Abdomen- Ch. 21 Flashcards
(30 cards)
Liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus are examples of?
Solid viscera
Stomach, gall bladder, SI, colon, bladder are examples of?
Hollow viscera
What are the divisions of the abdomen?
RUQ
LUQ
RLQ
LLQ
What is the proper way to complete an abdominal assessment?
Systematic starting with RLQ and going clockwise
Proper steps of abdominal assessment?
Inspect
Auscultation
Percussion
Palpation
Why do we palpate and Percussion last?
Because we may activate/ disrupt bowel sounds
Subjective data: health history questions
- change in appetite, anorexia nervosa
- dysphagia?
- abdominal pain? History of GI issues?
- N/V?
- bowel habits?
- medications?
- nutritional status?
Objective Data: the physical exam
- enhance relaxation- easier to inspect abdominal muscles
- determine if there is any pain before beginning the exam
The aging adult
- delayed esophageal emptying= ⬆️ risk for aspirations
- ⬇️ gastric secretions, pernicious anemia, CA+ absorption may be altered
- coughin while eating? Swallow test
- ⬆️incidence of gall stones
- ⬇️ liver size after 80
👀Inspection: inspect the patient abdomen lying down with arms at their sides, relaxed position
Inspect contour (flat, rounded, scaphoid, protuberant)
Symmetrical both sides?
Umbilicus- midline (invented or everted-pregnant/acites)
Skin assessment- presence of striae
Pulsation or movement- peristalsis, aortic pulse can be normal but can also indicate and aneurysm- seen in pregnant women and very thin people
What is striae?
Silvery white, elastic fibers break down causing stretch marks
Pregnancy
Acites
After large weight loss
What are we assessing/inspecting for?
Abdominal distention Buldges Maas Hernias Obesity Air/gas Acites Presence of feces
👂🏻Auscultation: listening for bowel sounds, movement of air and fluid thru the small intestine
Use diaphragm and hold lightly
Note character and frequency of sounds
Bowel sounds
Normal- high pitch, gurgling, cascading, irregular sounds, heard 5-30 times per minute
Hypoactive- <30 sounds per minute( diarrhea, bowel obstruction)
Absent- must listen for 5 minutes to make this determination (usually post surgery-NPO-ileocecal valve)
Auscultate for vascular sounds
Use the bell of stethoscope to listen (low pitched sounds)
- aortic, renal, iliac (bilaterally)
- normal not to hear anything, may hear heart beat especially when listening for abdominal bruit.
- bruit- swooshing sound also heard in the heart of a murmur is present
Aortic artery
Midline, above umbilicus
Renal artery
Above umbilicus, lateral to midline
Iliac artery
Below umbilicus, lateral to midline
👆🏻Percussion- assessing for density, size, location of organs and any masses or fluid
*tympany- should be the dominant sound produced
Dull sound over organs (liver)
Flat sound over bone
*follow a system- RLQ, RUQ, LUQ, LLQ
Palpation ✋🏻
Last step in abdominal assessment
- when palpating- palpate in each quadrant and go clockwise, it follows the patterns of the intestines, 4 fingers close together
- ask about pain or tender areas and palpate them last
- start with light palpation(1cm) and move to deep (5-8cm)
- to palpate liver have patient bend knees to relax
Abdominal distention
-common reasons
Obesity Air/gas Ascites Ovarian cyst Pregnancy Feces Tumor
3 types of hernias?
Umbilical
Epigastric
Incisional
Umbilical hernia
Protrusion of omentum or intestine thru a weakness of closure of the umbilical ring “outie”
Epigastric hernia
Protrusion of the abdominal structures presenting a small fatty nodule at epigastric in midline thru the linea Alba muscle
