Abdominal Assessment Flashcards
Solid Viscera
viscera that maintains a characteristic shape regardless of their contents
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus
Hollow Viscera
the shape of the viscera depends on their contends
- typically not palpable unless distended with
contents (feces, urine, etc)
stomach, gallbladder, small intestine colon bladder
Abdominal Quadrants in Anatomical Position
RLQ - right lower quadrant
RUQ - right upper quadrant
LUQ - left upper quadrant
LLQ - left lower quadrant
Health History Points (9)
- Changes in Appetite - eating, weight
- Difficulty Swallowing
- Food Intolerance - to what? what happens?
- Abdominal Pain - OPQRSTU
- Nausea/ Vomiting -
- Bowel Habits - frequency, quality, recent changes
- Previous Abdominal History
- Medications - laxatives
- Alcohol and Tobacco - risk for cancers
- Nutrition - assess for nutritional deficits and
malnutrition
Anorexia
loss of appetite
- occurs with gastro-intestinal disease, as an
adverse effect of medication, pregnancy, or with
psychological disorders
Dysphagia
Difficulty swallowing
- occurs with disorders of the throat or esophagus
Pyrosis
heartburn caused by reflux of gastric acid
Belching
excessive burping
- can occur with food intolerance
- can be indicative of a hiatal hernia
Hematemesis
blood in the vomit
- occurs with stomach or duodenal ulcers
Melena
black and tarry feces due to gastrointestinal bleeding
- if taking iron supplements, black feces might
occur without the tarry texture
Inspection Points
- Demeanor
- Contour, Symmetry of the abdomen
- Umbilicus
- Skin
- Pulsations or Movement
Inspection: Demeanor
observe the patient for signs of pain, discomfort or distress:
- flexion of the knees
- grimacing
- involuntary rigidity
- voluntary guarding
Voluntary Guarding
voluntary contraction of the abdominal musculature to avoid unpleasant sensation (cold, pain, tickles)
- occurs bilaterally
- muscles relax during exhalation
- often involves pushing examiner away
Involuntary Rigidity
involuntary tightening of the abdominal musculature that occurs in response to underlying inflammation
- constant
- unilateral
- same area experiencing rigidity often becomes
painful when the patient increases intra-
abdominal pressure
Inspection: Contour, Symmetry
Positioning - standing on the patient’s right side, look at the abdomen from above, and from the side to note the contour
a. flat or rounded –> normal
b. scaphoid - associated with extreme weight
loss, malnutrition
c. perturbant - associated with obesity, ascites,
pregnancy
Notes:
- the abdomen should be symmetrical
bilaterally
- no bulging, pulsations, visible masses, or
asymmetrical shapes should be present
Inspection: Umbilicus
the umbilicus should be midline and inverted
- if everted, note whether or not this is normal
for the patient –> can become everted with
ascites, hernias, or masses
- inspect for signs of discoloration,
inflammation or hernia
Inspection: Skin
- Colour - should be uniform, consistent with ethnicity
- note any redness, rashes, bruises, etc
- Striae - stretch marks
- normal finding if consistent with rapid or
prolonged skin stretching, otherwise
abnormal
- normal finding if consistent with rapid or
- Lesions - not usually present
- Presence of veins - not usually present
- Turgor - good skin elasticity reflects healthy nutrition, hydration
- Temperature - should be warm
Skin is normally warm, dry and intact with colour consistent with ethinicity, and no presence of lesions, masses, rashes, or bruising
Auscultation Points
a. Bowel Sounds
b. Vascular Sounds
Auscultation of Bowel Sounds
start in the LRQ and continue clockwise unless pain or tenderness is expressed –> then start in the next quadrant and do painful one last
- uses the diaphragm of the stethoscpe
Types of Bowel Sounds (4)
a. Normal - 5-30 sounds per minute
b. Hyperactive - increased motility (30+)
- often occurs when digesting food, or in early
bowel obstruction (when consistent with
other signs)
c. Hypoactive - decreased motility (<5)
- often occurs following abdominal surgery,
when the patient has not eaten for a while
d. Absent - listen for 5 minutes to distinguish hypoactive and absent sounds
Auscultation of Vascular Sounds
assess the presence of vascular sounds in the abdomen prior to palpation
- Normal: no sounds
- use the bell end of the stethoscope to listen
over the aorta, left and right renal artery, iliac
a artery and femoral artery
Types of Vascular Sounds (2)
- Systolic Bruit - pulsing, blowing sound
- causes: abdominal aortic aneurysm, partial
occlusion of the femoral arteries, renal artery
stenosis –> anything causing partial occlusion of
blood flow
- causes: abdominal aortic aneurysm, partial
- Venous Hum - soft, continuous humming sound
- causes: portal hypertension, liver cirrhosis
- heard between the xiphoid process and
umbilicus
Documenting the Presence of Vascular Sounds (3)
- Location
- Pitch
- Timing - during the cardio cycle
Percussion of the Abdomen
used to:
a. assess the relative density of abdominal
contents
b. to locate organs
c. screen for abdominal fluid or masses
perform while the patient is supine, starting in the RLQ (skip to next if patient expresses pain/tenderness in RLQ) –> move clockwise
Sounds associated with Abdominal Percussion
a. Tympany - heard over the intestines/ colon (air rises to the surface when supine)
b. Dullness - heard over solid structures, a distended bladder, adipose tissue, fluid or mass
- note whether dullness should be heard over
area examined
- abnormal finding if noted over areas that should
be tympany
c. Hyper-Resonance - is heard with gaseous
distension
Palpation of the Abdomen
LIGHT palpation is used to:
a. assess surface characteristics - texture,
temperature, moisture, swelling, rigidity,
pulsations
b. presence of pain
perform while the patient is supine, depressing the skin approximately 1cm while making a gentle rotary motion, lifting the fingers from the skin completely before moving to the nest location
- if patient does not express pain/ tenderness,
start in RLQ and move clockwise
- if patient expresses pain/ tenderness in RLQ,
start at next quadrant clockwise
ALWAYS save areas of pain/ tenderness for last
Abdominal Palpation: Abnormal Findings (4)
- Voluntary Guarding - intermittent contraction of
muscles - Involuntary Rigidity - constant rigidity of the
muscles - Tenderness - associated with acute and chronic
pain/ inflammation
- acute pain extending from the umbilicus to
the RLQ is indicative of appendicitis - Organomegaly - abnormal enlargement of the organs
Ascites
fluid accumulation in the peritoneal cavity due to portal hypertension an flow albumin in the blood
Causes: liver cirrhosis, congestive heart failure
Inspection: perturbant abdomen (single curve),
everted umbilicus, bulging flanks in supine
position (gravity pushes to the sides), skin is tight,
glistening, recent weight gain, increase in
abdominal girth
Auscultation: normal over intestines (when supine,
fluid moves to the side), diminished over fluid
Percussion: tympany over intestines (when supine,
fluid moves to the side + intestines “float”), dull
over fluid
Palpation: skin is tight (movement is limited),
glistening/ moist, increased intra-abdominal
pressure
Bowel Obstruction
Inspection: distended abdomen, vomiting, fever, decreased blood pressure, increased pulse rate, increased breathing rate, dehydration + loss of electrolytes (hypovolemic shock = loss of fluids)
Auscultation: initially hyperactive (to compensate), then hypoactive –> potentially none if severe
Percussion: dull over areas above blockage (accumulation of fluid and gas), tympany over areas distal to blockage
Palpation: skin is tight (pressure from excess fluid and gas leaking into peritoneum), limited movement, potentially feel the blockage
Older Adult Considerations: Physiological Changes
- Changes in accumulation of adipose tissue
a. women - accumulates in suprapubic areas (dec
estrogen levels)
b. men - deposits in abdominal areas - Delayed esophageal emptying - food moves
slower down the esophagus into the stomach –>
increases the risk of food/ liquid entering the
trachea/ lungs (aspiration + pneumonia secondary
to aspiration) - Decreased:
a. salivation - dry mouth, decrease in taste
b. gastric acid secretion - absorption of oral
medications impaired or delayed
c. liver size - decreased ability to process and clear
medication –> risk of accumulation + toxicity
d. renal functioning - decreased ability to clear
toxic build up (+ liver size)
Older Adult Considerations: Increased Risks
a. Dehydration - reduced ability to conserve water,
respond to changes in temperature, acuteness of
thirst
- less likely to drink when thirsty due to decreased ability to perform AODL
b. Gallstones - secondary to dehydration
c. Constipation - poor dietary habits (+ decreased
taste, smell), sedentary lifestyle, decreased ADOL
(ignoring the urge to defecate)
