Week 8 - Abdominal Assessment Flashcards
Solid Viscera
Organs that maintain characteristic shape
Palpable
Hollow Viscera
Shape depends on the contents
Not usually palpable
Examples of Solid Viscera (7)
Liver Pancreas Spleen Adrenal glands Ovaries Uterus Aorta
Examples of Hollow Viscera (5)
Stomach Gallbladder Small intestine Colon Badder
Considerations for Infants and Children (4)
- Larger liver: can be palpable lower than right costal margin
- Bladder is higher, found closer to the umbilicus
- Abdominal wall is less muscular, easier to palpate
- Increased risk for GI illness
Considerations for Pregnancy (5)
- Nausea/vomiting
- Acid indigestion: elevated levels of progesterone relax smooth muscle which slows motility, also pressure from growing fetus
- Constipation (also because of reduced motility)
- Diminished bowel sounds: the uterus pushes intestines up and back
- Skin changes on the abdomen
- Striae
- Linea nigra
Considerations for Older Adults (7)
- Adipose tissue redistribution to abdomen and hips
- Abdominal muscle relaxation
- Decreased salivation (dry mouth)
- Decreased gastric acid secretion (absorption of oral medication is delayed)
- Liver size decreased
- Decreased renal functioning (risk of increased toxicity of meds)
- Increased incidence of gallstones and colorectal cancer
Components of Subjective Assessment (10)
- Appetite
- Dysphagia (difficulty swallowing)
- Food intolerance
- Abdominal pain
- Nausea/Vomiting
- Bowel habits
- Past abdominal history
- Medications
- Alcohol and Tobacco use
- Nutritional assessment (24-hr recall)
Components of Objective Assessment
IAPP (auscultation is first because palpation can promote peristalsis = skewed findings)
Inspection of abdomen (7)
- Contour: flat, scaphoid, rounded, protuberant
- Symmetry
- Umbilicus
- Skin
- Pulsations or movement
- Hair distribution
- Demeanor
Auscultation of abdomen
Bowel sounds (air and fluid through intestine)
Vascular sounds - listen for bruits (turbulent blood flow)
- Aorta
- Renal arteries
- Iliac arteries
- Femoral arteries
Types of bowel sounds
- Hypoactive (diminished, decreased motility)
- Hyperactive (increased, increased motility)
e. g., Borborygmus (tummy growl) - Absent
e. g., Paralytic ilieus (nothing moving in intestines)
Borborygmus
Hyperactive bowel sound, tummy growl
Percussion finding of the stomach
General tympany
Special percussion tests
Hepatomegaly
Splenomegaly
Inflammation of the Kidney
Costovertebral Angle Tenderness
Hepatomegaly percussion tests
Liver span test
Scratch test
Splenomegaly percussion tests
Splenic Dullness
Light Palpations
Depress in 1cm
Forming an overall impression
Deep Palpations
- Depress in 5-8cm
- Use one hand or two
- Noting location, size, consistency, mobility or organs/masses, enlargement of organs, tenderness
Bloomberg’s Sign
Tests for appendicitis
Push on location of appendix, remove hand quickly
If pain = positive for appendicitiy
Iliopsoas muscle test
Lift pt leg up, we try to push down, pain = positive
Murphy’s sign
Push down on liver margin
Take deep breath
If it’s in pain, then gallbladder is inflamed
Ascites
Excess fluid in periteal cavity
Fluid wave
Visceral Pain
Pain from visceral organ, over distended or stretched, hard to find or localize… “all over”, annoying, burning, cramping
Parietal Pain
Originates in parietal peritoneum (sharp, steady pain) and right over the organ.
Aggravated with movement and coughing.
Guarding of abdomen.
Referred Pain
Radiating pain at another structure innervated at same spinal level as the inflamed organ.
Abdomen is often the site of referred pain from other structures.
Hematemesis
Blood in emesis
Looks like blood or coffee grounds
Melena stool
Tarry stool
Signals upper GI bleed
Frank blood
red blood, lower GI bleed
Hernia
protrusion of abdominal visceral through abdominal wall
Three types of hernias
- Umbilical hernia
- Incisional hernia
- Inguinal hernia
