Abdominal Assessment Flashcards
Three abdominal regions
Epigastric
umbilical
Hypogastric/Supragastric
RUQ Structures
- Liver
- Gallbladder
- Duodenum
- Head of pancreas
- Right Kidney and adrena
LUQ Structures
*Stomach
* Spleen
* Left lobe of liver
* Pancreas
* Left kidney and adrenal
* Splenic flexure of colon
* Part of transverse and
descending colon
RLQ Structures
- Cecum
- Appendix
- Right Ovary and tube
- Right Ureter
- Right Spermatic cord
LLQ Structures
Part of descending colon
* Sigmoid colon
* Left ovary and tube
* Left ureter
* Left spermatic cord
Midline Structures
*Aorta
* Uterus
* Bladder
4 Steps of abdominal assessment
(overview)
-Inspection
- Auscultation
- Percussion
- Palpation
Patient prep for abdominal assessment
- Supine position, pillow under the head, arms at the
sides - Draping the patient
- — Raise the gown to just below the nipple line above the xiphoid process
- Level of the symphysis pubis
- Empty bladder
- Warm hands and stethoscope
- Nails short
Abdomen Development
**Infant and children
Umbilicus is prominent
* Liver takes up more space at birth, may be palpable
* Urinary bladder located higher in abdomen
* Less muscular-organs more easily palpated
Abdominal development
**Pregnant
Enlarged uterus
* Intestines displaced upwards and to right
* Bowel sounds diminished
* Motility may cause constipation
* Skin changes-striae, Linea nigra
Inspection
(What am I looking for in the abdomen?)
Temp- diaphoretic?
Color- bruises, erythema, jaundice, rashes
Scars
Striae-stretch marks
Dilated veins
Symmetry/umbilicus- Inverted?
Pulsations/movement
Visible organs/masses
Hair distribution
Auscultation sounds (what does it sound like?)
**Diaphragm
(high pitched sounds)
Auscultation sound-
Assessment
How do I do it? Frequency of bowel sounds?
Bowel sounds:
-Start in RLQ at ileocecal valve area-bowel …….sounds are normally always present here.
- Auscultate all 4 quadrants
- Note frequency and character
usually 5 - 30 per minute
- Occur every 5-20 seconds.
Auscultation sounds (what does it sound like?)
**Bowel
high pitched, gurgling, and irregular
Types of bowel sounds
- Present (positive bowel sounds)
- Hyperactive
- Hypoactive
- Absent: established after 5 minutes of
continuous listening
Borborygmus
(Bowel sound)
stomach
growling-hyperperistalsis
Abdominal: Auscultate for Vascular sounds
(Types of sounds)
- Bruits in the aortic, renal, iliac, and
femoral arteries (not normally heard) - Check especially in people
with HTN - Occurs with stenosis or
occlusion of an artery - Pulsatile blowing sounds
- Abdominal Aortic Aneurysm (AAA)
Abdominal inspection (shape)
Contour
Flat
Rounded: slightly distended
Scaphoid: concave, Sunken
Protuberant: distended
Developmental Considerations:
Children
Potbelly, flat while supine
Liver palpable
Developmental Considerations:
Adult after middle age
Females with fat accumulation
Males w fat deposits
Gallstones
Gastric acid secretion
Decreased salivation/taste
Esophageal emptying delayed
Liver-size decreases
Constipation
Vascular sounds
(what is it?)
Turbulent blood flow
(not normal)
Why do we percuss the abdomen?
Looking for solids
Organs like the Liver/spleen
Fluid collection
Masses
Distinguish the tympany vs dullness
What is tympany
it’s heard over abdominal areas that may be filled with abdominal air/gas (stomach for example)
What is dullness?
it’s heard over solid organs, fluid collection, or areas of consolidations (such as tumor or mass)
What does dullness help indicate?
helps estimate liver size; can indicate ovarian tumor, distended bladder, ascites, fluid, mass, or adipose tissue
What is hyperresonance?
Distended abdomen
Costovertebral Angle Tenderness (CVA)
used for indirect percussion to assess kidneys
done over 12th rib and CVA on back
- place palm of one hand on patient back, thump with fisted hand
– pain with inflammation of kidney
– causes: renal colic, pyelonephritis
What is palpation and what is it used for? (in this class instance - light palpation)
to assess surface characteristics
feel for organs, enlarged organs, masses, tenderness, fluid and ascites
What are the two types of palpation
light: abdominal tenderness, muscular resistance, superficial organs and masses
deep: advanced
Characteristics of light palpation
How to: use the finger pads and gently press down about 1cm or 1/2 inch
gently press down and use light circular motions to palpate for:
- texture
- masses
- moisture
- pulsations
- temperature
- tenderness
Deep Palpation characteristics (advanced assessment - do we need to know this?)
assess and feel for the location and size of internal organs, masses, and tenderness
may be done using one or two hands – 5-6cm or 2-3 inches
if pain reported in an area - gently palpate last
Advanced assessment - deep palpation: bimanual technique
one hand over the other, push down
obese patient uses bimanual
Abdominal masses may be characterized by:
Different types of masses…
Physiological, inflammatory, vascular, neoplasitc,obstructive
physiological: pregnant uterus
inflammatory: diverticulitis
vascular: AAA
neoplastic: colon cancer
obstructive: distended bladder or dilated loop of bowel
Abnormal findings in palpation
guarding, rigidity, rebound tenderness (when pain is felt when moving hand away), peritonitis
Peritonitis indications
positive cough test, involuntary guarding, rigidity, rebound tenderness and percussion tenderness
Palpation of the liver
place left hand posteriorly parallel to and supporting 11th and 12th ribs on right
place right hand in upper quadrant below area of liver dullness
have patient take a deep breath, feel liver margin for smoothness, firm sharp edge
Hooking technique - advanced assessment
alternative to liver palpation
hook hands under costal margin as patient takes a deep breath
Palpation of the kidneys - advanced
usually not palpable unless enlarged!
right kidney: usually inferior pole of the right kidney
- place left hand underneath patient’s back
- have patient take a deep breath
- palpate with right hand on anterior abdominal wall
- feel for lower pole of kidney
- have patient release breath
- slowly release kidney
left kidney is rarely palpable
Palpation of the spleen
spleen is not normally palpable; is palpable when enlarged
an enlarged spleen expands anteriorly, downward and medially
- it replaces tympany of stomach and colon with dullness
have patient take a deep breath, feel the edge of spleen with fingertips
Abnormal assessment finding - appendicitis
localized tenderness in RLQ, right flank
rebound tenderness
inflamed peritoneum
Rovsing sign - indirect tenderness
Psoas sign - irritation to the iliopsoas muscles
What is the Rovsing sign
when you palpate the LLQ and the patient has pain on the RLQ
Abnormal assessment findings - umbilical hernia
protrusion of intestine through weakness in umbilical ring
Abnormal assessment findings - incisional hernia
bulge near operative scar
Abnormal assessment findings - epigastric hernia
protrusion of abdominal structures through epigastrium
Abnormal assessment findings - hepatomegaly
enlarged liver
causes: hepatitis, cirrhosis, portal obstruction/HTN
Abnormal assessment findings - cholecystitis
RUQ pain, Murphy sign
Murphy sign - pain on inspiration from palpation of gallbladder
Abnormal assessment findings - splenomegaly
Enlarged spleen
causes: inflammation, HIV, splenic infarct, Mono, trauma, malaria
Abnormal assessment findings - pancreatitis
LUQ pain, radiates to back, mid-epigastrium, left scapula
aggravated by eating, severe nausea and vomiting
Abnormal assessment findings - gastric ulcer
ask if they take anything to help?
stomach
pain is dull, brought on by food; radiates to back
Abnormal assessment findings - gastritis
inflammation of stomach lining
gnawing or burning feeling in the upper abdomen; LUQ
Abnormal assessment findings - gastroenteritis
Small intestine
Diffuse abdominal pain; ask for pain rating on pain scale
caused by Norovirus
nausea and vomiting
Abnormal assessment findings - ascites
fluid accumulation
rigid/taut
increased girth
fluid shift
can be very hard depending on amount of fluid and tightness
measure to see if abdomen is growing in size
can trigger other conditions in patient
ask: are you in pain? how long? have you sought help for this before?
Abnormal assessment findings - distended abdomen
can be caused by: obesity, pregnancy, ovarian cyst, ascites, tumor, stool, gas/air
Abnormal assessment findings - distended abdomen - the F’s (she listed in class)
Fluid
Feces
Full bladder
Flatulence
Fetus
Fatal tumor
Fatal feces
Fat
Abnormal assessment findings - intestinal obstruction
fever, vomiting
absent stool/gas passage
pain above obstruction
hyperactive bowel sounds initially, then hypoactive or absent
abdomen tender to touch
distended abdomen
abdominal surgery
Abnormal assessment findings - large bowel obstruction
bloating, gradual onset of pain
can rupture internally – feces in abdominal cavity
vomiting
hypoactive bowel sounds
5 questions to ask patient beginning of abdominal assessment
- Have you recently had any nausea or vomiting?
- Have you had any abdominal surgery?
- What is your dietary pattern like? How often do you eat meals?
- Are you currently having any abdominal pain/tenderness?
- When was your last bowel movement? Color/form
Describe Bruits and the cause
Turbulent sounding caused by stenosis of the Aorta
Palpation- expected findings
Nontender with relaxed muscles
