Chapter 22 - Abdomen

• Study notes on the abdomen, including pathophysiology, structures, assessment, and health promotion

Abdominal Structures and Quadrants

• Right Upper Quadrant (RUQ) contains the liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal gland, hepatic flexure of colon, and parts of the ascending and transverse colon
• Left Upper Quadrant (LUQ) contains the stomach, spleen, left lobe of the liver, body of the pancreas, left kidney and adrenal gland, splenic flexure of the colon, and parts of the transverse and descending colon
• Right Lower Quadrant (RLQ) contains the cecum, appendix, right ovary and fallopian tube, right ureter, and right spermatic cord
• Left Lower Quadrant (LLQ) contains part of the descending colon, sigmoid colon, left ovary and fallopian tube, left ureter, and left spermatic cord

Subjective Data Collection

• Changes in appetite or difficulty swallowing
• Food intolerances, abdominal pain, nausea, or vomiting
• Frequency of bowel movements and any past GI disease
• Current medications and a 24-hour food recall

Objective Data Collection

• Have the patient empty their bladder before starting the assessment
• Position the person supine with a pillow under their head and knees, and arms at their sides or across the chest

Inspection

• Contour: Note if the abdomen is flat, scaphoid (caved in), rounded, or protuberant (distended)
• Symmetry: Check for localized bulging, visible masses, or asymmetric shape, which may indicate a hernia or enlarged organs
• Skin: Observe for striae (stretch marks), pigmented nevi (moles), and surgical scars
• Pulsation or movement: Note any pulsations from the aorta in the epigastric area, especially in thin individuals
• Hydration and Nutrition: Assess skin turgor for adequate hydration
• Facial Expression: Note the patient’s facial expression and position in bed

Auscultation

• Begin in the RLQ and move clockwise, unless the patient indicates pain that is in another area
• Bowel Sounds: Assess character and frequency
• Normal bowel sounds: High-pitched, gurgling, cascading, occurring irregularly from 5 to 30 times per minute
• Hyperactive bowel sounds (borborygmus): Loud, high-pitched, rushed, tinkling sounds occurring more than 30 times per minute, indicating increased motility
• Hypoactive bowel sounds: Decreased motility, occurring less than 5 times per minute
• Absent bowel sounds: Listen for 5 minutes to confirm absence
• Vascular Sounds (Bruits): Use the bell of the stethoscope over the aorta, renal arteries, iliac, and femoral arteries, especially in hypertensive patients

Percussion

• Percuss lightly in all four quadrants to determine tympany and dullness
• Tympany: Predominates due to air in the intestines
• Dullness: Indicates a distended bladder, adipose tissue, fluid, or a mass
• Hyperresonance: Present with gaseous distention
• Ascites: Free fluid in the peritoneal cavity, associated with cirrhosis, tumors, heart failure, hypertension, hepatitis, pancreatitis, and cancer

Palpation

• Light Palpation: Depress the skin about 1 cm with the first four fingers to assess size, location, and consistency of organs, and to screen for abnormal masses or tenderness
• Deep Palpation: Advanced technique, pushing down about 5 to 8 cm to assess organs

Urgent Abdominal Assessments

• Rebound Tenderness: Pain upon release of pressure, indicating peritoneal inflammation
• Inspiratory Arrest (Murphy Sign): Pain during palpation of the liver border while the person takes a deep breath, suggesting cholecystitis (gallbladder inflammation)
• McBurney Point Tenderness: Pain located 1.5 to 2 inches from the ileum along a line from the anterior superior spinous process to the umbilicus, indicating appendicitis
• Iliopsoas Muscle Test: Pain in the RLQ when lifting the right leg straight up and pushing down over the lower thigh, indicating inflammation of the iliopsoas muscle

Stool Characteristics

• Hard, separate lumps: Constipation
• Fluffy, ragged edges (mushy) or liquid: Diarrhea
• Brown stool: Normal
• Light-colored stool: Lack of bile, pancreatic or liver disease
• Yellow stool: Fat in stool, malabsorption issues
• Green stool: Excess bile or dietary changes, diarrhea
• Bright red stool: Bleeding in the lower GI tract
• Black or dark-colored stool: Bleeding in the upper GI tract

Charting Stool Output

• Note the time, amount (small, medium, large), color, consistency, shape, and source

Developmental Considerations

Infants

• Protuberant abdomen due to immature abdominal musculature
• Inspect the umbilical cord, should have 2 arteries and 1 vein
• Monitor the umbilical cord for infection
• Umbilical hernias are common, usually disappearing by age 1
• Diastasis recti (separation of rectus muscles) is common in Black infants and usually disappears by early childhood
• Newborn’s first stool is greenish-black meconium within 24 hours of birth

Child

• Abdomen looks protuberant until age 4
• Use objective signs to assess pain, such as changes in cry, grimacing, moving away, and guarding

Pregnancy

• Symptoms include nausea, vomiting, reflex, and constipation

Aging Adult

• Salivation decreases, causing dry mouth and decreased taste
• Esophageal emptying is delayed
• Gastric acid secretion decreases
• Incidence of gallstones increases, especially in females
• Liver size decreases, but most liver functions remain normal
• Increased abdominal subcutaneous fat deposits

Health Promotion and Risk Reduction

• Primary prevention involves risk-factor modification through lifestyle changes
• Routine screening for colorectal cancer starting at age 45

Study notes covering the abdomen, including its structures, pathophysiology, assessment techniques, and strategies for health promotion. Key areas covered are abdominal quadrants and subjective data collection. Focus is on understanding anatomy, recognizing abnormalities, and promoting abdominal health.