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Abdominal Assessment

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Title: Abdominal Assessment


1
Abdominal Assessment
  • Week 8

2
Surface Landmarks of the Abdomen
3
Internal Anatomy of the Abdomen
4
Related Organs in the Abdominal Cavity
5
Costovertebral Angle
6
Four Quadrants of the Abdomen
Figure 19-6. p. 585.
7
Transcultural Considerations
  • Lactase digestive enzyme necessary to absorb
    carbohydrate lactose (milk sugar)
  • 70 - 90 blacks, Native Americans, Asians,
    Mediterranean groups have declining activity of
    lactase by adulthood
  • Only 15 of North Americans Northern Western
    Europeans are lactose intolerant.

8
Subjective Data Collection
  • Appetite
  • Dysphagia
  • Food intolerance
  • Abdominal pain
  • Nausea/vomiting.
  • Bowel habits
  • Past abdominal history
  • Medications
  • Nutritional assessment.

9
Preparation for Physical Exam
  • Strong overhead light secondary stand light
  • Proper draping
  • Promote abdominal wall relaxation
  • Empty bladder
  • Room warm
  • Position person supine, head on pillow, knees
    bent, arms at sides or on chest
  • Warm stethoscope hands, fingernails short
  • Ask about any painful areas before you start
    leave till end of exam
  • Learn to use distraction.

10
Inspection
  • Contour
  • Symmetry
  • Umbilicus
  • Skin
  • Pulsation movement
  • Hair distribution
  • Demeanour.

11
Auscultate Bowel Sounds
  • Caused by air fluid moving through small bowel
  •  Use diaphragm hold lightly against skin
  • Begin at RLQ move in clockwise direction  
  • Note character frequency
  • Heard irregularly 5 to 30 times per minute
    dont count, judge if normal, hypoactive or
    hyperactive
  • Stomach growling borborygmus
  •  Perfectly silent abdomen is uncommon listen
    for 5 minutes by watch before deciding bowel
    sounds are completely absent.

12
Auscultate Vascular Sounds
13
Percussion
  • Done to assess density of abdominal contents to
    locate organs screen for abnormal fluid/masses
  • Percuss lightly over 4 quadrants 1st, to
    determine prevailing tympany
  • Percuss organ boundaries
  • Liver span hepatomegaly?
  • Splenic dullness splenomegaly?
  • Costovertebral angle tenderness assesses kidney
  • Fluid wave/Shifting dullness.

14
Percuss 4 Quadrants
Figure 19-13. p. 596.
15
Liver Span
  • Measure Liver Span

13
Figure 19-15. p. 597.
16
Costovertebral angle tenderness
13
Figure 19-18. p. 599.
17
Fluid Wave test for ascites
Figure 19-19. p. 600.
18
Shifting Dullness test for ascites
  • Percuss for Shifting Dullness

Figure 19-20. p. 600.
19
Palpation
  • Judge size, location consistency of certain
    organs screen for abnormal mass or tenderness
  • Promote relaxation of abdominal musculature,
    similar measures as before plus
  • Bend persons knees
  • Keep palpating hand low parallel to abdomen
  • Teach client to breathe slowly
  • Keep own voice low soothing conversation may
    help
  • Try emotive imagery
  • If person ticklish keep their hand under your own
    or palpate after auscultation use stethoscope.

20
Light Deep Palpation
  • Light palpation 1st, obtain overall impression of
    skin surface, superficial musculature, get client
    use to being touched
  • Assess involuntary rigidity (constant board-like
    hardness) vs voluntary guarding
  • Gentle rotary motion, lift fingers to move to new
    area
  • Clockwise coverage
  • Deep organ palpation - same general technique but
    push down about 5 8 cm (2 3) .

21
Normally Palpable Structures
22
If identify a mass note
  • Location
  • Size
  • Shape
  • Consistency
  • Surface (smooth, nodular)
  • Mobility
  • Pulsatility
  • Tenderness.

23
Liver Palpation
Figure 19-26. p. 604.
24
Spleen Palpation
Figure 19-28A. p. 605.
25
Right Kidney Palpation
Figure 19-29A. p. 606.
26
Left Kidney Palpation
Figure 19-29B. p. 606.
27
Aorta
  • Use opposing thumb fingers palpate aortic
    pulsation in upper abdomen slightly to the left
    of midline
  •  Normally 2.5 to 4 cm wide in adult pulsates in
    anterior direction.

28
Special Procedures
  • Rebound Tenderness insert hand at 90 degree
    angle slowly and deeply, lift up quickly
    shouldnt hurt
  • Inspiratory Arrest (Murphys sign) - Hold fingers
    under liver border, have client take deep breath,
    normal response is to finish breath without pain.

29
Special Procedures (cont.)
  • Iliopsoas Muscle Test test for appendicitis
    person supine, lift R leg straight up, flexing at
    hip, push down over lower part of right thigh as
    person tries to hold leg up shouldnt hurt
    (Fig. 21-32)
  • Obturator test also to test for appendicitis -
    person supine, lift R leg, flexing at hip 90
    degrees at knee, hold ankle rotate the leg
    internally externally should not hurt. (Fig.
    21-33)

30
Dev. Considerations of Aging Adult
  • Fat accumulates
  • Abdominal musculature relaxes
  • Salivation decreases
  • Esophageal emptying is delayed - ? risk
    aspiration
  • Gastric acid secretion decreases with aging
  • Incidence of gallstones increases with age
  • Liver size ? - Blood flow ? 55 60
  • Increased risk of constipation
  • Because of thinner abdominal walls easier to
    palpate organs - normally feel liver edge
    kidneys easier to palpate .

31
Supporting Lab Work
  • Stool
  • C S
  • Occult blood
  • Ova parasites
  • X-rays
  • abdomen
  • Barium swallows or enemas
  • IVPs
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