NR509 Advanced Health Assessment Final Exam
Questions and Correct Answers, Complete Solution.
Regions of the abdomen
-right hypochondriac, epigastric, left hypochondriac
-right lumbar, umbilical, left lumbar
-right iliac/inguinal, hypogastric, left iliac/inguinal
Structures in RUQ
liver, gallbladder, pylorus, duodenum, hepatic flexure of colon, and head of pancreas
Structures in LUQ
Spleen, splenic flexure of colon, stomach, and body and tail of pancreas
Structures in LLQ
Sigmoid colon, descending colon, left ovary
Structures in RLQ
Cecum, appendix, ascending colon, terminal ileum, and right ovary
Bone in the abdomen that protects the stomach
Xiphoid process
Ribs that protect most of the spleen
Left 9th, 10th, 11th
Palpating the pancreas in healthy adults
Cannot be detected
Where do you check for kidney tenderness?
At the costovertebral angle (CVA)
Where is the costovertebral angle?
Formed by the lower border of the 12th rib, and the transverse process of the upper
lumbar vertebrae
What can be palpated above the symphysis pubis?
A distended bladder
Key info to obtain for someone with abdominal pain: Onset
The timing as to when the patient's symptoms occurred and it's progression can help
determine the likelihood of an emergent cause
Key info to obtain for someone with abdominal pain: location
The knowledge of where the viscera are positioned in the abdominal cavity is a key part
in narrowing the differential diagnosis to the potential affected organs
Key info to obtain for someone with abdominal pain: character
Determining underlying pathophysiologic process of the patient's pain (visceral vs
somatic) may help in elucidating the cause
Key info to obtain for someone with abdominal pain: radiation
Presence or absence of the pain migration can help determine the cause, especially in
disease, processes involving the liver, biliary, tract, and appendix.
Key info to obtain for someone with abdominal pain: palliative, provoking, or
associated factors
These may provide insight into the differential diagnosis. Examples include relief of pain
by vomiting, increased pain with eating, anorexia, fever, diarrhea, and constipation.
,Key info to obtain for someone with abdominal pain: Past medical, surgical, and
social history
Can help provide clues to possible causes. Examples include prior similar pain episodes
in the past; Presence of comorbid conditions, such as diabetes or atrial fibrillation;
medication use like NSAIDs; history of previous abdominal surgery; smoking and illicit
drug use, history of STI's, and infertility.
visceral pain
-Occurs when hollow abdominal organs, such as the intestines or biliary tree contract
unusually forcefully, or are distended or stretched.
-solid organs, such as the liver, can also become painful when they're capsules are
stretched
-Pain is typically nonspecific and difficult to localize
-Palpable near the midline at levels that vary according to the structure involved
-ischemia can stimulate these pain fibers
-Pain varies in quality and may be gnawing, cramping, or aching. As the pain,
progressive, systemic symptoms, such a sweating, pallor, nausea, vomiting, and
restlessness can follow.
Visceral pain in the right upper quadrant suggests
Liver distention against its capsule from various causes of hepatitis, including alcoholic
hepatitis, or biliary pathology
Visceral periumbilical pain can be suggestive of...
Early acute appendicitis from distention of an inflamed appendix.
It gradually changes to parietal pain in the right lower quadrant from inflammation of the
adjacent parietal peritoneum to
Pain disproportionate to physical findings in the abdomen
Suspicious for intestinal mesenteric ischemia
somatic pain (parietal)
-Originates from inflammation of the parietal, peritoneum, a.k.a. peritonitis, which can be
localized or diffuse
-steady, aching pain that is usually more severe than visceral pain and more precisely
located over and involves structure.
-Typically aggravated by movement or coughing
-Patients with this type of pain prefer to lie still
patients with colicky pain from renal stone tend to.....
Move around frequently, trying to find a comfortable position
referred pain
, -Felt in more distant sites that are innervated at approximately the same spinal levels as
the disorder structures
-often develops as the initial pain becomes more intense, and seems to radiate or travel
from the initial site.
-Palpation at the site of referred pain often does not result in tenderness
Pain of duodenal or pancreatic origin may be referred to....
The back
Pain from the biliary tree may radiate to
The rate scapular region or the right person thorax
Pain from pleurisy or inferior wall MI may be referred to
Epigastric reason
Pain may also be referred to the abdomen from the….
Chest, spine, or pelvis
discomfort
Subjective negative feeling that is non-painful. Can include various symptoms, such as
bloating, nausea, upper abdominal fullness, and heartburn.
Dyspepsia
Chronic or recurrent discomfort or pain centered in the upper abdomen, characterized
by epigastric pain or burning (or both) parentheses and postprandial fullness or early
satiety (or both)
Functional, or non-ulcer, dyspepsia
Three month history of nonspecific, upper abdominal discomfort or nausea, not
attributed to structural abnormalities or peptic also disease.
Symptoms usually recurring and present for more than six months
Multifactoral causes include delayed gastric emptying, PUD with or without H. pylori,
PUD, IBS, and psychosocial factors.
If a patient reports heartburn and ever let us regurgitation together more than
once a week...
The accuracy of diagnosing GERD is over 90%
RUQ pain is associated with...
...pathology with the biliary tree and the liver
Risk factor for GERD
reduced salivary flow, which increases mucosal acid exposure by dampening the
actions of the bicarbonate buffer; obesity; delayed gastric emptying; selected
medications; hiatal hernia and increased intraabdominal pressure
heartburn
rising retrosternal burning pain or discomfort occurring weekly or more often
what aggravates heartburn
foods such as alcohol; chocolate; citrus fruits; coffee; onions; and peppermint;
or positions like bending over, exercising, lifting, or lying supine.
Pain in the LLQ accompanied by diarrhea in a patient with a history of
constipation is suggestive of
Questions and Correct Answers, Complete Solution.
Regions of the abdomen
-right hypochondriac, epigastric, left hypochondriac
-right lumbar, umbilical, left lumbar
-right iliac/inguinal, hypogastric, left iliac/inguinal
Structures in RUQ
liver, gallbladder, pylorus, duodenum, hepatic flexure of colon, and head of pancreas
Structures in LUQ
Spleen, splenic flexure of colon, stomach, and body and tail of pancreas
Structures in LLQ
Sigmoid colon, descending colon, left ovary
Structures in RLQ
Cecum, appendix, ascending colon, terminal ileum, and right ovary
Bone in the abdomen that protects the stomach
Xiphoid process
Ribs that protect most of the spleen
Left 9th, 10th, 11th
Palpating the pancreas in healthy adults
Cannot be detected
Where do you check for kidney tenderness?
At the costovertebral angle (CVA)
Where is the costovertebral angle?
Formed by the lower border of the 12th rib, and the transverse process of the upper
lumbar vertebrae
What can be palpated above the symphysis pubis?
A distended bladder
Key info to obtain for someone with abdominal pain: Onset
The timing as to when the patient's symptoms occurred and it's progression can help
determine the likelihood of an emergent cause
Key info to obtain for someone with abdominal pain: location
The knowledge of where the viscera are positioned in the abdominal cavity is a key part
in narrowing the differential diagnosis to the potential affected organs
Key info to obtain for someone with abdominal pain: character
Determining underlying pathophysiologic process of the patient's pain (visceral vs
somatic) may help in elucidating the cause
Key info to obtain for someone with abdominal pain: radiation
Presence or absence of the pain migration can help determine the cause, especially in
disease, processes involving the liver, biliary, tract, and appendix.
Key info to obtain for someone with abdominal pain: palliative, provoking, or
associated factors
These may provide insight into the differential diagnosis. Examples include relief of pain
by vomiting, increased pain with eating, anorexia, fever, diarrhea, and constipation.
,Key info to obtain for someone with abdominal pain: Past medical, surgical, and
social history
Can help provide clues to possible causes. Examples include prior similar pain episodes
in the past; Presence of comorbid conditions, such as diabetes or atrial fibrillation;
medication use like NSAIDs; history of previous abdominal surgery; smoking and illicit
drug use, history of STI's, and infertility.
visceral pain
-Occurs when hollow abdominal organs, such as the intestines or biliary tree contract
unusually forcefully, or are distended or stretched.
-solid organs, such as the liver, can also become painful when they're capsules are
stretched
-Pain is typically nonspecific and difficult to localize
-Palpable near the midline at levels that vary according to the structure involved
-ischemia can stimulate these pain fibers
-Pain varies in quality and may be gnawing, cramping, or aching. As the pain,
progressive, systemic symptoms, such a sweating, pallor, nausea, vomiting, and
restlessness can follow.
Visceral pain in the right upper quadrant suggests
Liver distention against its capsule from various causes of hepatitis, including alcoholic
hepatitis, or biliary pathology
Visceral periumbilical pain can be suggestive of...
Early acute appendicitis from distention of an inflamed appendix.
It gradually changes to parietal pain in the right lower quadrant from inflammation of the
adjacent parietal peritoneum to
Pain disproportionate to physical findings in the abdomen
Suspicious for intestinal mesenteric ischemia
somatic pain (parietal)
-Originates from inflammation of the parietal, peritoneum, a.k.a. peritonitis, which can be
localized or diffuse
-steady, aching pain that is usually more severe than visceral pain and more precisely
located over and involves structure.
-Typically aggravated by movement or coughing
-Patients with this type of pain prefer to lie still
patients with colicky pain from renal stone tend to.....
Move around frequently, trying to find a comfortable position
referred pain
, -Felt in more distant sites that are innervated at approximately the same spinal levels as
the disorder structures
-often develops as the initial pain becomes more intense, and seems to radiate or travel
from the initial site.
-Palpation at the site of referred pain often does not result in tenderness
Pain of duodenal or pancreatic origin may be referred to....
The back
Pain from the biliary tree may radiate to
The rate scapular region or the right person thorax
Pain from pleurisy or inferior wall MI may be referred to
Epigastric reason
Pain may also be referred to the abdomen from the….
Chest, spine, or pelvis
discomfort
Subjective negative feeling that is non-painful. Can include various symptoms, such as
bloating, nausea, upper abdominal fullness, and heartburn.
Dyspepsia
Chronic or recurrent discomfort or pain centered in the upper abdomen, characterized
by epigastric pain or burning (or both) parentheses and postprandial fullness or early
satiety (or both)
Functional, or non-ulcer, dyspepsia
Three month history of nonspecific, upper abdominal discomfort or nausea, not
attributed to structural abnormalities or peptic also disease.
Symptoms usually recurring and present for more than six months
Multifactoral causes include delayed gastric emptying, PUD with or without H. pylori,
PUD, IBS, and psychosocial factors.
If a patient reports heartburn and ever let us regurgitation together more than
once a week...
The accuracy of diagnosing GERD is over 90%
RUQ pain is associated with...
...pathology with the biliary tree and the liver
Risk factor for GERD
reduced salivary flow, which increases mucosal acid exposure by dampening the
actions of the bicarbonate buffer; obesity; delayed gastric emptying; selected
medications; hiatal hernia and increased intraabdominal pressure
heartburn
rising retrosternal burning pain or discomfort occurring weekly or more often
what aggravates heartburn
foods such as alcohol; chocolate; citrus fruits; coffee; onions; and peppermint;
or positions like bending over, exercising, lifting, or lying supine.
Pain in the LLQ accompanied by diarrhea in a patient with a history of
constipation is suggestive of
