Assessing the Abdomen Flashcards
abdomen anatomy
four quadrants. abdominal wall muscles
four quadrants
RLQ, RUG, LLQ, LUQ
Abdominal wall muscles - three layers
external abdominal oblique (outer), internal abdominal oblique (middle), transverse abdominis (inner layer)
internal anatomy
peritoneum - thin shiny serous membrane, lines abdominal cavity, provides protection of internal abdominal organs
solid viscera
liver, pancreas, spleen, kidneys, uterus, ovaries
pancreas
not normally palpable, endocrine gland, accessory organ of digestion
spleen
not normally palpable, filter blood of cellular debris, digest microorganisms, return breakdown products to liver
kidneys
filter blood
Hollow viscera
stomach, gallbladder, small/large intestine, urinary bladder
What do hollow viscera do?
store things for the body
vascular structures
perfusion by abdominal aorta/major branches, pulsations of aorta frequently visible/palpable midline in upper abdomen, pulsations of right/left iliac arteries may be felt in RLQ/LLQ
History of present concern
any abdominal pain (COLDSPA), indigestion (COLDSPA), n/v - triggers, increase/decrease in appetite - weight/BMI change/extended illness causing weight increase/decrease, yellowing of skin/sclera - jaundice, bowel elimination
bowel elimination
describe stools, change in pattern, constipation/accompanying symptoms, diarrhea/accompanying symptoms, clay colored stool - liver disease
Personal health history
any GI disorders, UTIs, viral hepatitis - abc, surgery/trauma, OTC
Family history
GI cancer, other GI disorders
lifestyle
alcohol, types of food, exercise, stress - affect eating/elimination, current GI disorder/how affecting lifestyle
abdominal pain terms
visceral, parietal, referred pain
visceral pain
when hollow abdominal organs become distended or contract forcefully, or capsules of solid organs stretched. poorly defined - dull, aching, burning
parietal pain
parietal peritoneum becomes inflamed. ex: appendicitis or peritonitis - localized, severe, steady
referred pain
distant sites that are innervated at approximately same levels as disrupted abdominal organ, travels from primary site to become highly localized at distant site
physical assessment
routine screening. inspection, auscultation, percussion, palpation
Routine screening includes
observe color, vascularization, scars, rashes, lesions of abdomen, observe umbilicus, abdominal contour/symmetry, aortic pulsations/peristaltic waves, auscultate bowel sounds, percuss four quadrants, lightly palpate four quadrants
inspection
observe color, note vascularity, note striae, scars, lesions/rashes, umbilicus should be midline at lateral line, contour of umbilicus, abdominal contour, abdominal symmetry - supine, signs of hernia/mass/diastasis recti - raise head, abdominal movement when breathing, aortic pulsations, peristaltic waves
new striae are
pink or blue
old striae are
silvery, white, linear, uneven stretch marks
Abdominal contour
flat, rounded, scaphoid, should be evenly rounded
Aortic pulsations
slight pulsation of abdominal aorta in epigastrium full length in thin people
Peristaltic waves
normally not seen, maybe if thin, abnormal in LUQ or RLQ - obstruction
Auscultate bowel sounds
diaphragm of stethoscope, warm, start RLQ/proceed clockwise, 5 min before document no bowel sounds, minimum 1 min per quadrant to confirm no bowel sounds, normally every 5-15 sec. note intensity, pitch, frequency
Auscultate vascular sounds
bell, listen for bruits (abnormal), auscultate abdominal aorta/renal/iliac/femoral arteries
Listen for venous hum
bell, epigastric/umbilical areas
Listen for friction rub
over liver and spleen, use diaphragm, over right/left lower rib cage
percussion
lightly/systematically through all quadrants, determine span and height of liver by determining upper/lower borders - normal decreases after 50, spleen dullness should be noted left 10th rib/slightly posterior to MAL. blunt percussion on liver/kidneys
Blunt percussion on liver and kidneys
assess for tenderness, over CVA - costovertebral angles
palpation
light, deep, bladder
light palpation
abdomen should be non tender/soft
deep palpation
all four quadrants, detect subtle masses, mild tenderness normal over diploid, aorta, cecum, sigmoid colon, ovaries
palpate for
masses, umbilicus/surrounding for swelling, bulges, masses, palpate aorta, liver/spleen/kidneys - rarely palpable
palpate bladder
empty not palpable or tender, distended smooth/round/firm
Blumberg sign
abdominal pain/tenderness when examiner tests for rebound tenderness - palpate at 90 degrees into abdomen halfway between umbilicus/anterior iliac crest
signs
psoas, obturator, murphy, rovsing
Psoas sign
pain in RLQ when leg hyperextended, appendicitis
Obturator sign
pain in RLQ when hip/knee are flexed, leg rotated internally/externally, irritation of obturator muscles due to appendicitis or perforated appendix
Murphy sign
pain when pressure applied under liver border at right costal margin and client inhales deeply, inflammation of gallbladder
Rovsing sign
pain in RLQ during pressure in LLQ, acute appendicitis
