Transcript Abdominal Assessment

Abdominal
Assessment
Lisa Pezik, RN, BScN
Clinical Educator
Objectives
 Review basic anatomy of the abdominal system.
 Discuss assessment techniques.
 Critically think through common problems.
 Discuss treatment plans for these problems.
GI System
 Gastrointestinal System
 30 Feet Long
 Muscles, vessels, organs
 From mouth to anus
 Turns food into energy, growth, cell repair
 Hormones of digestion
 Gastrin
 Secretin
 Cholecystokinin
 Gastric inhibitory peptide
Hormones
Digestion
Outside Muscles
Inside Muscles
 Muscles
 Support the abdominal cavity
 Protect organs
 Weakness leads to:
 Hernias
 Distention
 Postural problems
 Back pain
 Risk of Falls
Vessels
 Arteries carry oxygenated blood away from the heart.
 Veins carry de-oxygenated blood to the heart.
Organs


Upper GI

Esophagus

Pancreas

Gallbladder

Stomach

Spleen

Liver

Duodenum
Lower GI

Small Intestine

Large Intestine

Appendix
Functions of The Organs
 Esophagus
 Carries liquids and saliva to the stomach
 Pancreas
 Digestive enzymes to control insulin and glucagon
 Stomach
 Secretes enzymes to digest food
 Muscles churn to process food
 Pyloric sphincter pushes food to the small intestine
Functions of the Organs
 Spleen

Stores and produces lymphocytes to aid immunity
 Gallbladder

Aids in fat digestion and stores bile
 Liver

Bile production

Immune functions

Blood clotting

Stores sugar

Metabolizes drugs
Functions of the Organs



Small intestine

Chemical digestion occurs

Absorbs nutrients

21 feet long
Large intestine

Absorbs water and lubricates contents

Neutralizes acids and bacteria

5 feet long
Appendix

4 inches long

Junction of small and large intestine

Stores good bacteria in the gut?
Assessment Basics
 Inspection
 Auscultation
 Percussion
 Palpation
Inspection and Palpation
 Look for distention or un-evenness of the umbilicus
 Palpate 1cm for any painful areas
 Measure abdominal growth if applicable
Organs Per Quadrant
Auscultation
 Where to begin

Start in RUQ and listen 2 minutes in each quadrant

Absent, hypo/hyper/normoactive
 Normal sounds in the small intestine

High pitched and gurgling
 Normal sounds in the large intestine

Low pitched and rumbling
 Normal Rate

5-35 sounds a minute
Percussion
 Percuss all quadrants for dullness
 Percuss for tympany
 Low drum like sound caused by gas
 Percuss for hyper-ressonance
 Increased lower pitch due to distended bowel
 Percuss bladder volume
 Fullness causes pressure upwards
Interpretation of Results
Constipation
 Mild Concern
 Inability to pass stool, hard stool, or self impaction
 Complaints of fullness
 Can cause hemorrhoids
Constipation
 Moderate Concern
 Leaking, small stools
 Cramping, bloating
 Straining
 Blood tinged stool
 Vomiting
 Fecal impaction
 A large lump of dry stool
 Caused by chronic constipation
Stool
Constipation
 Severe Concern
 Bowel Obstruction
 Complete blockage of the small and large intestines
 Distended tympanic abdomen
 Tachypnea, Tachycardia, Low BP
 Cramping, Pain, Tenderness
 Vomiting
 Diarrhea
 Bloody Stools
 Absent or hyperactive bowel sounds
Small Bowel Obstruction
Large Bowel Obstruction
Ascites
 Build up of fluid in the abdomen
 High pressure in the blood vessels of the liver
 Low levels of albumin
 Caused by:
 Cancer
 Liver failure
 Pancreatitis
 CHF
 Portal Vein Thrombosis
Peritonitis
 Inflammation of the peritoneum causing severe pain
Points to Ponder
 Pain = Inflammation
 Dullness with percussion = Fullness of normal OR
abnormal structure
 Crepitus = Diverticulitis or organ perforation
 Bruising = Hemorrhage or injury
Questions?