Assessment Of Abdomen PDF Fall 2024/25

ASSESSMENT OF ABDOMEN AUTHOR Mr. Hamza Chehade PRESENTER Mr. Hamza Chehade COLLEGE College of Health Sciences PROGRAMME Nursing SEMESTER Fall 2024/25 11 Course Outcomes (From Course Specification) A1 - Dis...

ASSESSMENT OF ABDOMEN AUTHOR Mr. Hamza Chehade PRESENTER Mr. Hamza Chehade COLLEGE College of Health Sciences PROGRAMME Nursing SEMESTER Fall 2024/25 11 Course Outcomes (From Course Specification) A1 - Discuss the concept of health assessment and its type A2 - Identify the steps used in performing selected examination procedures B1 - Perform comprehensive health assessment correctly and confidently B2 - Apply appropriate sequencing in conducting a physical health examination in an systematic manner. C1 - Analyze the relationship of nursing process health assessment and its implication in comprehensive health assessment C2 - Select examination techniques appropriate for clients of different ages. D1- Reflect on social and ethical responsibilities required to function as a professional. D2 - Demonstrate good understanding of the values and ethics of the profession 2  Learning Objectives On completion of the session, students will be able to: Review the anatomy and physiology of the digestive system. Identify the equipment needed to assess the abdomen. Apply various techniques used to assess the abdomen. Identify the normal observations during an abdominal assessment. Distinguish abnormal observations in an abdominal assessment. Relate abnormal observations with the related disorder. Document the observations made during the abdominal assessment. 1  Anatomy and Physiology- Digestive System https://www.youtube.com/watch?v=i5MH6ddyi74 2  Common client complaints ▪ Appetite ▪ Presence of dysphagia ▪ Food intolerance ▪ Abdominal pain ▪ Nausea ▪ Vomiting ▪ Bowel habits (any diarrhea or constipation) ▪ Past history of abdominal diseases 4  Components and techniques of abdominal assessment 1. General appearance 2. Inspection 3. Auscultation 4. Percussion 5. Palpation 5 Exam of the Abdomen Think Anatomically: ▪ Abdominal Quadrant Approach: Examine the abdomen using a four-quadrant system (RUQ, RLQ, LUQ, LLQ). ▪ Anatomical Awareness: Visualize the organs located within each quadrant during inspection, auscultation, palpation, and percussion. ▪ Differential Diagnosis: Knowing organ location aids in identifying normal findings and potential pathologies. Quadrants of the Abdomen 7 Topical Anatomy of the Abdomen 8  1. General appearance Abnormal Observations Restlessness and constant turning with colicky pain (sharp, localized gastrointestinal or urinary pain that can arise abruptly, and tends to come and go in spasm like waves) Absolute stillness. Knees flexed up, facial grimacing, and rapid, uneven respirations also indicate pain. 6  2. Abdomen- Inspection Normal Findings Abnormal Observations Normal contour/ shape is rounded or flat. Scaphoid abdomen caves Look for symmetry in. Protuberant abdomen indicates abdominal distension. Hernia- protrusion of abdominal viscera through abnormal opening in the muscle wall. Bulging Visible mass 7 Asymmetric shape.  2. Abdomen- Inspection Normal Findings Umbilicus is midline, inverted, Abnormal Observations without discolouration, inflammation or hernia. Everted with ascites or underlying mass. Umbilicus becomes everted and pushed upward with Deeply sunken with obesity pregnancy. Enlarged, everted with umbilical hernia. Bluish periumbilical colour occurs with intraperitoneal bleeding (Cullen Sign). 8  2. Abdomen- Inspection Normal Findings Abnormal Observations Redness indicates localized Smooth and even skin surface. inflammation. No surgical scars Striae, glistening & taut skin- Normal Skin turgor ascites. Respiratory movements Surgical scar -possible adhesions, & excess fibrous tissue. Spider angiomas -liver disease. Decreased skin turgor 9 Abnormalities on Inspection 13 Obese abdomen Hepatomegaly Markedly enlarged gall bladder Ascites Umbilical Hernia 14  2. Abdomen- Inspection Normal Findings Abnormal Observations Peristaltic waves Marked pulsation of aorta occurs with widened pulse pressure Aortic pulsation (hypertension, aortic aneurysm). Marked visible peristalsis together with a distended abdomen indicates intestinal obstruction. 10 3. Abdomen- Auscultation (Bowel sounds) Normal Findings Abnormal Observations Diaphragm of the Hyperactive sounds- loud, stethoscope- Begin at the high pitched, rushing, tinkling RLQ sounds that signal increased Bowel sounds are high motility. pitched, gurgling, cascading Hypoactive or absent sounds- sounds, occurring irregularly after abdominal surgery or from 5 to 30 times per with peritonitis. minute. Hyperperistalsis due to hyperactive bowel sound (borborygmus) 11 Auscultate the abdomen for vascular sounds with the bell of the stethoscope. Using firm pressure, listen over the aorta, as shown, as well as over the renal, iliac, and femoral arteries. 17 3. Abdomen- Auscultation(Vascular sounds) Normal Findings Abnormal Observations No vascular sounds or bruits A systolic bruit is a pulsatile over the aorta, renal arteries, blowing sound and occurs ileac and femoral arteries. with stenosis, partial occlusion About 4-20% of healthy or aneurysm of an artery. people may have a normal bruit originating from the celiac artery, which is systolic, medium to low in pitch, heard between xiphoid process and the umbilicus. 12 19  4. Abdomen- Percussion Normal Findings Abnormal Observations Move clockwise, all 4 Dullness- distended bladder, quadrants -determine the adipose tissue, fluid or mass existing tympany & dullness.. Hyperresonance is present with Tympany should predominate gaseous distension. Shifting dullness Ascites -heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, cancer. Test for a fluid wave The blow will generate a fluid wave through the abdomen if ascites is present. A distinct tap will also be felt in the left hand (examiner). 13 Drum and Humdrum! Normally, two sounds can be heard during percussion of the abdomen: TYMPANY AND DULLNESS. TYMPANY—a clear, hollow sound similar to a drum beating—occurs when you percuss over hollow organs such as an empty stomach or bowel. The degree of tympany depends on the amount of air present and gastric dilation. When you percuss over solid organs, such as the liver, kidney, or feces-filled intestines, the sound changes to DULLNESS. Abdominal Percussion 21  5. Abdomen-Percussion Normal Findings Abnormal Observations To assess the Kidney -place Costovertebral angle one hand over the 12th rib at tenderness the costovertebral angle on the back. Thump that hand Sharp pain -inflammation of with the ulnar edge of the the kidney or paranephric area. other fist. The person normally does not feel pain, but feels a thud. 17 STOP! Don’t percuss if the patient has an abdominal aortic aneurysm or a transplanted abdominal organ. Doing so can precipitate a RUPTURE OR ORGAN REJECTION. 23 Percussing The Kidneys Have the patient sit up. Place the ball of your nondominant hand on the patient’s back at the Costovertebral angle of the 12th rib. Strike the ball of that hand with the ulnar surface of your other hand. Use just enough force to cause a painless but perceptible thud. 24 Normal Versus Abnormal Abdominal Percussion findings: Liver: Usually mostly covered by ribs; occasionally a small edge protrudes below the costal margin. Percussion reveals a dull sound. Spleen: Usually, resonance but dull only with splenomegaly (enlarged spleen). Intestines: Tympanic (drum-like) sounds due to gas; dullness possible if fluid-filled. Stomach: Tympanic sound in the left upper quadrant, near the sternum. Overall: Percussion helps determine the cause of abdominal distention. 25  5. Abdomen- Palpation Normal Findings Abnormal Observations Palpate for liver in the Liver is displaced downwards from RUQ. its normal to hyper inflated lung. feel the edge of the liver with the Hepatomegaly- liver palpated more than 1- 2 cm below the right costal fingertips. It feels like margin a firm, regular ridge. Pain during inspiration- inflamed gall Spleen- normally not bladder. palpable. Note for McBurney point tenderness. Palpate for liver Palpate for spleen Enlarged spleen bumps the finger tips. Stop palpating if enlarged spleen is felt, because over palpation can lead to rupture. Muscle guarding, rigidity, large masses or tenderness. 14  5. Abdomen- Palpation Normal Findings Abnormal Observations Enlarged kidneys and Palpate for the kidneys kidney masses Occasionally, the lower pole of the Rt. kidney is felt as a round, smooth mass that slides between the fingers. The left kidney sits 1 cm higher than the right and is not palpable normally. 15  5. Abdomen- Palpation Normal Findings Abnormal Observations Palpate for rebound tenderness Pain on release of pressure conforms rebound Normally pain is not felt by the tenderness which indicates patient (performed at the end peritoneal inflammation that of the examination) usually accompanies appendicitis. Rovsing's sign- pain in the RLQ when pressure is applied in the LLQ 16 Rebound Tenderness (Blumberg's sign) ▪ Help the patient into a supine position with his knees flexed to relax the abdominal muscles. ▪ Place your hands gently on the right lower quadrant at McBurney’s point (located about midway between the umbilicus and the anterior superior iliac spine). ▪ Slowly and deeply dip your fingers into the area; then release the pressure in a quick, smooth motion. ▪ Pain on release—rebound tenderness—is a positive sign. The pain may radiate to the umbilicus. To minimize the risk of rupturing an inflamed appendix, don’t repeat the maneuver for assessing rebound tenderness. 29 30 Rovsing’s sign Rovsing’s sign is performed on an individual lying flat on their back, usually on an examination table. A clinician will press slowly and gently into the left lower quadrant of the individual’s abdomen, and then gradually release pressure. If the individual feels sudden pain in the right lower quadrant of the abdomen, it is indicative of a positive Rovsing’s sign 31 Is Rovsing’s sign the same as Rebound Tenderness? Rebound Tenderness: Rovsing’s Sign: Pain felt when pressure on the abdomen is Pressure is applied to the left lower released, not when it's applied. This quadrant of the abdomen. If this causes suggests irritation of the peritoneum (the pain in the right lower quadrant (where the lining of the abdominal cavity). It's a appendix is located), it's a positive Rovsing's general indicator of peritonitis, which can sign. This is thought to happen because stem from various causes, including pressure on the left side pushes gas across appendicitis. to the right, causing distention and pain in the already inflamed appendix region. 32 Documentation-Sample Abdomen flat (scaphoid/protuberant), symmetric with no apperant masses (asymmetric with bulging/hernia in LLQ). Skin smooth with no striae, scars or lesions (presence of striae and transverse scar about 4 cm in the lower abdomen). Bowel sounds present (hyperactive/hypoactive/absent), no bruits (bruits heard in epigastric area/aorta). Tympany predominates in all 4 quadrants (dullness noted over RLQ). Abdomen soft with no masses or tenderness (tenderness noted around umbilicus). 33 References Taylor, C et.al (2008). Fundamentals of Nursing, The Art and Science of Nursing care, 6th Ed. Lippincott Williams & Wilkins. Google photos Jarvis. Physical Examination & Health Assessment (2020). 8th ed. Elsevier. Chapter 22. Wilson, Giddens. Health Assessment for Nursing Practice (2013). 5th ed. Elsevier Rastogi, V., Singh, D., Tekiner, H., Ye, F., Kirchenko, N., Mazza, J. J., & Yale, S. H. (2018). Abdominal Physical Signs and Medical Eponyms: Physical Examination of Palpation Part 1, 1876-1907. Clinical Medicine & Research, 16(3-4): 83–91. DOI: 10.3121/cmr.2018.1423 34 Thank You 35 35