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NURP 500 - Exam 3 Review_ CH 11 Abdomen.
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1 500 - Exam 3 Review_ CH 11 Abdomen.NURP
ABDOMEN: Bates Chapter 11
Structures by Quadrant
RUQ Sections LUQ
Liver Stomach
Gallbladder Spleen
Duodenum Epigastric Left lobe liver
Head of pancreas Body of
Right Kidney & Adrenal pancreas
Hepatic flexure of Left Kidney & adrenal
colon Part of ascending Splenic flexure of colon
and Parts of transverse and
transverse colon Umbilical descending colon
RLQ LLQ
Cecum Part of descending colon
Appendix Sigmoid Colon
Right Ovary/Fallopian Left Ovary/Fallopian
Tube Right Ureter Hypogastric tube Left Ureter
*McBurney’s point: 2” from Suprapubic
anterior superior spinous
process of ilium on a line
drawn from that point to the
umbilicus.
ABD H/HX: Common Concerning Symptoms
GI Disorders RED sx highlighted in ppt GU/Renal Disorders
Abd pain (Acute and Chronic) Suprapubic pain
Indigestion, N/V Difficulty urinating (dysuria)
Hematemesis Urinary urgency and Frequency
Anorexia, early satiety Hesitancy, stream (in males)
Difficulty swallowing (dysphagia) Polyuria, Nocturia
Pain with swallowing (odynophagia) Incontinence (stress, urgency, overflow, urge)
Change in bowel function Hematuria
Diarrhea/Constipation Flank pain
Jaundice Ureteral Colic
Upper GI Sx: Abd pain, heartburn, N/V Lower GI *often accompanied by GI sx such as abd pain,
Sx: Diarrhea, constipation, blood in stool, and N/V (from bates)
change in bowel function.
ABD H/Hx:
, 2 500 - Exam 3 Review_ CH 11 Abdomen.
NURP
• Pain in ABD: Onset, duration (timing of pain)
o Intermittent/Persistent
o Acute vs Insidious onset
• Location and movement of pain
• Radiation of pain
• Reproduceable?
• Quality and Severity
• Description – spasm, coliky, steady, dull, tearing, penetrating, sharp.
• Recurrent Pain
• Aggrivating/Relieving Factors.
*Ask patient to point to the location and describe sx in their own words*
Useful findings in Hx and PE
• Although location of abd pain guides the initial evaluation, associated symptoms
are predictive of certain causes/sources of abd pain and can help narrow the DDx.
History
• N/V • Weigh gain/loss
• Rectal bleeding • Type of diet
• Elimination o Pain in relation to meals
o Diarrhea/Constipation • Change in appetite
o Change in color Urine/Stool • Chewing swallowing problems
• Hemorrhoids • Heartburn
• Voiding difficulty • Age, Gender
• Assoc sx: fever, cough, jaundice
Pain
Visceral pain:
• Poorly localized – occurs often in the epigastrium, periumbilical and lower abdomen.
• Occurs when hollow organs such as the intestines or biliary tree forcefully contract or are
distended/stretched. Solid organs such as the liver can cause pain when their capsules
are stretched.
• May be difficult to localize.
• Typically pain is palpable near midline and at levels according to the structure involved.
• Ischemia also stimulates visceral pain fibers.
• Visceral pain in RUQ suggests liver distention against its capsule from various causes
of hepatitis, including chronic alcoholic hepatitis.
• Visceral periumbilical pain suggests early acute appendicitis from distention and
inflamed appendix. It gradually changes to parietal pain in RLQ from inflamed adjacent
parietal peritoneum.
, 3 500 - Exam 3 Review_ CH 11 Abdomen.
NURP
Qualities of Visceral Pain:
• Burning • Sweating
• Gnawing • Pallor
• Cramping • N/V
• Aching • Restlessness
• Severe pain
Types of Visceral Pain:
• RUQ visceral pain or epigastric pain from inflamed biliary tree
• Epigastric pain from stomach, duodenum, or pancreas
• Periumbilical pain from small intestine, appendix or proximal colon.
• Hypogastric pain (suprapubic pain) from the colon (colon pain may be more
diffuse), bladder, or uterus
• Suprapubic or sacral pain from rectum
Parietal Pain (Somatic):
• Well Localized, usually to a specific area. Pain is usually sharp.
• Originates from inflammation of parietal peritoneum (called peritonitis)
• Steady aching pain usually more severe than visceral and more precisely located
over the involved structure than visceral pain.
• Aggravated by moving or coughing – patient may prefer to lay still.
• In contrast to peritonitis, patient with colicky pain from renal stones will move
around and try to find a comfortable position.
Referred Pain:
• Localized to an area remote from affected organ.
• Felt in more distant sites which are innervated at approximately the same spinal level
as the disordered structure.
• Referred pain often develops as the initial pain and becomes more intense.
• Pain from duodenum or pancreas may be referred to the back
• Pain from biliary tree may be referred to Right Scapula or right posterior thorax
• Pain may also be referred to the abdomen from the chest, spine or pelvis
• Pain from pleurisy or MI ⟶ epigastric area
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