Abdominal Assessment Overview
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Questions and Answers

What is the primary function of the four layers of large flat muscles in the abdominal wall?

  • To facilitate digestion
  • To assist in respiration
  • To compress the stomach
  • To protect and hold the organs in place (correct)

    • Which of the following organs is considered solid and maintains its shape?

  • Gallbladder
  • Stomach
  • Spleen (correct)
  • Colon

    • Where is the gallbladder located in relation to the liver?

  • Medial to the liver
  • Behind the liver
  • Below and lateral to the liver (correct)
  • Above the liver

    • What is a common gastrointestinal change associated with aging?

    <p>Gallstones formation</p> Signup and view all the answers

    Which technique is performed second during an abdominal assessment?

    <p>Auscultation</p> Signup and view all the answers

    What is one of the recommended preparations to enhance abdominal wall relaxation during assessment?

    <p>Empty the bladder</p> Signup and view all the answers

    What should be assessed last during an abdominal assessment to ensure patient comfort?

    <p>Palpation of painful areas</p> Signup and view all the answers

    Which measurement indicates the positions of the aorta during an abdominal assessment?

    <p>Just left of the midline, bifurcating 2cm below the umbilicus</p> Signup and view all the answers

    What is the normal range of bowel sounds per minute?

    <p>5-30 sounds</p> Signup and view all the answers

    Which of the following techniques is used for assessing costovertebral angle tenderness?

    <p>Indirect fist percussion</p> Signup and view all the answers

    What sign indicates peritoneal irritation during abdominal examination?

    <p>Rebound Tenderness</p> Signup and view all the answers

    When performing deep palpation, how deep should the examiner press into the abdomen?

    <p>5-8 cm</p> Signup and view all the answers

    Which condition is indicated by an enlarged spleen that feels firm with sharp edges?

    <p>Cirrhosis</p> Signup and view all the answers

    What is the typical width of a normal aortic area when palpating for pulsation?

    <p>2-3 cm</p> Signup and view all the answers

    What abnormal finding is indicated by diminished bowel sounds?

    <p>Obstruction</p> Signup and view all the answers

    Which technique is recommended for light palpation of the abdomen?

    <p>Using four fingers in circular motion</p> Signup and view all the answers

    A patient who is tense or ticklish may exhibit which type of guarding during palpation?

    <p>Voluntary guarding</p> Signup and view all the answers

    What characteristic does ascites have when palpated?

    <p>Dullness over fluid</p> Signup and view all the answers

    Which of the following indicates involuntary rigidity during a palpation assessment?

    <p>Pain with increased intra-abdominal pressure</p> Signup and view all the answers

    What physical sign might indicate the presence of an aortic aneurysm during palpation?

    <p>A pulsating mass greater than 5 cm</p> Signup and view all the answers

    What outcome signifies a positive Murphy’s Sign during an abdominal exam?

    <p>Pain when the patient takes a deep breath</p> Signup and view all the answers

    Which finding is most characteristic of ascites during physical examination?

    <p>Everted umbilicus and taut skin</p> Signup and view all the answers

    What is the appropriate technique for assessing costovertebral angle tenderness?

    <p>Indirect fist percussion on the back</p> Signup and view all the answers

    Which condition is likely indicated by the palpation of a rounded, soft enlarged spleen?

    <p>Mononucleosis</p> Signup and view all the answers

    During which part of the abdominal assessment is involuntary guarding likely observed?

    <p>In cases of peritoneal inflammation</p> Signup and view all the answers

    Which sound is characterized as borborygmus in abdominal auscultation?

    <p>Loud gurgling noises during digestion</p> Signup and view all the answers

    What is an expected finding when palpating the aorta in a healthy individual?

    <p>Pulsation measured at the midline</p> Signup and view all the answers

    Which statement is true regarding the technique of light palpation?

    <p>Involves depressions of about 1 cm with circular motion</p> Signup and view all the answers

    What is the location of the pancreas in relation to other abdominal organs?

    <p>Behind the stomach in the RUQ</p> Signup and view all the answers

    Which of the following structures is located laterally to the left midaxillary line?

    <p>Spleen</p> Signup and view all the answers

    Which change is NOT typically associated with aging in relation to abdominal assessment?

    <p>Increased salivation</p> Signup and view all the answers

    What is the proper order of techniques during an abdominal assessment?

    <p>Inspection, auscultation, percussion, palpation</p> Signup and view all the answers

    How should the abdominal wall be prepared to enhance relaxation before assessment?

    <p>Ensure the bladder is empty</p> Signup and view all the answers

    Which organ is responsible for maintaining its shape and is classified as solid?

    <p>Liver</p> Signup and view all the answers

    Which area in the abdomen is the abdominal aorta located?

    <p>On the left side of the midline</p> Signup and view all the answers

    What preparation technique helps in enhancing abdominal wall relaxation?

    <p>Having the patient supine with knees bent</p> Signup and view all the answers

    What sign might indicate the presence of an enlarged uterus upon inspection?

    <p>Obvious abdominal bulge in midline</p> Signup and view all the answers

    What might cause a patient to have a dry mouth during an abdominal assessment?

    <p>Decreased salivation</p> Signup and view all the answers

    Study Notes

    Abdominal Assessment: Surface Landmarks

    • Diaphragm to the top of the pelvis
    • Vertebral column and paravertebral muscles (back)
    • Lower rib cage and abdominal muscles (side and front)
    • Four layers of large flat abdominal wall muscles
      • Protect and hold organs in place

    Abdominal Assessment: Structure & Function

    • Viscera
      • Solid Organs: Liver, pancreas, spleen, adrenal glands, kidneys, ovaries
        • Maintain shape
      • Hollow Organs: Stomach, gallbladder, small intestine, colon, bladder
        • Shape changes

    Abdominal Assessment: Structures

    • Liver: Mostly right upper quadrant (RUQ)
    • Stomach: Between the liver and spleen, just below the diaphragm
    • Gallbladder: Below the liver, just lateral to the right midclavicular line
    • Small Intestine: All four quadrants
    • Spleen: Lateral to the left midaxillary line, 9th-11th rib
    • Aorta: Just left of midline, bifurcates 2 cm below the umbilicus
    • Pancreas: Behind the stomach, RUQ
    • Kidneys: Costovertebral angle

    Abdominal Assessment: Structures & Function (Midline)

    • Aorta: Midline
    • Renal Artery: Midline
    • Uterus: Midline, if enlarged
    • Bladder: Midline, if distended

    Abdominal Assessment: The Aging Adult

    • Fat deposits
    • Decreased salivation
    • Dry mouth
    • Decreased taste
    • Delayed esophageal emptying
    • Decreased gastric acid secretion
    • Gallstone formation
    • Decreased blood flow to the liver
    • Constipation

    Abdominal Assessment: Subjective Data

    • Adult
      • Appetite
      • Dysphagia
      • Food intolerances
      • Pain
      • Nausea/Vomiting
      • Bowel habits
      • GI history
      • Medications
      • Nutrition
    • Older Adult
      • Groceries and meal preparation
      • Eating alone
      • Food diary
      • Bowel movements

    Abdominal Assessment: Objective Data - Preparation

    • Drape appropriately
    • Enhance abdominal wall relaxation:
      • Empty bladder
      • Keep room warm
      • Supine position: head on pillow, knees bent or on pillow, arms at side
      • Warm stethoscope and hands
      • Assess painful areas last

    Abdominal Assessment: Objective Data - Inspection

    • Contour: Shape of abdomen
    • Symmetry: Shine a light across the abdomen toward you; ask the patient to take a deep breath and assess again
    • Umbilicus: Normal location, contour, and any signs of hernia
    • Skin: Striae, nevi, scars, rashes, lesions
    • Peristalsis: Wavelike movements of the intestines usually not visible
    • Pulsations: Normal abdominal aorta pulsation may be visible

    Abdominal Assessment: Objective Data - Auscultation

    • Bowel Sounds:
      • Affected by time since last meal
      • 5-30 sounds per minute (normoactive)
      • Hypoactive: slowed or diminished
      • Hyperactive: increased sounds
      • Borborygmi: loud, gurgling sounds
      • Absent bowel sounds: no sound after listening for 5 minutes
    • Vascular Sounds:
      • Aorta, renal arteries, iliac arteries, femoral arteries
      • Bruits: blowing, swooshing sound indicating turbulent blood flow through narrowed arteries

    Abdominal Assessment: Objective Data - Percussion

    • Splenic Dullness: 9th-11th intercostal space just behind the left midaxillary line
    • Costovertebral Angle Tenderness:
      • Patient sitting up
      • Indirect fist percussion: Place non-dominant hand over the 12th rib at the costovertebral angle on the back, thump the hand with the ulnar edge of the other fist
      • Pain may indicate kidney inflammation or infection

    Abdominal Assessment: Objective Data - Palpation

    • Palpation Purpose: Helps judge size, location, and consistency of underlying organs, assess for masses and tenderness
    • Relaxation: Encourage relaxation for accurate assessment
    • Light Palpation: Use four fingers, depress about 1 cm, circular motions
    • Deep Palpation: Similar technique as light palpation, but push down 5-8 cm
    • Obese Abdomen: Use bimanual technique
    • Note: Location, size, consistency, and mobility of any palpable organs, any enlargement, tenderness, or masses

    Abdominal Assessment: Palpation - Liver

    • Left hand under the patient's right back, parallel to the 11th and 12th ribs
    • Right hand on RUQ, fingers parallel to the midline
    • Push down and under the right costal margin
    • With the patient breathing slowly, move the right hand up 1-2 cm with each exhalation
    • The edge of the liver may be felt with the fingertips

    Abdominal Assessment: Palpation - Aorta

    • Palpate on the upper abdomen slightly left of midline
    • Area of 2.5-3 cm
      • Wider area may suggest an aneurysm
    • Use thumb and fingers to palpate the aortic pulsation

    Abdominal Assessment: Palpation - Rebound Tenderness

    • Used when the patient complains of abdominal pain and/or tenderness with palpation
    • Hold your hand 90° to the abdomen (McBurney Point)
    • Push down slowly and deeply and lift up quickly
    • Pain indicates peritoneal irritation

    Abdominal Assessment: Palpation - Inspiratory Arrest

    • Hold fingers under the liver border
    • Ask the patient to take a deep breath
    • Pain indicates cholecystitis (gall bladder inflammation)

    Abdominal Assessment - Ascites

    • Everted umbilicus
    • Taut, glistening skin
    • Diminished bowel sounds over the fluid
    • Dullness over the fluid
    • Limited palpation

    Abdominal Assessment - Aortic Aneurysm

    • Most are located below the renal arteries and extend to the umbilicus
    • Pulsating mass greater than 5 cm
    • Auscultate for a bruit
    • Femoral pulses present but decreased

    Abdominal Assessment - Enlarged Spleen

    • Enlarges down and toward the midline
    • Mononucleosis: Enlarged, soft, and rounded edge
    • Chronic Cause (cirrhosis): Firm with sharp edges
    • Usually not tender unless the peritoneum is inflamed
    • The spleen needs to be three times its normal size to be palpable

    Abdominal Assessment

    • Abdominal assessment is performed to assess the organs within the abdominal cavity
    • Abdominal cavity is located between the diaphragm and the top of the pelvis

    Surface Landmarks

    • The abdominal wall is formed by four layers of large flat muscles that protect and hold the organs in place
    • The abdominal wall has the following landmarks:
      • Vertebral column and paravertebral muscles (back)
      • Lower rib cage and abdominal muscles (side and front)

    Structures & Function

    • The abdominal cavity contains both solid and hollow viscera
    • Solid viscera maintain their shape and include: Liver, pancreas, spleen, adrenal glands, kidneys, and ovaries
    • Hollow viscera change in shape and include: Stomach, gallbladder, small intestine, colon, and bladder

    Structures

    • Liver: Mostly located in the right upper quadrant (RUQ)
    • Stomach: Between the liver and spleen just below the diaphragm
    • Gallbladder: Located below the liver, just lateral to the right midclavicular line
    • Small intestine: Located in all four quadrants
    • Spleen: Located lateral to the left midaxillary line, between the 9th and 11th rib
    • Aorta: Located just left of midline, bifurcates 2 cm below the umbilicus
    • Pancreas: Located behind the stomach in the RUQ
    • Kidneys: Located at the costovertebral angle

    Midline Structures

    • Aorta: Located along the midline, just left of the midline
    • Renal Artery: Located along the midline
    • Uterus: Located along the midline, if enlarged
    • Bladder: Located along the midline, if distended

    The Aging Adult

    • Fat deposits are often present in the abdomen of the aging adult
    • Decreased salivation and a dry mouth are common in aging adults, which can lead to decreased sense of taste
    • The esophagus slows down in aging adults, making it take longer for food to empty from the stomach
    • Decreased gastric acid secretion in aging adults can impair digestion
    • Aging adults are at increased risk for gallstone formation
    • Blood flow to the liver is decreased with age
    • Constipation is a common problem in aging adults

    Subjective Data

    • Obtain subjective data from the patient using specific questions
    • Questions to ask an adult:
      • Appetite
      • Dysphagia (difficulty swallowing)
      • Food intolerance
      • Pain
      • Nausea/Vomiting
      • Bowel habits
      • GI history
      • Medications
      • Nutrition
    • Questions to ask an older adult:
      • Groceries and meal preparation
      • Eating alone
      • Food diary
      • Bowel movements

    Objective Data

    • The abdominal assessment includes four components: Inspection, Auscultation, Percussion, and Palpation
    • Performing the abdominal assessment requires proper preparation:
      • Drape the patient appropriately
      • Ensure patient's bladder is empty
      • Keep the room warm
      • Position the patient supine with their head on a pillow, knees bent or on a pillow, and arms at their side
      • Warm the stethoscope and hands
      • Assess painful areas last

    Inspection

    • Visual assessment of the abdomen
    • Assess the following:
      • Contour
      • Symmetry: Shine a light across abdomen toward you, lengthwise and ask the patient to take a deep breath and assess again
      • Umbilicus
      • Skin: Inspect for striae (linea albicantes), nevi, scars, rashes, and lesions
      • Peristalsis -Pulsations

    Auscultation

    • Auscultation is the second component of the abdominal assessment, and it is performed before percussion and palpation to minimize bowel sounds
    • Start auscultation in the right lower quadrant (RLQ) as this is a common location of bowel sounds
    • Assess bowel sounds:
      • Normoactive: 5-30 sounds per minute
      • Hypoactive: Decreased bowel sounds
      • Hyperactive; Increased bowel sounds
      • Borborygmi: Loud, gurgling bowel sounds
      • Absent bowel sounds: No bowel sounds heard after 5 minutes
    • Bowel sounds can be affected by the time elapsed since eating
    • Vascular sounds (bruits) should be listened for in the following locations:
      • Aorta
      • Renal Arteries
      • Iliac Arteries
      • Femoral Arteries

    Percussion

    • Percussion helps to assess the density of abdominal contents, detecting fluid, air, or solid masses
    • Specific percussion techniques:
      • Splenic dullness: Percuss for dullness in the 9th-11th intercostal space just behind the left midaxillary line
      • Costovertebral angle tenderness:
        • Patient should be sitting up
        • Perform indirect fist percussion over the costovertebral angle on the back
          • Place non-dominant hand over the 12th rib at the costovertebral angle
          • Thump that hand with the ulnar edge of your other fist
        • Pain is abnormal.

    Palpation

    • Palpation helps to assess the size, location, and consistency of underlying organs
    • Palpation is also used to assess for masses and tenderness
    • Important to ensure patient relaxation during palpation
    • Never perform deep palpation of an enlarged or tender liver or spleen due to the risk of causing organ rupture

    Light Palpation

    • Use four fingers
    • Depress about 1 cm
    • Perform circular motion
    • Palpate painful areas last
    • Assess for:
      • Skin surface
      • Superficial abdominal muscles

    Voluntary Guarding

    • May occur when the patient is cold, tense, or ticklish
    • Bilateral guarding is usually relaxed slightly with exhalation
    • Voluntary guarding is not a sign of inflammation or peritoneal irritation

    Involuntary Rigidity

    • Occurs from peritoneal inflammation
    • May be unilateral
    • Pain with increased intra-abdominal pressure

    Deep Palpation

    • Same technique as light palpation except push down 5-8 cm
    • For obese patients, use a bimanual technique
    • Note:
      • Location
      • Size
      • Consistency
      • Mobility of any palpable organs
      • Enlargement
      • Tenderness
      • Masses

    Palpation of the Liver

    • Place your left hand under the patient’s right back, parallel to the 11th and 12th ribs
    • Place your right hand on the RUQ, fingers parallel to the midline
    • Push down and under the right costal margin
    • With the patient breathing slowly, move your right hand upward 1-2 cm with each exhalation
    • The edge of the liver may be felt with the fingertips

    Palpation of the Aorta

    • Palpate just above the umbilicus slightly left of midline
    • The normal width of the aorta is 2.5-3 cm
    • If wider than 3 cm, suspect an aneurysm
    • Palpate the aortic pulsation between your thumb and fingers

    Rebound Tenderness (Blumberg Sign)

    • Perform if the patient complains of abdominal pain and/or tenderness with palpation
    • Hold your hand 90° to the abdomen (McBurney Point)
    • Push down slowly and deeply and lift up quickly
    • Pain is a sign of peritoneal irritation and inflammation

    Inspiratory Arrest (Murphy’s Sign)

    • Hold your fingers under the liver border
    • Ask the patient to take a deep breath
    • Pain is a sign of cholecystitis (gallbladder inflammation)

    Ascites

    • Inspection of the abdomen may show the following signs of ascites:
      • Everted umbilicus
      • Taut glistening skin
    • Auscultation of the abdomen with ascites may show:
      • Diminished bowel sounds over fluid
    • Percussion of the abdomen with ascites may show:
      • Dullness over fluid
    • Palpation of the abdomen with ascites may show:
      • Limited palpation

    Aortic Aneurysm

    • Most aneurysms are located below the renal arteries and extend to the umbilicus
    • A pulsating mass greater than 5 cm may indicate an aneurysm
    • Auscultate for a bruit
    • Femoral pulses are present but decreased

    Enlarged Spleen

    • An enlarged spleen will enlarge toward the midline
    • In mononucleosis, the spleen is enlarged, soft, and rounded
    • In chronic causes (cirrhosis), the spleen will be firm with sharp edges
    • An enlarged spleen is usually not tender unless the peritoneum is inflamed
    • The spleen needs to be 3 times its normal size to be palpable.

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    Abdominal Assessment PDF

    Description

    Explore the key surface landmarks, structures, and functions of the abdominal assessment. This quiz will cover the organization of solid and hollow organs, as well as their anatomical locations. Gain a deeper understanding of the abdominal cavity and its components.

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