What is the Abdomen?
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Large oval cavity
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Extends from the diaphragm down to the brim of the pelvis
Review of Structure & Function
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Viscera - All internal organs
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Solid viscera
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liver pancreas spleen adrenal glands ovaries and uterus
Hollow viscera
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stomach, gallbladder, small intestine, colon and bladder
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shape of the hollow viscera depends on its contents.
Abdominal cavity
Abdominal Quadrants
Costovertebral Angle
Abdominal Region Names
Questions to ask/ Subjective Data
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Changes in appetite?
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Any difficulty swallowing?
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Any food intolerances?
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Complaints of abdominal pain?
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Any nausea or vomiting?
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Ask about bowel habits.
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Ask about past abdominal history.
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Any medications?
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Nutritional assessment via 24-hour recall.
Past Medical History
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Gastrointestinal disorders
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Hepatitis or cirrhosis of liver
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Abdominal or urinary tract surgery
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Urinary tract infections
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Major illness
Personal and Social History
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First day of last menstrual period
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Alcohol intake
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Recent stressful event
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Exposure to infectious diseases
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Trauma
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Use of street drugs
Cultural Consideration
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Lactose Intolerance
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Incidence is 70% to 90% in blacks, Native Americans, Asians and Mediterranean groups
Objective Data
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Inspection
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Auscultation
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Percussion
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Palpation
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Special procedures
Prepare for the Assessment
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Expose only the abdomen
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Encourage patient to empty bladder
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Avoid placing arms over the head
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Exam painful areas last
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Use distraction for relaxation
Inspect
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Skin…color, scars, veins
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Contour (describe)
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Flat, Scaphoid, Rounded, Protuberant
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Symmetry
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Umbilicus
Cullen’s Sign… Bluish Discoloration
Inspection Continued…
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Generalized skin color changes
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Pulsation or movement
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Umbilicus/umbilical hernia
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Bleeding
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Stretch marks
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Lesions and nodules
Auscultate
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Bowel sounds
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Vascular sounds
Auscultation is done first,
because percussion and palpation
can increase peristalsis,
which would give false bowel sounds
Auscultation cont.
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Where to listen
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Listening for bowel sounds to assess motility
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Normal sounds are irregular clicks and
gurgles --- 5-30 times per minute
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Abnormal sounds--- hypoactive or silent sounds
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Must listen for 5 minutes before declaring absent
Bowel Sounds
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Hypoactive bowel sounds
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Signal decreased motility
Hyperactive bowel sounds
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Signal increased motility
More on Auscultation
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Increased bowel sounds are due to hypermotility of peristalsis
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Decreased are due to paralytic ileus or peritonitis
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Intestinal obstruction can present with increased or decreased sounds
Vascular Sounds
Percuss
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General tympany
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Liver span
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Splenic dullness
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Costovertebral angle tenderness
Liver Spans
Splenic Dullness
Splenomegaly
Costovertebral Angle Tenderness
Special Procedures
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Two procedures used to differentiate ascites from gaseous distention:
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Fluid Wave
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Shifting Dullness
Ascites
Palpate
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Light Palpation
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Using first 4 fingers, depress skin 1cm
Deep Palpation
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Depress skin 5 to 8cm (2 to 3 inches)
Light Palpation
Palpating the liver
Palpating the Spleen
Palpating the Kidneys
Palpating the Aorta
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Normally it is 2.5cm to 4cm wide in the adult
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Aorta may be widened with aneurysm
Sites for Referred Abdominal Pain
Friction Rub and Vascular Sounds
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Peritoneal friction rub
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Rough, grating sound indicating peritoneal inflammation
Vascular sounds
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Arterial
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Venous
Abnormalities on Palpation
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Enlarged liver
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Enlarged nodular liver
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Enlarged gallbladder
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Enlarged spleen
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Enlarged kidney
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Aortic aneurysm
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Special Procedures
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Rebound tenderness (Blumberg’s sign)
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Inspiratory arrest (Murphy’s sign)
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Used to assess peritoneal inflammation accompanied with appendicitis
Used to assess for inflammation of gallbladder
Iliopsoas muscle test
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Used to assess for appendicitis
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Obturator test
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Used to assess for appendicitis
Summary of Assessment
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Inspect contour, symmetry, umbilicus, skin, pulsations, hair and demeanor
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Auscultate bowel sounds and vascular sounds
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Percuss all four quadrants, liver and spleen
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Palpate all four quadrants, liver, spleen and kidneys