Abdominal Assessment Second Half

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Abdominal AssessmentSecond Half
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Age Condition

• Infants
• Children
• Pregnancy
• Older Adult

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Pyloric Stenosis
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Intussusception
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Hirshprung
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Abdominal Exam

• Landmarks
• Four quadrants
• Nine abdominal areas

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Inspection

• General
• Respiratory
• Skin
• Hands
• Feces

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Inspection

• Abdomen
• Fs
• Fat
• Fluid
• Feces
• Fetus
• Fibroid
• Fatal Tumor
• Hernias

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Inspection

• Hernias
• Superficial Veins
• Symmetry
• Scars

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Auscultation

• Bowel sounds
• Distention sounds
• Peritoneal rubs
• Bruits

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Bruits

• A - Aorta
• R - Renal
• I - Iliac
• F - Femoral

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Percussion

• All quadrants
• Liver
• Spleen
• Kidneys
• Other
• Ascities

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Percussion

• Tympany
• Hyperessonance
• Resonance
• Dullness

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Palpation

• Away from pain
• Light then deep
• Size shape
• Mobility consistency
• Tension

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Abdominal Organs

• Liver
• Gallbladder
• Spleen
• Aorta
• Abdominal reflexes

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Rectal Exam
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Special Techniques
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Pain

• Acute
• Sub acute
• Location

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Substernal

• Esophagus
• Cardiac

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Shoulder

• Diaphragm
• Subphrenic abscess

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Epigastric

• Stomach
• Duodenum
• Gallbladder, bile ducts
• Liver
• Pancreas

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Right Scapula

• Biliary tract
• Aorta
• Pancreas

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Midback

• Aorta
• Pancreas

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Hypogastrium

• Colon

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Sacrum

• Rectum

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Ectopic Pregnancy
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Peritoneal Irritation

• Abdominal rigidity
• Tenderness guarding
• Absent bowel sounds
• Positive obturator test
• Positive iliopsoas test

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Peritoneal Irritation

• Rebound tenderness (Blumberg sign)
• Abdominal pain on walking
• Positive heel jar (Markle sign)
• Positive Rovsing sign (LLQ pressure/RLQ pain

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Tests to consider

• CBC Differential
• UA
• Pregnancy
• Stool for WBC, culture, O P, H H, fat
• Liver chemistries
• Sedimentation Rate

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Tests

• Sed rate
• Serum Amylase Lipase
• Electrolytes
• Radiology

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Case Examples
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Case 1

• Epigastric pain 2 hours after eating

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Case 2

• Vomiting Diarrhea
• Abdominal cramping pain

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Case 3

• Periumbilical pain

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Case 4

• Abdominal pain
• Radiates to left shoulder