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
Percussion to measure Spleen
- Percuss left midaxillary line for dull sound from 9th-11th intercostal space
(Area of splenic dullness usually not more than 7cm in adults) - Percuss lowest interspace in left anterior axillary line, tympany should result
ASK PATIENT TO TAKE DEEP BREATH - Tympany should remain through whole inspiration
DULLNESS - positive spleen percussion sign (indicates spleen enlargement)
Percussion to measure Kidneys
Assess for costovertebral angle tenderness (90 degree angle at bottom of ribcage and spine) by placing hand over 12th rib on back.
- Thump the hand with ulnar edge of other fist
NORMAL
- Patient feels no pain
ABNORMAL
- Sharp pain due to kidney inflammation
Rebound Tenderness Test
- Blumberg’s Sign may indicate inflammation (appendicitis).
Inspiratory Arrest Test
Murphy’s sign indicates cholecystitis (inflammation of gallbladder)
Iliopsoas Muscle Test
Inflamed iliopsoas muscle could indicate Peritonitis, or perforated appendix (burst).
Developmental Concerns (INFANTS)
NEWBORNS
- Umbilical cord shows prominently on abdomen
- Liver takes up proportionately more space
- Urinary bladder is higher in abdomen than adults
EARLY CHILDHOOD
- Abdominal wall is less muscular and organs are easier to palpate
Developmental Concerns (OLDER ADULTS)
DURING/AFTER MIDDLE AGE
- Females accumulate fat in suprapubic area (hypogastric region) as a result of decreased estrogen
- Males show fat in abdominal area, resulting in “spare tire” appearance
IN OLDER ADULTS
- Aging alters appearance of Abdominal Wall
- Adipose tissue distributed away from face and into extremities, hips, and stomach
Abnormal Findings
- Referred pain is common with abdominal issues. Pain is referred to site where organ was located during fetal development
RIGHT SHOULDER - LIVER ISSUES
LEFT SHOULDER - PANCREAS ISSUES
MID-BACK/RIGHT SHOULDER - PERFORATED ULCERS
RIGHT/LEFT SHOULDER - GALLBLADDER ISSUES
Abnormal Findings (INSPECTION)
Distension - Ascites (fluid collected in spaces of abdomen, feces, cysts, pregnancy)
Umbilical Hernia - Intestines goes through umbilicus
Epigastric Hernia - Small fatty nodule you can feel
Incisional - Looks like bulging scar
Diastasis Recti - Separation of abdominal muscle. (Very common after childbirth)
Abnormal Findings (AUSCULTATION)
Succussion Splash - Loud splash heard when baby is rocked side to side.
- Caused by increased air and fluid from pyloric obstruction (opening between stomach and intestines) or hiatal hernia (stomach bulges through abdomen)
Hypo/Hyperactive bowel sounds
Abnormal Findings (PALPATION)
Enlarged Organs
- Typically indicates inflammation of organs
Enlarged Nodular Liver - Tertiary syphilis, cirrhosis, cancer
Enlarged Gallbladder - Cholecystitis
Abdominal aortic aneurysm(bulge in artery) (AAA)
- Can possibly palpate and bruit is present
- Do not press on AAA as it can rupture
