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