Assessment of Assessment of AbdomenAbdomen

CHAPTERCHAPTER

Examination

• InspectionInspection

• AuscultationAuscultation

• PercussionPercussion

• Palpation Palpation

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CHAPTERCHAPTER

AbdominalAbdominalquadrantsquadrants

• Upper right Upper right quadrantquadrant

• Upper left Upper left quadrantquadrant

• Lower right Lower right quadrantquadrant

• Lower left Lower left quadrantquadrant

9Abdominal Structure and FunctionAbdominal Structure and Function

CHAPTERCHAPTER

9 Abdominal Structure and FunctionAbdominal Structure and Function

Abdominal quadrants

CHAPTERCHAPTER

Equipment neededEquipment needed

The only equipment needed The only equipment needed are:are:

• StethoscopeStethoscope• cloth or plastic rulercloth or plastic ruler• PencilPencil• Examination tableExamination table• LightLight• Small pillowSmall pillow• Drapes to cover the patientDrapes to cover the patient

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CHAPTERCHAPTERSubjective HistorySubjective History

• AppetiteAppetite• DysphagiaDysphagia• Food intoleranceFood intolerance• Nausea /VomitingNausea /Vomiting• Bowel habitsBowel habits• Past abdominal Past abdominal

historyhistory• MedicationsMedications• Nutritional assessmentNutritional assessment

Abdominal painAbdominal pain•OnsetOnset•LocationLocation•DurationDuration•CharacteristicsCharacteristics•Associated Associated findingsfindings•Relieving factorsRelieving factors•Tx attemptedTx attempted

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CHAPTERCHAPTER

The ExaminationThe Examination

• ClientClient– Empty bladder, disrobe & gown, supine, head on Empty bladder, disrobe & gown, supine, head on

pillow, knees bent, arms at side or across chest, have pillow, knees bent, arms at side or across chest, have pt ID any area of painpt ID any area of pain

• NurseNurse– Warm hands & stethoscope, warm environment, good Warm hands & stethoscope, warm environment, good

lighting, approach slowly, monitor pt’s face during lighting, approach slowly, monitor pt’s face during exam, tender areas lastexam, tender areas last

• Inspect, Auscultate, Percuss, Palpate- light & deepInspect, Auscultate, Percuss, Palpate- light & deep

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CHAPTERCHAPTER

InspectionInspection

Contour - flat, rounded.Contour - flat, rounded.

Symmetry- Symmetry-

UmbilicusUmbilicus

Skin - Skin - texture, color, lesions, veins, turgortexture, color, lesions, veins, turgor

Surface motion - pulsations or peristalsisSurface motion - pulsations or peristalsis

Respiratory movementRespiratory movement

Hair distributionHair distribution

DemeanorDemeanor

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CHAPTERCHAPTER

Abdomen - HerniaAbdomen - Hernia9

CHAPTERCHAPTER

AuscultationAuscultation

•Use diaphragm high pitchedUse diaphragm high pitched•hold lightly against skinhold lightly against skin•Begin RLQ (ileocecal valve area)Begin RLQ (ileocecal valve area)•Bowel soundsBowel sounds

•character & frequencycharacter & frequency•originate from air & fluid movement thru small originate from air & fluid movement thru small intestinesintestines•hi pitched, gurgling, cascading, irregular,hi pitched, gurgling, cascading, irregular,•5-30 times/min, depends on last time pt ate5-30 times/min, depends on last time pt ate

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CHAPTERCHAPTER

Auscultation contAuscultation cont..

• FindingsFindings

– NormalNormal

– hypoactive - absent, slow ie) surgery, hypoactive - absent, slow ie) surgery, inflammationinflammation

– hyperactive - loud, rushing, tinklinghyperactive - loud, rushing, tinkling

– – hyper peristalsis, ”stomach growling”hyper peristalsis, ”stomach growling”

• Listen for 5 minutes before deciding absentListen for 5 minutes before deciding absent

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CHAPTERCHAPTER

Auscultation contAuscultation cont..• Vascular soundsVascular sounds

– Bruits- pulsatile blowing sound with artery Bruits- pulsatile blowing sound with artery occlusion (use firmer pressure)occlusion (use firmer pressure)–aortaaorta–renalrenal–iliaciliac–femoralfemoral

– Venous hum- periumbilical regionVenous hum- periumbilical region– Peritoneal friction rubPeritoneal friction rub

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CHAPTERCHAPTER

Palpation--Specific OrgansPalpation--Specific Organs

• LiverLiver

• SpleenSpleen

• KidneyKidney

• AortaAorta

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CHAPTERCHAPTERSpecial ProceduresSpecial Procedures

• Blumberg sign (Appendix test)Blumberg sign (Appendix test)–Rebound tendernessRebound tenderness

• Murphy’s sign (Gallbladder test)Murphy’s sign (Gallbladder test)

• HerniasHernias

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