Abdominal Assessment 2 Flashcards
approach to exam of abdomen
Empty bladder (full bladder alters percussion); Expose abdomen—xyphoid to iliac crests; Observe facial features; want pt supine
Sequence change of abdomen exam—
inspect, auscultate, percuss, palpate last; because you don’t want to alter bowel sounds
F’s of abdominal distention
(why is abdomen distended?) 1. fat 2. fluid 3. feces 4. fetus 5. flatus 6. fibroid 7. full bladder 8. false pregnancy 9. fatal tumor
inspection of abdomen
Contour; Scars, Striae, Rashes, Lesions; Umbilical area—discharge, irritation; Epigastric pulsation; Hernia; Veins; Flank area
contour
symmetry, flat, rounded, protruding, scaphoid, sunken, F’s of abdominal distention (look for rounded or concave)
Epigastric pulsation
pronounces pulse
hernia
(damage of muscle cell wall, so weaken wall causes protrusion) umbilical, inguinal, incisional
veins inspection
spider around umbilicus shows liver failure
flank area
—ecchymoses; gray turner’s sign -pancreatitis, or extra parietal bleeding
cullen’s sign
bluish color around umbilicus, illeuspancreatitis, intra parietal blood
auscultation
Diaphragm all four quadrants; Assess for bowel motility & peristalsis - High-pitched gurgles, 5-30 per minute or one every 5-15 seconds, Increased over ileocecal valve after eating, Listen 5 minutes before stating absent sounds
auscultation should start
where illeical value is, RLQ where hear bowel sounds the loudest, move clockwise
normal amount of bowel sounds per minute
5-30 every minute
hyperactive bowel sounds
greater than 30/min; Borborygmi
Borborygmi—
excessive sounds, hear without stethoscope (stomach growling)
hyperactive bowel sounds
less than 5/min, widely separated; Paralytic ileus; decrease peristalsis so decrease blood, fluid, slowing of bowel
Paralytic ileus—
pinging, high pitched sound
if twinkling bowel sound
illeus is developing, will show up on xray, often missed in the hospital
Vascular sounds—
bruits; Aorta, Renal artery, Iliac artery, Femoral artery (turbulent blood flow)
Venous Hums—
increase portal circulation, heard best over RUQ (liver)
auscultate over liver and spleen for
friction rub
for percussion ask pt
if they have any pain and do that area first
when percussing start with
at 3rd intercostal space and go down
scratch test
gently scratch and once the sound is louder know at the border of the liver
percussion
Assess for fluid, air, organs (size & tenderness), or masses; Tympany in varying degrees is most common finding; Dullness is heard over organs, masses, fluid
liver span -
use MCL—upper border 5-7th ICS and lower border just at costal margin; Usually 6-12 cm
Costovertebral angle—
kidney tenderness; in lower back over kidneys (Pt sitting up right, used for kidney stones)
light palpation
(1-2 cm) to assess superficial and surface characteristic and areas of tenderness—use one hand
deep palpation
(4-6 cm) to assess organs, masses and deeper pain—use two hands; can actually feel liver, feeling for smoothness and checking for masses/ tenderness
observe _____ palpating
face
don’t palpate on
organ transplant pt, child, tumor, or severe injury, can cause more damage
start palpations
RLQ then work around in circular motion
what can’t you palpate
left kidney
palpate bladder for
fullness
after palpating abdomen
palpate for aorta
if pt in pain when palpating
then pillows beneath knees, take deep breaths when exhale then palpate
Palpation Considerations
Bladder distention, Peritonitis (surgical pts/ dialysis pts), McBurney’s point, Murphy’s sign, Rebound tenderness, Ascities (free fluid - fluid overload), Referred pain, Abdominal Reflexes
common labs
basic metabolic channels, glucose, BUN, scope, CT scan, MRI, electroyltes, colon scope, A1c, peptic ulcers - H pylori, EKG
common abnormalities
Abdominal Aortic Aneurysm, Appendicitis, Cancer, Cholecystitis, Hepatitis, Cirrhosis, Diverticulitis, Hernias, Inflammatory diseases, Pancreatitis, Ulcer
