Abdominal Assessment PDF

ABDOMINAL ASSESSMENT  SURFACE LANDMARKS s Between diaphragm and top of pelvis s Vertebral Column and paravertebral muscles (back) s Lower rib cage and abdominal muscles (side and front) s 4 layers of large flat muscles form the abdominal wall s Protect and hold the organs in place STRU...

ABDOMINAL ASSESSMENT  SURFACE LANDMARKS s Between diaphragm and top of pelvis s Vertebral Column and paravertebral muscles (back) s Lower rib cage and abdominal muscles (side and front) s 4 layers of large flat muscles form the abdominal wall s Protect and hold the organs in place STRUCTURE & FUNCTION Viscera s Solid—Maintain shape s liver, pancreas, spleen, adrenal glands, kidneys, and ovaries s Hollow—Shape changes s Stomach, gallbladder, small intestine, colon, and bladder  STRUCTURES s Liver- Mostly RUQ s Stomach-between liver & spleen-just below diaphragm s Gallbladder-below liver- just lateral to R midclavicular line s Small Intestine—all 4 quadrants s Spleen-lateral to L midaxillary line-9th-11th rib s Aorta-just L of midline-bifurcates 2cm below umbilicus s Pancreas-behind stomach-RUQ s Kidneys-costovertebral angle  STRUCTURE AND FUNCTION Midline Aorta Renal Artery Uterus, if enlarged Bladder, if distended  THE AGING ADULT s Fat deposits s Decreased salivation s Dry mouth s Decreased sense of taste s Delayed esophageal emptying s Decreased gastric acid secretion s Gallstones formation s Decreased blood flow to liver s Constipation  SUBJECTIVE DATA Adult Older Adult s Appetite s Groceries and meal s Dysphagia preparation s Food Intolerance s Eat alone s Pain s Food diary s Nausea/Vomiting s Bowel movements s Bowel Habits s GI history s Medications s Nutrition  OBJECTIVE DATA 1. Inspection 2. Auscultation 3. Percussion 4. Palpation  OBJECTIVE DATA PREPARATION s Drape accordingly s Enhance abdominal wall relaxation by: s Empty bladder s Keep room warm s Supine—head on pillow, knees bent or on pillow, arms at side s Warm stethoscope and hands s Assess painful areas last  INSPECTION s Contour s Symmetry s Shine light across abdomen toward you—shine it lengthwise across the patient s Ask patient to take a deep breath and assess again s Umbilicus s Skin s Striae (linae albicantes) s Nevi s Scars s Rashes, Lesions s Peristalsis s Pulsations  AUSCULTATION IS 2ND! s Always begin in RLQ (ileocecal valve) s Bowel Sounds s Affected by time elapse since eating s 5-30 sounds per minute s Normoactive s Hypoactive s Hyperactive s Borborygmus s Absent bowel sounds  AUSCULTATION Vascular Sounds (Bruits) s Aorta, Renal Arteries s Iliac Arteries s Femoral Arteries PERCUSSION  PERCUSSION s Splenic Dullness s 9th-11th intercostal space just behind the L midaxillary line  PERCUSSION Costovertebral Angle Tenderness s Patient should be sitting up s Indirect fist percussion s Place non-dominant hand over 12 rib at costovertebral angle on back s Thump that hand with the ulnar edge of your other fist s Should not feel pain  PALPATION s Helps to judge size, location, and consistency of underlying organs s Assess for masses and tenderness s Important to ensure relaxation s Never perform deep palpation of an enlarged or tender liver or spleen due to risk of causing rupture of the organ  PALPATION s Begin with light palpation s Assess skin surface and superficial abdominal muscles s Use 4 fingers s Depress about 1 cm s Circular motion s Palpate painful areas last  PALPATION s Voluntary Guarding s Occurs when person is cold, tense or ticklish s Bilateral s Muscles relax slightly with exhalation s Involuntary rigidity s Occurs from peritoneal inflammation s May be unilateral s Pain with increased intra-abdominal pressure  PALPATION s Deep Palpation s Same technique as light palpation except push down 5- 8 cm s For obese abdomen s Use bimanual technique s Note location, size, consistency and mobility of any palpable organs s Note enlargement, tenderness or masses  PALPATION OF LIVER s Left hand under patient’s R back-parallel to the 11th and 12th ribs s R hand on RUQ—fingers parallel to midline s Push down and under R costal margin s With patient breathing slowly, move R hand up 1-2 cm with each exhalation s Edge of liver may be felt with fingertips PALPATION OF THE AORTA s On upper abdomen slightly L of midline s Area of 2.5-3 cm s If wider area---may mean aneurysm s Use thumb and fingers s Palpate aortic pulsation  Rebound Tenderness (Blumberg Sign) s Done when patient c/o abdominal pain and/or tenderness with palpation s Hold your hand 90° to abdomen (McBurney Point) s Push down slowly and deeply and lift up quickly s Pain = sign of inflammation (peritoneal irritation) Inspiratory Arrest (Murphy’s Sign) s Hold fingers under liver border s Ask patient to take deep breath s Pain = cholecystitis (gall bladder inflammation)  ASCITES s Everted umbilicus s Taut glistening skin s Diminished BS over fluid s Dullness over fluid s Limited palpation  AORTIC ANEURYSM s Most are located below renal arteries and extend to umbilicus s Pulsating mass more >5 cm s Auscultate a bruit s Femoral pulses present but decreased  ENLARGED SPLEEN s Enlarges down and toward midline s Mononucleosis—enlarged, soft, and rounded edge s Chronic Cause (cirrhosis)—firm with sharp edges s Usually not tender unless peritoneum inflamed s Spleen needs to be 3 times its normal size for it to be palpable.