Physical Assessment of Abdomen - Ibrahim Rawhi Ayasreh
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Transcript of Physical Assessment of Abdomen - Ibrahim Rawhi Ayasreh
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Physical Assessment
Abdomen
Ibrahim R. Ayasreh
ACNS, MSN
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Collecting Subjective Data
Are you experiencing abdominal pain?
Do you experience indigestion? Describe
Abdominal pain occurs when specific digestive organs or structures are affected
by chemical or mechanical factors such as inflammation, infection, distention,
stretching, pressure, obstruction, or trauma
Indigestion (pyrosis), often described as heartburn, may be an indication of
acute or chronic gastric disorders including hyperacidity, gastroesophageal reflux
disease (GERD), peptic ulcer disease, and stomach cancer.
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Collecting Subjective Data
Do you experience nausea? Describe.
Have you been vomiting? Describe the vomitus
Nausea may reflect gastric dysfunction and is also associated with many
digestive disorders and diseases of the accessory organs, such as the liver and
pancreas, as well as with renal failure and drug intolerance. Nausea may also be
precipitated by dietary intolerance, psychological triggers, or menstruation.
Vomiting is associated with impaired gastric motility or reflex mechanisms.
Description of vomitus (emesis) is a clue to the source. For example, brighthematemesis is seen with bleeding esophageal varices and ulcers of the
stomach or duodenum
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Collecting Subjective Data
Have you noticed a change in your appetite.
Do you have constipation? Describe. Do you have any accompanying symptoms?
Have you experienced diarrhea? Describe
Loss of appetite (anorexia) is a general complaint often associated with digestive
disorders, chronic syndromes, cancers, and psychological disorders
Constipation is usually defined as a decrease in the frequency of bowel
movements or the passage of hard and possibly painful stools
Diarrhea is defined as frequency of bowel movements producing unformed or
liquid stools
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Preparing the Client
Ask the client to empty the bladder before beginning the examination to eliminate
bladder distention and interference with an accurate examination.
Instruct the client to remove clothes and to put on a gown.
Help the client to lie supine with the arms folded across the chest or resting by
the sides.
Drape the client with sheets so the abdomen is visible from the lower rib cage to
the pubic area.
Instruct the client to breathe through the mouth and to take slow, deep breaths;
this promotes relaxation.
Before touching the abdomen, ask the client about painful or tender areas. Theseareas should always be assessed at the end of the examination.
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Collecting Objective Data
Observe the coloration of the skin.
Note any striae
Purple discoloration at the flanks indicates bleeding within the abdominal wall,
possibly from trauma to the kidneys, pancreas, or duodenum or from pancreatitis
Pale, taut skin may be seen with ascites
Redness may indicate inflammation
- Dark bluish-pink striae are associated with Cushings syndrome.
- Striae may also be caused by ascites, which stretches the skin
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Dark bluish-pink striae
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Collecting Objective Data
Note the vascularity of the abdominal skin.
Inspect for scars
Dilated veins may be seen with cirrhosis of the liver, obstruction of the inferior
vena cava, portal hypertension, or ascites.
Dilated surface arterioles and capillaries with a central star (spider angioma) may
be seen with liver disease or portal hypertension
Nonhealing scars, redness, inflammation. Deep, irregular scars may result
from burns
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Dilated veins in abdomen
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Spider angioma
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Collecting Objective Data
Inspect the umbilicus.
Inspect abdominal contour.
- Bluish or purple discoloration around the umbilicus (Cullens sign) indicates
intra-abdominal bleeding.
- A deviated umbilicus may be caused by pressure from a mass, enlarged organs,
hernia, fluid, or scar tissue.- An everted umbilicus is seen with abdominal distention.
- An enlarged, everted umbilicus suggests umbilical hernia.
- A generalized protuberant or distended abdomen may be due to obesity, air
(gas), or fluid accumulation.
- A scaphoid (sunken) abdomen may be seen with severe weight loss or cachexia
related to starvation or terminal illness.
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Collecting Objective Data
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Abnormal Findings
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Abnormal Findings
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Abnormal Findings
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Abnormal Findings
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Collecting Objective Data
Observe aortic pulsations.
Auscultate for bowel sounds.
- A series of intermittent, soft clicks and gurgles are heard at a rate of 5 to 30 per
minute
Vigorous, wide, exaggerated pulsations may be seen with abdominal aortic aneurysm
Hypoactive bowel sounds indicate diminished bowel motility. Common causes includeabdominal surgery or late bowel obstruction.
Hyperactive bowel sounds indicate increased bowel motility. Common causes include
diarrhea, gastroenteritis, or early bowel obstruction.
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Collecting Objective Data
Auscultate for vascular sounds.
A bruit with both systolic and
diastolic components occurs whenblood flow in an artery is turbulent or
obstructed. This usually indicates
aneurysm or arterial stenosis
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Collecting Objective Data
Percuss for tone.
- Generalized tympany predominates over the abdomen because of air in the
stomach and intestines. Normal dullness is heard over the liver and spleen.
Accentuated tympany or
hyperresonance is heard over a
gaseous distended abdomen.
An enlarged area of dullness is
heard over an enlarged liver or
spleen.
Abnormal dullness is heard over a
distended bladder, large masses,
or ascites
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Collecting Objective Data
Percuss the span or height of the liver.
Hepatomegaly, a liver span that
exceeds normal limits (enlarged),
is characteristic of liver tumors,
cirrhosis, abscess, and vascular
engorgement.
Atrophy of the liver is indicated by
a decreased span.
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Collecting Objective Data
Perform blunt percussion on the liver and the kidneys.
Tenderness elicited over the liver
may be associated withinflammation or infection
(e.g., hepatitis or cholecystitis).
Tenderness or sharp pain elicited
over the CVA suggests kidney
infection (pyelonephritis), renalcalculi, or hydronephrosis
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Collecting Objective Data
Perform light palpation.
- Light palpation is used to identify areas of tenderness and muscular
resistance.
- Abdomen is nontender and soft. There is no guarding.
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Collecting Objective Data
Deeply palpate all quadrants to delineate abdominal organs and detect
subtle masses.
- Normal (mild) tenderness is possible over the xiphoid, aorta, cecum, sigmoid
colon, and ovaries with deep palpation.
Severe tenderness or pain may
be related to trauma, peritonitis,
infection, tumors, or enlarged or
diseased organs.
A mass detected in any quadrant
may be due to a tumor, cyst,
abscess, enlarged organ,
aneurysm, or adhesions
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Collecting Objective Data
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Collecting Objective Data
Palpate the aorta.
- The normal aorta is approximately 2.5 to 3.0 cm wide with a moderately strong
and regular pulse.
A wide, bounding pulse may be
felt with an abdominal aortic
aneurysm.
A prominent, laterally pulsating
mass above the umbilicus withan accompanying audible bruit
strongly suggests an aortic
aneurysm.
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Tests for Ascites
Test for shifting dullness.
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Tests for Ascites
Perform the fluid wave test.
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Tests for Appendicitis
Assess for rebound tenderness and Rovsings Sign
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Tests for Appendicitis
Assess for Psoas sign
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Tests for Appendicitis
Assess for Obturator sign.
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Test for Cholecystitis
Murphys sign.
- Press your fingertips under the liver border at the right costal
margin and ask the client to inhale deeply.
- Accentuated sharp pain that causes the client to hold his or
her breath (inspiratory arrest) is a positive Murphys sign.