Test 2: Abdominal Assessment Flashcards
Abdominal assessment consists of what components
preparation and positioning
observation
auscultation
percussion
palpation
neuro tests
prep/positioning for abdominal assessment
empty bladder
supine with UEs at side
stand at patients R side
be able to view pt facial expression
what are the 2 quadrants above and below the umbilical middle quadrant referred to as
above = epigastric
below = hypogastric
what is in the LUQ
spleen
stomach
aorta
pancreas
transverse colon
what is in the RUQ
liver
gallbladder
R kidney
duodenum
what is in the RLQ
ascending colon
iliac artery
cecum
appendix
bladder
what is in the LLQ
descending colon
sigmoid colon
bladder
what asymmetries might you find with observation
surface contour= distension could be bowel obstruction, mass, etc
swelling or ascites = possibly indicated by inverted umbilicis
umbilicis should be midline
discoloration may indicate
jaundice with liver dysfunction
ecchymosis indicating bleeding
vein distension indicating liver or vena cava obstruction
marking you may look for
scars
rashes
stretch marks
pulsatile mass may indicate
abdominal aortic aneurysm
not unusual on lean individuals though
what is peristalsis
wavelike motion that may indicate intestinal obstruction
what might indicate a hernia
sudden bulging with lifting head or a cough could indicate hernia
when/how long to perform auscultations
perform before percussion and palpation to avoid altering the bowel sounds
utilize stethescope for 2 min in each quadrant
what is normal and abnormal for bowel sounds
normal = high pitch clicks and gurgling every 5-10 sec
abnormal= non indicating bowel obstruction, particularly with cramping OR more sounds may indicate overactivity like with lactose intolerance
what are you listening for/where is the abdominal aorta
just L of midline and umbilicus at peri sternal line
bruits indicate turbulent blood flow
what is the procedure for percussions
hyperextend and apply firm pressure with non-dominant and distal aspect of middle finger
avoid contact anywhere else
position dominannt hand close to surface with extended wrist
strick non-dominant middle finger with flexed dominant middle finger
strike twice
normal sounds for percussion
tympanic or hollow sound over stomach and bowels or more air filled organs unless full of “substance”
deep resonance or lasting sound over thorax/lungs
dullness over more solid or full organs (i.e. heart, diaphragm, or spleen)
where to percuss the stomach
closer to the L rib cage just inferior to the sternum
tympanic or hollow sound if empty; otherwise dull if full
where to percuss the liver and findings
just above umbilicis along mid clavicular line
progress superiorly
starts with tympany or hollow sound
changes to dullness at liver (2.5-5 in)
resonance of lung tissue begins superior to liver
abnormal = large area of dullness
where to percuss the spleen
starts at L lower rib cage anterior to axillary line
tympany or hollowness should be produced
move posteriorly toward mid axillary line; should become dull
dullness should be present between 9th and 11th ribs
abnormal = dullness found more medially and inferiorly or mull dullness while inspiring
what is murphy test
percussion in sitting or prine with firm fist thumping on contralateral flat hand over costovertebral angle looking for pain
how to perform palpations
start at firm light pressure in slow circular fashion with each quadrant
broad hand contact and possibly palpate through pt’s hand
forearm in same plane as abdomen
if no resistance or symptom provocation apply deeper pressire
also look for masses/guarding
normal = pressure
abnormal palpation findings
tender/muscle guarding = swelling/dysfunction
confirm similar response with cough/percussion
progress to rebound tenderness if necessary by applying pressure then quick release
crepitus/crunchiness = excess air
hernias common around inguinal/umbilical regions
mass or cyst may be palpated
