Abdominal percussion is performed to assess the relative density of abdominal contents, locate organs, and screen for abnormal fluid or masses in the abdomen. The liver is a solid organ which is located in the right upper quadrant and would elicit a dull percussion note. Tympany is heard over air-filled organs such as the stomach and intestines. It is the predominant sound that should be heard over the intestines, because air in the intestines rises to the surface when the person is supine. Resonance is a low-pitched, clear, hollow sound that predominates in healthy lung tissue. Hyperresonance is a lower-pitched, booming sound found when too much air is present such as with gaseous distension of the intestines in the abdomen or emphysema in the lungs.
The bladder is located in the suprapubic area (above the pubic bone) and if distended would elicit a dull sound when percussed and feel firm to palpation. However, this technique has been found to be unreliable and bedside bladder scanning with ultrasound is commonly used to estimate the bladder volume.
A bulging and stretched abdomen is described as protuberant. A protuberant abdomen is rounded, bulging, and stretched. A scaphoid abdomen caves inward. An obese abdomen appears uniformly rounded with a sunken umbilicus. A hernia is a protrusion of the abdominal viscera through an abnormal opening in the abdominal muscle wall.
Pulsations from the aorta are normally observed beneath the skin in the epigastric area, particularly in thin people who have good muscle wall relaxation. Pulsations of the renal arteries are not visible. The vena cava is a vein, not an artery, and does not have pulsations. Waves of peristalsis are sometimes visible in very thin people and appear as a slow ripple moving obliquely across the abdomen.
Diminished or absent bowel sounds signal decreased gastrointestinal motility which can be caused from inflammation from peritonitis, a paralytic ileus after abdominal surgery, or with a bowel obstruction. Diarrhea, laxative use, and gastroenteritis cause hyperactive, not hypoactive, bowel sounds.
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Part A: Day 1 Initially, Mr. K.B. lost water, sodium in the mucus content, and hydrogen and chloride ions in the hydrochloric acid portion of the gastric secretions.
Alkalosis develops for two reasons, the first being the direct loss of hydrogen ions and the second being the effects of chloride ion loss. When chloride ion is lost in the gastric secretions, it is replaced by chloride from the serum.To maintain equal numbers of cations and anions in the serum, chloride ion and bicarbonate ion can exchange places when needed. Therefore more bicarbonate ions shift into the serum from storage sites in the erythrocytes to replace the lost chloride ions. More bicarbonate ions in the serum raise serum pH, and the result is hypochloremic alkalosis. Describe the early signs of dehydration in Mr. K.B.