Abdominal Assessment Flashcards
Right Upper Quadrant
liver gallbladder right kidney part of ascending colon head of pancreas
Right Lower Quadrant
appendix
cecum
right ureter
Left Upper Quadrant
stomach spleen left lobe of liver body of pancreas left kidney part of descending colon
Left Lower Quadrant
part of descending colon
sigmoid colon
left ureter
Midline
aorta
uterus (if enlarged)
bladder (if distended)
three region of the abdomen
epigastric - between costal margins
umbilical - around umbilicus
hypogastric/suprapubic - area above pubic bone
rectus abdominus
strip of muscle that extends the length of the midline
linea alba
where the four layers of large, flat muscles join
External obliques
Internal obliques
Transversus
three anterolateral abdominal wall muscles
aponeurosis
sheet of pearly-white fibrous tissue that attach sheet0like muscles
parietal peritoneum
visceral peritoneum
parietal - outer layer touching abdo wall
visceral - inner layer touching internal organs
solid viscera
maintains shape
- liver
- pancreas
- spleen
- adrenal glands
- kidneys
- ovaries
- uterus
- aorta
hollow viscera
shape depends on content
(not palpable unless full)
- stomach
- gallbladder
- small intestines
- colon
- bladder
Dev Considerations - infants and children
- larger liver
- bladder is higher (closer to umbilicus)
- abdo wall less muscular
- increased risk for GI illness (immune system not fully developed until 5-6 years of old)
Dev Considerations - pregnancy
- nausea/vomiting
- acid indigestion
- constipation
- diminished bowel sounds (decreased motility and peristalsis, displaced upwards and back)
- skin changes (striae, linea nigra)
Dev Consideration - older adults
- adipose tissue redistribution to abdo and hips
- abdo muscles relax
- decreased gastric acid secretion
- decreased liver size
- decreased renal function
- increased incidence of gallstones and colorectal cancer
Subjective Assessment
a. appetite
b. dysphagia
c. food intolerance (pyrosis)
d. abdominal pain
e. nausea/vomiting (hematemesis - blood present)
f. bowel habits
melena stool
- black and tarry stool, upper GI tract bleeding
frank blood
- bright red blood, lower GI tract bleeding
g. past abdominal history
(IBD - increase risk of colon cancer, IBS - does not cause lasting damage, colorectal cancer, FAP)
h. medications
i. alcohol/tobacco
j. nutritional assessment
pyrosis
heartburn caused by reflux of gastric content
visceral pain
Pain from organ
- usually contracting
- difficult to localize
- aching, burning, cramping
- mark pallor and sweating when severe
parietal pain
Inflammation in parietal peritoneum, usually originats from specific organ
- precisely localized pain
- sharp, severe, stabbing
- unable to move, guarding
referred pain
Referring to another region but originates from abdomen
- precisely localized and consistent
- structures innervated at same spinal level
Familial adenomatous polyposis (FAP)
polyp forming mainly in the epithelium of large intestine
- untreated can develop into colon cancer
Objective Assessment - Inspection
a. contour (flat, rounded, scaphoid, protuberant - ascites)
b. symmetry
c. umbilicus (inverted, midline, everted - mass underneath)
d. skin
e. pulsations or movement (aorta or peristalsis)
f. hair distribution
g. demeanor (in pain, relaxed)
hernia
umbilical hernia - at umbilicus
incisional hernia - from incision
inguinal hernia
diastasis recti
separation of abdominal wall muscles as abdomen expands - in pregnancy
Objective Assessment - Auscultation
a. bowel sounds (hypoactive, hyperactive, absent)
- all four quadrant
b. vascular sounds (if bruit, do not palpate)
- aorta
- renal arteries
- iliac arteries
- femoral arteries
borborygmus
hyperactive sounds heard when hungry
Objective Assessment - Percussion
a. all four quadrant
- general tympany should be heard
(dullness - distended bladder, fluid, mass)
(hyperresonance - gaseous distension)
Special Percussion Tests
- to detect hepatomegaly
Liver Span
Scratch Test
- to detect splenomegaly Splenic dullness (percuss 9th-11th intercostal space)
- inflammation of the kidney
Costovertebral angle tenderness (percuss angle between spine and rib)
Objective Assessment - Palpation
a. masses, enlargement of an organ, tenderness
b. light palpation
depress in 1 cm using all 4 fingers
c. deep palpation
depress in 5-8 cm using one hand or two
- location, size, consistency, mobility, masses, enlargement of organs, tenderness
Normally palpable structures
a. Xiphoid process
b. Normal liver edge
- deep palpation
c. Pulsatile aorta
- relaxed abdominal muscles
- using thumb and forefinger, 2.5-4cm
d. Rectus muscles
e. Uterus (gravid)
f. Full bladder
When can the spleen be felt?
enlarged to three times its size
left hand across to back between 11th and 12th rib, right hand just under rib margin toward axilla
aortic aneurysm
abnormal bulge in aorta
Special Tests
a. Appendicitis
Blumberg’s sign (rebound tenderness)
Iliopsoas muscle test (supine, light right leg straight up flexing at hip, push down over lower thigh while person tried to hold leg up)
b. Gallbladder inflammation
Murphy’s sign (deep breath with holing fingers under liver border)
c. Ascites
Fluid Wave (ulnar edge of hand down midline, place one hand on one side and strike firmly with other hand on other side)
Shifting Dullness
