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Where does the hepatic artery transport blood to and from?
from the aorta to the liver
Where does the portal vein carry blood to and from?
from the digestive tract and spleen to the liver
Where is the liver located?
- below diaphragm
- above gb, rt kidney, & hepatic flexure of colon
Where do the 3 hepatic veins carry blood?
fro the liver and empty into the IVC
What is gluconeogensis? Where does this happen?
The process of converting amino acids to glucose (in the liver)
What does the liver do with cholesterol?
uses it to form bile salts
In the liver, what is made from carbs and proteins?
What happens to proteins in the liver?
They are broken down into amino acids by hydrolysis and then their waste products are converted to urea for excretion
The liver stores ______.
glucose, vitamins, and iron
The liver produces _______.
- coagulation substances
- plasma proteins
- also synthesizes bile
What two ducts form the common bile duct?
cystic and hepatic
How does the pancreas act as an endocrine gland?
islet cells produce insulin and glucagon
How does the pancreas act as an exocrine gland?
- acinar cells produce digestive enzymes
- pancreatic duct empties into duodenum at the duodenal papilla
Where is the spleen?
- above left kidney
- below diaphragm
Each kidney extends from the vertebral level of _____ to ______.
T12 to L3
The _____ kidney is usually slightly lower than the ______.
How do the kidneys act as endocrine glands?
- produces renin, which controls aldosterone secretion
- is primary source of EPO production in adults
- synthesizes prostaglandins
- produces biologically active form of vit D
Dullness extending above the fifth intercostal space suggests?
upward displacement of the liver due to abdominal fluid or masses
What organs are in the LUQ?
spleen and stomach
What organs are in the RUQ?
What organs are in the LLQ?
What organs are in the RLQ?
What is Murphey's sign used to test?
In older adults, hepatic BF decreases as a result of?
decline in CO
The size of the ________ is unaffected by aging
The _______ cells of the pancrease produce enzymes.
What is a Cullen sign and what does it suggest?
- bluish periumbilical discoloration
- intraabdominal bleeding
What may be the first sign of an intraabdominal malignancy?
- Sister Mary Joseph's Nodule
- (a pearl-like, enlarged and sometimes painful umbilical nodule)
A __________ contour is characteristic of young children, but in adults it is the result of fat or poor muscle tone.
rounded or convex
Males exhibit primarily ______ movement with respiration, whereas females show mostly ______ movement.
Normal rate of bowel sounds
5-35 per minute
What does a high-pitched tinkling sound in the bowel suggest?
intestinal fluid and air under pressure (early obstruction)
Decreased BS occur with ______ and paralytic ileus.
Listen with the diaphragm for friction rubs over the _______.
liver and spleen
What may a bruit indicate?j Where do you listen for one?
- vascular disease
- epigastric region (with bell) in aortic, renal, iliac, and femoral arteries
A lower liver border more than ______ below the costal margin may indicate organ enlargement or downward displacement of the diaphragm.
2-3cm (3/4 to 1 in)
The upper border of the liver is usually where?
fifth right ICS
An upper border below the 5th ICS may indicate?
downward displacent or liver atrophy
Dullness extending above the 5th right ICS suggests?
- upward displacement or
- abdominal fluid or masses
Liver span is usually greater in _____ and ______.
Normal liver span at midsternal line
4-8 cm (1 1/2 to 3 in)
What is Traube's space?
- a semilunar region
- 6th rib superiorly
- midaxillary line laterally
- left costal margin inferiorly
With splenic enlargement, tympany changes to dullness as the spleen is brought _____ with INSPIRATION.
forward and downward
Light palpation is useful in identifying ___________.
- muscular resistance &
- areas of tenderness
Moderate palpation with the side of the hand is useful in assessing which organs?
- liver & spleen
- (they move with respiration)
During INSPIRATION, the liver and spleen are displaced _________.
When might the scratch test for the liver be useful?
if the abdomen is distended or the abdominal muscles tense
A palpable, TENDER gallbladder indicates ______; whereas NONTENDER enlargement suggests ___________.
- common bile duct obstruction
The ______ kidney is more commonly palpable, wherease the ______ kidney is not normally palpable.
A prominent _______ pulsation suggests an AAA.
What is the Alvarado score?
- a pain assessment tool for appendicitis (MANTRELS)
- Migration of pain
- Tenderness in the RLQ
- Rebound pain
- Elevation of temp
- Shift to the Left
What is a positive Blumberg sign?
Rebound tenderness causing a sharp pain at the site of peritoneal inflammation
What is a positive McBurney sign?
rebound tenderness in the LRQ (over McBurney's point) and suggests appendicitis
When is the Iliopsoas Muscle Test performed?
- When there is suspected appendicitis b/c an inflamed appendix may cause irritation of the lateral iliopsoas muscle.
When is the obturator muscle test performed
- When a ruptured appendic or pelvic abscess is suspected due to irritation of obturator muscle
- Pain in rt hypogastric region is a positive sign
What is McBurney's point?
over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel)
What does a scaphoid abdomen in a newborn suggest?
abdominal contents are displaced into the thorax
Pulsations in the ______ area are common in newborns & infants.
When are superficial veins visible in an infant?
when the infant is thin
Are distended veins across the abdomen an expected finding in a newborn or infant?
NO! Suggests vascular or abdominal obstruction
What is diastasis rectus abdomens?
- a separation 1-4 cm wide in midline, usually b/w xiphoid and umbilicus in infants
- common when muscles do not approximate ea other
When is the spleen palpable in infants?
first few weeks after birth
What would cause an enlarged liver in a newborn?
Mom with DM
Where may the liver edge be palpable in infants and toddlers?
1-3 cm below the right costal margin
Before 2 yo, _____ have a slightly LARGER liver span than _____.
When can the olive-shaped mass of pyloric stenosis be detected in an infant?
with deep palpation in RUQ after he/she vomits
Localized epigastric pain when stomach is empty; pain is relieved by FOOD or antacids.
Epigastric pain/heartburn that worsens when lying down.
hiatal hernia w/ esophagitis
What is a positive Kehr sign?
- pain in LUQ that radiates to left shoulder
- symptom of spleen laceration/rupture
When are Cullen and Grey Turner signs noted?
In severe necrotizing pancreatitis
What to suspect if s/s of pyelonephritis (chills, fever, dysuria, flank pain) persist beyond 72 hrs of abx therapy.
What is a positive Dance sign?
- *RLQ feels empty*
- (sausage-shaped mass may be palpated in RUQ or LUQ as in Intussusception)