Abdomen Flashcards
Abdomen assessment
stand on the patients right side order of assessment: Inspection auscultation percussion palpation
inspection
Scars Striae Dilated veins Rashes/lesions Masses Umbilicus Contour Symmetry Peristalsis Pulsations
Scars/Striae note
size, color, location
striae may be silvery color, stretch marks due to pregnancy, rapid weight gain or large weight loss
dilated veins
prominent, dilated veins occur with portal hypertension, cirrhosis, ascites, vena cava obstruction, and malnutrition
Rashes, lesions, masses
link to skin assessment
ABCDE
asymmetry, border, color, diameter, elevation and enlargement
umbilicus
note contour, location, and any signs of inflammation or hernia. An umbilical hernia protrudes through the umbilicus
Contour of abdomen
flat: appropriate weight and muscle tone
scaphoid: sunken (dehydration)
rounded: slightly obese, early pregnancy
protuberant: pregnancy, distension, obesity, tumors, ascites
Peristalsis
eye level to assess
may need to observe for several mintues
may be visible in thin individuals
Pulsations
aortic pulsation may be visible in the epigastric area
Auscultation
Warm the diaphragm
Begin in RLQ, then to RUQ, LUQ, LLQ
Bowel Sounds
Normal: 5-30 per minute Hypoactive: less than 5/minute Hyperactive: more than 30/minutes borborygmus: stomach growling Absent sounds: must listen for 5 minutes; result of decreased intestinal motility, paralytic ileus, late bowel obstruction, peritonitis, appendicitis
Venous Hum
continuous medium pitched sound auscultated in the epigastric and umbilical area. may indicate hepatic cirrohosis
very rare
listen with bell
Friction rub
rough grating sound
may indicated infection, inflammation, and malignancy
listen with diaphragm
percuss
purpose is to detect fluid, gaseous distension, and masses
tympany
Lightly percuss in all four quadrants
Move clockwise
Air in the intestines rises to the surface when supine
Dullness
Distended bladder
Adipose tissue
Fluid
Mass
Hyperresonance
Gaseous distention
liver span
percuss down along the right midclavicular line beginning at the nipple area, moving from lung resonance to liver dullness. mark with china pin
liver span cont
percuss up along the right midclavicular line from the level of the umbilicus to liver dullness. mark with pin
measure with tape should be 6-12 inches in the adult. The liver width is greater in men and tall individuals
percuss spleen
9th or 10th mid axillary line and percuss, shoudl be tympanic
dull sound could be mono, trauma, or infection
percuss stomach
gastric air bubble, left side of patient 6th or 7th rib
should be tympanic
palpation
begin with light palpation
start in RLQ, RUQ, LUQ, LLQ
muscular resistance- muscle tone
abdominal tenderness- stiffening with pain
deep palpation
used to distinguish inferior organs or elicit deep pain
deep masses
note size, location, mobility, contour, consistency(soft, firm or hard), tenderness
tender areas
palpate last
aorta
press deep into the upper abdomen slightly to the left of the midline. identify the aortic pulsation
Normally 2.5 cm – 4 cm in the adult
abnormal finding: widened w/ aneurysm
upper abdominal reflexes
stroke the abdomen toward the umbilicus with the handle of the reflex hammer
should move toward the stimulus
lower abdominal
stroke the abdomen below the umbilical area but towards the midline
umbilicus should deviate towards the stimulus
Absent reflex
could indicate a pyramidal tract lesion
