Abdominal Assessment Flashcards
bowel sounds
abdominal sounds caused by the products of digestion as they move through the lower gastrointestinal tract, usually heard on auscultation
linea alba
tendinous seam that joins the 4 layers of large, flat muscles forming the ventral abdominal wall at the midline
skin turgor
refers to the elasticity of the skin; its ability to change shape and return to normal and used to determine the extent of dehydration by pinching
light palpation
detects surface characteristics and accustoms the person to being touched
- with the first four fingers close together, depress the skin approximately 1 cm and make a gentle rotary motion, sliding the fingers and skin together; then lift the fingers (do not drag them) and move clockwise to the next location around the abdomen (objective is to form an overall impression of the skin surface and superficial musculature)
deep palpation
similar to light palpation but with pushing down 5-8 cm, assesses an organ or mass deeper in a body cavity
rectus abdominus
forms a strip extending the length of the midline and its edge is often palpable; the muscles protect and hold the organs in place, and they flex the vertebral column
bruits
vascular sound associated w/ turbulent blood flow
dehydration
excessive loss of fluid in the body
friction rub
rough, grating sound, like 2 pieces of leather rubbed together, indicating peritoneal inflammation (can occur over liver or spleen as a result of abscess, infection or tumour)
what are the abdominal surface landmarks?
borders of the abdominal cavity, abdominal muscles and linea alba
what are the 4 abdominal quadrants?
RUQ, LUQ, RLQ, LLQ
what are the solid viscera of the abdomen?
liver, spleen, pancreas, adrenal glands, kidneys, ovaries, uterus
what are the hollow viscera of the uterus?
stomach, gallbladder, small intestine, colon and bladder
abdominal anatomy: developmental considerations for infants and children
prominence of umbilical cord containing 2 arteries and a vein, liver and urinary bladder position, abdominal wall less muscular, risk for GI illness and dehydration related to diarrhea and vomiting
abdominal anatomy: developmental considerations for pregnant women
morning sickness, heartburn, constipation and decreased bowel sounds, hemorrhoids, intestines pushed upward and posteriorly
abdominal anatomy: developmental considerations for older adults
suprapubic fat accumulation in women, abdominal accumulation in men, decreased salivation/gastric acid secretion, delayed esophageal emptying (risk of aspiration), more susceptible to dehydration, decreased liver size and increased gallstones, decreased renal function (adverse or toxic drugs effects), constipation, increased risk of colon cancer
cultural and social consideration
increasing rates of obesity, prevalence of lactose intolerance, rates of celiac (autoimmune), GERD, peptic ulcer disease, inflammatory bowel disease (early age at onset for Crohn’s), relationship of hepA and GI illnesses to socioeconomic factors
what should you ask for in the abdominal health history?
appetite, diet & nutritional assessment, dysphagia, food intolerance, abdominal pain, nausea/vomiting, bowel habits, past abdominal history, medications, alcohol and tobacco, impact on daily life
preparations for the abdominal physical exam
lighting and draping, raise bed, measures to enhance abdominal wall relaxation (warm room, knees bent on pillow, arms at sides), equipment needed (stethoscope, alcohol swab)
what is the order of abdominal assessment?
inspection, auscultation, percussion, palpation
what do you inspect during an abdominal exam?
skin colour, moles, lesions, scarring, pulsation/movement, hair distribution, contour, symmetry, umbilicus, demeanor & facial expression
what do you auscultate during an abdominal exam?
bowel sounds, vascular sounds (bruits)
how to listen for bowel sounds
use the diaphragm, press lightly, start in RLQ and listen in all4 quadrants, zigzag across abdomen, note character and frequency (high pitched gurgling, irregular 5-30 times/min)
why is auscultation done before percussion and palpation?
so bowel sounds are not altered by promoted peristalsis through palpation
percussion in the abdominal assessment
percussion identifies abdominal contents, locates organs, screens for fluid and masses
- move clockwise
- general tympany
what does palpation assess in the abdominal assessment?
texture, temperature, moisture, swelling, rigidity, pulsations, tenderness/pain, masses
voluntary guarding
a deliberate muscle wall contraction; occurs when the person is cold, tense, or ticklish, is bilateral, and you will feel the muscles relax slightly during exhalation
rebound pain
discomfort or tenderness that occurs with sudden release of pressure; a clinical sign of appendicitis
if you identify a mass, note:
location, size, shape, consistency, surface, mobility, pulsatility, tenderness
abdominal assessment: developmental considerations for infants and children
newborns: inspect umbilical cord, umbilical hernia, diastasis recti, movemment w/ respirations, differences in percussion and palpation, meconium
abdominal assessment: developmental considerations for children
protuberant abdomen, positioning for palpation, use objective signs to aid assessment
abdominal assessment: developmental considerations for older adults
increased fat deposits on abdomen and hips, thinner abdominal musculature, organs easier to palpate
referred liver pain
RUQ or epigastrium
referred esophageal pain
midepigastrium or lower sternum
referred gallbladder pain
Right or left scapula
referred pancreatic pain
midepigastric, radiating to back
referred stomach pain
epigastric, radiates to back or substernal
referred appendix pain
periumbilical, shifts to RUQ
referred kidney pain
Flanks or lower abdominal
referred small intestine pain
diffuse abdominal
referred colon pain
lower abdomen
