• Physical examination of the abdomen includes inspection, auscultation, percussion, and palpation
• Auscultate for bowel sounds


  1. Apply light pressure or simply rest the stethoscope on a tender abdomen

  2. Begin in the RLQ and proceed clockwise, covering all quadrants

  3. Listen for at least 5 minutes before determining that no bowel sounds are present and that the bowels are silent

  4. Confirm bowel sounds in each quadrant

  5. Listen for up to 5 minutes (minimum of 1 minute per quadrant) to confirm the absence of bowel sounds
• Normal bowel sounds


  • A series of intermittent, soft clicks and gurgles are heard at a rate of 5–30 per minute
  • Hyperactive bowel sounds referred to as "borborygmus" may also be heard. These are the loud, prolonged gurgles characteristic of one's "stomach growling"
• Abnormal bowel sounds


  • "Hyperactive" bowel sounds that are rushing, tinkling, and high pitched may be abnormal indicating very rapid motility heard in early bowel obstruction, gastroenteritis, diarrhea, or with use of laxatives
  • "Hypoactive" bowel sounds indicate diminished bowel motility. Common causes include paralytic ileus following abdominal surgery, inflammation of the peritoneum, or late bowel obstruction. May also occur in pneumonia
• Decreased or absent bowel sounds signify the absence of bowel motility, which constitutes an emergency requiring immediate referral
• Auscultate for vascular sounds


  Use the bell of the stethoscope to listen for bruits (low-pitched, murmur-like sound, pronounced BROO-ee) over the abdominal aorta and renal, iliac, and femoral arteries
• Normal vascular sounds


  Bruits are not normally heard over abdominal aorta or renal, iliac, or femoral arteries. However, bruits confined to systole may be normal in some clients depending on other differentiating factors
• Abnormal vascular sounds


  A bruit with both systolic and diastolic components occurs when blood flow in an artery is turbulent or obstructed. This may indicate an aneurysm or renal arterial stenosis (RAS). When blood flows through a narrow vessel, it makes a whooshing sound, called a bruit. However, the absence of this sound does not exclude the possibility of RAS. For a more accurate diagnosis, an ultrasound or an angiogram is needed
• Listen for venous hum


  Using the bell of the stethoscope, listen for a venous hum in the epigastric and umbilical areas
• Normal venous sounds


  Venous hum is not normally heard over the epigastric and umbilical areas
• Abnormal venous sounds


  Venous hums are rare. However, an accentuated venous hum heard in the epigastric or umbilical areas suggests increased collateral circulation between the portal and systemic venous systems, as in cirrhosis of the liver
• Auscultate for a friction rub over the liver and spleen


  Listen over the right and left lower rib cage with the diaphragm of the stethoscope
• Normal findings


  No friction rub over liver or spleen is present