4.1 Abdomen Assessment Flashcards
Structure of Abdomen
- Extends from diaphragm to brim of pelvis
- Bordered in the back by vertebral column
- Bordered on side and front by lower rib cage and abdominal muscles
- 4 Layers of large flat muscles form the ventral abdominal wall
Structure of Abdomen
- Internal organs in the abdominal cavity are called the viscera
- Abdomen divided into 4 quadrants. Upper right, lower right, upper left, lower left
- Midline area has aorta, uterus (if enlarged) and bladder (if distended, swollen due to pressure inside).
Review of Systems
History of
- Anorexia, pyrosis (heartburn), food intolerance/dietary restrictions
Current Medications - (Might cause GI issues like ulcers)
Self Care Habits
- Alcohol can cause GI issues
Review of Systems (Pain)
Visceral Pain - Dull, poorly localized, usually related to internal organ
Parietal Pain - Sharp, localized, peritoneum inflammation (tissue that covers organs and lines abdominal wall)
Referred Pain - Pain in different locations outside of abdomen.
Review of Systems (Stool Color)
Black - Indicates bleeding
Gray - Indicates hepatitis (inflammation of liver)
Red - Gastrointestinal Bleeding
Physical Assessment Order
Different order because percussion and palpation increase peristalsis (digestive muscle contractions) that could cause false findings with auscultation.
- Inspection
- Auscultation
- Percussion
- Palpation
Inspection of Abdomen
- Contour
- Stoop/sit and gaze across abdomen with head slightly higher than abdomen
- Assess contour for nutritional state (flat, rounded, scaphoid (Sunken), protuberant (protruding)) - Symmetry
- Symmetrical with no bulging masses/lesions
- Note Striae (stretch marks) which are silvery/white lines
- Look for bumps
Bumps could be a hernia (protrusion of abdominal viscera through opening in muscle wall)
- Umbilicus should be midline and will be deeply inverted in obese patients
Inspection of Abdomen (cont)
Inspect for Pulsation
- Pulsation may come from aorta beneath skin in epigastric area. (Particularly in thin people with good muscle wall relaxation)
- Respiratory movement (particularly in males) peristalsis also sometimes visible in thin people.
(Very visible peristalsis in distended abdomen indicates abdominal obstruction)
Inspection of Abdomen (cont)
Demeanor - Restless? - In pain? - Guarding Abdomen/resisting movement? May indicate Peritonitis (inflammation of peritoneum)
Auscultation of Abdomen
Use diaphragm side of stethoscope and hold lightly against skin
- Bowel sounds are relatively high pitch
- Pushing too hard can stimulate more bowel sounds
Auscultation of Abdomen
- Start in the RLQ (Right lower Quadrant) at the ileocecal value area. (Bowel sounds normally present here)
Classification of sounds
-Hyperactive - loud, high pitched, rushing/tinkling sounds indicating increased motility
-Hypoactive - Normal during post surgical or with peritoneal inflammation. - Borborygmus - Intense growling
(LISTEN FOR 5 MINUTES IN EACH QUADRANT IF BOWEL SOUNDS ARE INACTIVE OR HYPOACTIVE)
Auscultation of Abdomen (cont)
- Note vascular sounds or bruits over large vessels like aorta
- Use firmer pressure and bell side to check over aorta, renal arteries, iliac, femoral arteries, especially in patients with hypertension
- Usually no sound is present
Percussion of Abdomen
Tympany - Normal Sound over Abdomen
Dullness - Heard over distended bladder, adipose tissue, fluid, or mass.
- Percuss to assess density of abdomen, locate organs, screen for abdominal fluid/masses
Percussion Order
- Move clockwise and percuss all 4 quadrants, noticing tympany and dullness
- Tympany should be dominant (air rises to surface when patient is supine
- Percuss to map out boundaries of certain organs (liver, spleen, kidneys)
Percussion to Measure Liver
- Start on right midclavicular line. Start at lung resonance and percuss down until you hear dull sound.
(Mark this spot - usually in 5th intercostal space) - Start on (left) midclavicular line with abdominal tympany. Percuss up until you hear dull sound.
(Mark this spot - usually in right costal margin)
MEASURE DISTANCE BETWEEN 2 MARKS - Adult (6-12cm)
HEPATOMEGALY - Enlarged Liver
