Transcript Abdomen

Abdomen
N1037
Assessment of the Abdomen
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Provides information regarding the functions of :
– gastrointestinal tract
– cardiovascular system
– genitourinary system
Anatomy and Physiology
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Abdominal cavity -
btwn the diaphram & symphysis pubis
Anatomy and Physiology
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Peritoneum
– 2 linings : parietal/viseral
– intraperitoneum
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spleen, gallbladder, liver, bile
duct, stomach, sm & lrg intestine
– retroperitoneum
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pancreas, kidneys, ureters.
bladder
– linea alba - tendonous tissue
– 4 muscles groups
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abdominis rectus
transverse abdominis
external oblique
internal oblique
Anatomy and Physiology
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Abdominal vasculature
– descending aorta
– abdominal aorta
– L4 - aorta bifurcates into
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R & L common iliac arteries
above umbilicus
Anatomical Mapping
Anatomical Mapping
Assessment Landmarks
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1. Xiphoid process
2. Costal margin
3. Abdominal midline
4. Umbilicus
5. Rectus abdominis muscle
6. Ant superior iliac crest
7. Inguinal ligament
8. Symphysis pubis
Anatomy and Physiology
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Stomach
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J shaped, located in LUQ, under diaphram, R of spleen
reservoir for digestine (HCL acid + digestive enz)
liquefies foodstuff into chyme  duodeum for dig + absorption
capacity = 1-1.5L ,
Small intestine
– 30 ft convoluted loops
– extends form pyloric sphincter to ileocecal valve at lrg intestine
– 3 segments
– duodenum - digestion via common bile & pancreatic ducts
– jejunum - nutrient absorption occurs
– ileum - absorbs bile salts & Vit B12
Anatomy and Physiology
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Large intestine
– extends from ileocecal valve to anus
– 4 segments (ascending, transverse, descending, colon)
– forms stool & absorption of H20 & electrolytes
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Liver
– RUQ
– storage, detoxification & filtraton, metabolism, synthesis & secretion
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Gallbladder
– pear shaped sac under liver
– store & concentrate bile produced in liver
– contracts , releases bile into cystic ducts to common bile duct into
duodeneum
Anatomy and Physiology
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Pancreas
– URQ & ULQ of posterior abdominal wall
– exocrine gland= secrets Bicarbonate &pancreatic enz for digestion
– endocrine gland= secretes hormones (insulin, glucagon, gastrin)
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Spleen
– lymph organ in ULQ
– filters (old and deformed RBC/platelets)
– stores RBC for use in hemorrhage/exercise
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Vermiform appendix
– RLQ, fingerlike appendage
– often obstructs with content from cecum
Anatomy and Physiology
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Kidneys, ureters, and bladder
– kidneys = bean shaped, at T12 & T13 posteriorly
– Kidneys= rid body of waste products, maintain homeostasis via
acid base balance, fluid & electrolyte balance, arterial BP
– urine leaves kidneys via ureters to bladder =peristaltic wave
– Bladder = stores urine (200-400ml)
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Lymph nodes
– inguinal area = deep & superficial lymph nodes
– only superficial are palpable
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inguinal & popliteal nodes
Health History
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Patient profile
– Age
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Child to young adult: appendicitis
Adult: peptic ulcers, cholecystitis, diabetes
mellitus
– Gender
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Female: gallbladder disease
Male: GI cancers, cirrhosis, duodenal ulcers
Common Chief Complaints
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Nausea and vomiting
Diarrhea or constipation
Abdominal distension
Abdominal pain
Increased eructation or flatulence
Dysuria
Nocturia
Incontinence
Characteristics of
Chief Complaint
Quality
 Quantity
 Associated manifestations
 Aggravating factors
 Alleviating factors
 Setting
 Timing
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Past Health History
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Medical
– Abdomen specific
– Nonabdomen specific
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Surgical
– GI procedures
Common Medications
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Histamine-2 antagonists
PPI
Antibiotics
Lactulose
Antacids
Antidiarrheals
Laxatives or stool softeners
Antiemetics
Antiflatulents
Past Health History
Communicable diseases
 Allergies
 Injuries and accidents
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Family Health History
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Malignancies of stomach, liver,
pancreas, colon; peptic ulcer disease,
diabetes mellitus, irritable bowel
syndrome, colitis
Social History
Alcohol use
 Drug use
 Travel history
 Home and work environments
 Hobbies and leisure activities
 Economic status
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Health Maintenance Activities
Sleep
 Diet
 Exercise
 Stress management
 Use of safety devices
 Health check-ups
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Assessment of the Abdomen
Equipment
 Order ……NOTE CHANGE
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– Inspection
– ***Auscultation***
– Percussion
– Palpation
Inspection of Abdomen
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Observe for :
Contour
Symmetry
Rectus abdominis muscles
Pigmentation and color
Scars
Striae
Respiratory movement
Masses or nodules
Visible peristalsis
Pulsation
Umbilicus
Inspection of Abdomen
Normal Findings
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Abdomen is flat or round, symmetrical
Uniform in color and pigmentation
No scars or striae present
No respiratory retractions
No masses or nodules
Ripples of peristalsis may be visible
Nonexaggerated pulsation of the abdominal aorta may be
present
Umbilicus is depressed
Auscultation of Abdomen
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Bowel sounds
– Assess all four quadrants
– Listen for at least 5 minutes before
concluding bowel sounds are
absent
N = BS are heard in all quadrants
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Usually are high pitched
Occur 5 to 30 times per minute
Abnormal findings:
– Absent or hypoactive BS indicate 
motility and possible obstruction
– Hyperactive BS indicate  motility and
possible diarrhea, gastroenteritis
Auscultation of Abdomen
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Vascular sounds
– use bell over vascular landmarks
– listen for bruits
N = no audible bruits
Abnormal Finding : bruit present indicating
turbulent bld flow & parietal obstruction or
stenosis
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Venous hum
– listen for venous hum in all 4 Quads
N = not present
Abnormal Finding : continuous pulsating sound in
periumbilical area dt portal obstruction caused by
HPTN
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Friction rubs
– listen for rub over R & L costal margins, liver,
spleen
N= no rub heard (dt inflammation, tumors if heard)
Percussion
Percuss all four quadrants
 Assess liver span, liver descent, margins
of spleen, stomach, kidneys, liver,
bladder
 Sounds heard: tympany or dullness
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Percussion of Abdomen
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Percuss all four quads
N= Tympany heard over air-filled
areas, such as stomach and
intestines
N = Dullness heard over solid
areas, such as liver or a
distended bladder
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Abnormal Findings :
– Dullness over areas where
tympany is normally heard may
indicate a mass or tumor,
pregnancy, ascites, full intestine
Percussion of Abdomen
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Assess liver span
– percuss upwards from umbilicus to lower
border of liver on R midclavicular line
– mark where sound chgs
– percuss from lung to upper liver border R
midclavicular line
N= no tenderness, 6-12 cm btwn lines
or
– Scratch Test
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using stethoscope
Place stethoscope on R midclavicular line
and scratch RLQ q 1-2 cm towards
stethoscope …when you reach the lower
border the sound will be louder.
Abnormal Findings
– Liver span > 12 cm or < 6 cm
– May indicate hepatomegaly or cirrhosis
Percussion of Abdomen
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Percuss the Spleen
Percuss the lower level of the L lung posterior to the midaxillary line
Percuss downwards until dullness is heard
N= splenic dullness heard from the 6th to 10th rib
approx 6-8 cm above the L costal margin
Abnormal Findings:
Spleen dullness > 8 cm line
May indicate splenic enlargement
Percussion of Abdomen
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Percuss Stomach
– Percuss for gastric air bubble
– LUQ at L lower anterior rib cage and L
epigastric region
N = tympany of gastric bubble is lower in
pitch that of intestines
Fist Percussion
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Kidney
Direct method
 Indirect method
N= No tenderness
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Abnormal Findings:
– Costovertebral angle
tenderness may indicate
pyelonephritis
Fist Percussion
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Liver
Indirect method
 R lower rib cage
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N= No tenderness
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Abnormal Findings:
– Pain indicates cholecystitis or hepatitis
Percussion of Abdomen
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Bladder
– Percuss upwards from symphysis pubis to umbilicus
– Note sound changes form dullness to tympany
N =Urine filled bladder is dull to percussion
= Empty bladder is not percussable above the
symphysis pubis
Abnormal Findings:
Ability to percuss a recently emptied bladder may indicate
urinary retention
Palpation of Abdomen
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Palpate all 4 quadrants
Light vs. deep
N= No tenderness, Smooth with consistent softness, No muscle guarding
Abnormal Findings:
 Tenderness on palpation
 May indicate inflammation, masses, or enlarged organs
 Muscle guarding on expiration
 May indicate peritonitis
 Presence of masses, bulges, or swelling
 May indicate enlarged organs, cholecystitis, hepatitis, cirrhosis
Deep Palpation of Abdomen
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One hand Method
Bimanual Method
Assessing for Ascites
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Fluid Wave Test
Position pt supine
Firmly place ulnar side of
hand midline on abdomen
to prevent displacement of
fat
Place hand on pt’s R hip or
flank area
Deliver a blow to pt’s L hip
or flank area
N= no fluid wave felt
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Abnormal Findings:
– Presence of fluid wave =
ascites
Assessing the Liver
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Bimanual Method
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Hook Method
N= liver edge presents firm
sharp regular ridge
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Abnormal Findings:
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Liver is palpable below
costal margin
– May indicate CHF,
hepatitis, cirrhosis,
encephalopathy, cancer
– Enlrged liver
Assessing for Cholecystitis
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Murphy’s Sign
– Palpate below the liver margin at lateral border
– Have pt take deep breath
– N= no pain elicited
– Abnormal Finding:
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Pt stops inhaling to guard against pain indicates a
+ve Murphy’s sign = inflammation of gallbladder dt
cholecystitis
Assessing the Spleen
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Bimanual Method
– Reach over pt and place L
hand under rib cage, lift
upwards
– R hand deeply palpates
– Ask pt to take deep breath
N= the spleen is not palpable
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Abnormal Findings:
Spleen is palpable
– May indicate inflammation,
CHF, cancer, cirrhosis,
mononucleosis
Assessing the Kidneys
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Bimanual Method
N = kidneys are not
palpable
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Abnormal Findings:
Kidneys are palpable
– May indicate hydronephrosis,
neoplasms, polycystic kidney
disease
Palpation of the Arota
Press the upper abdomen
with one hand on either
side of the aorta
N= aorta width is 2.5-4 cm
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Abnormal Findings:
– Aorta width > 4 cm
May indicate abdominal
aortic aneurysm
Assessing for Abdominal Inflammation
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Rebound Tenderness
“Mc Burney’s Point”
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Apply firm pressure at 90°
in RLQ for 5 secs
Quickly release
N= no pain in McBurneys
point
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Abnormal Findings:
– Pain in RLQ indicates
appendicitis
Assessing for Appendicitis
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Rovsing’s Sign
– Press firmly in LLQ for 5 secs
– Note pts response
N= no pain elicited
– Abnormal Findings:
– Pain in RLQ indicates appendicitis
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+ve Rovsing’s Sign
Assessing the Bladder
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Deep palpation
Midline starting at symphysis
pubis upward to umbilicus
N = empty bladder is not palpable
Full bladder= smooth & round
Abnormal Findings:
 Able to palpate recently
emptied bladder
– May indicate urinary
retention
Assessing Lymph Nodes
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Pt supine , knees slightly flexed
Palpate lymph nodes in R & L inguinal area
N= palpable non- tender small, movable nodes <1cm in
diameter
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Abnormal Findings:
Palpable inguinal lymph nodes > 1 cm in diameter or
tender
– May indicate systemic infections, cancer
Gerontological Variations
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Abdominal musculature diminishes in mass and tone
Increased fat deposition in abdominal area
Altered GI motility results in changes in digestion
and absorption
Decreased secretion of gastric acid
Increased incidence of malignant disease
Changes in bowel habits