Chapter 17 Abdomen Copyright 2002, Delmar, A division of Thomson Learning Competencies Identify the physiological function of the gastrointestinal organs. Assess the health status of a patient with a gastrointestinal complaint. (continues) Copyright 2002, Delmar, A division of Thomson Learning Competencies Demonstrate the techniques of gastrointestinal assessment. Relate abnormal physical gastrointestinal findings to pathological processes. Outline the gastrointestinal variations associated with the aging process. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Abdominal cavity Peritoneum Abdominal vasculature Abdominal quadrants Right upper Right lower Left upper Left lower (continues) Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Stomach Small intestine Large intestine Liver Gall bladder (continues) Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Pancreas Spleen Veriform appendix Kidneys, ureters, and bladder Lymph nodes Copyright 2002, Delmar, A division of Thomson Learning Health History Patient profile Age Child to young adult: appendicitis Adult: peptic ulcers, cholecystitis, DM, gastrointestinal malignancies Gender Female: gallbladder disease Male: GI cancers, cirrhosis, duodenal ulcers Copyright 2002, Delmar, A division of Thomson Learning Common Chief Complaints Nausea and vomiting Anorexia Dysphagia Diarrhea or constipation (continues) Copyright 2002, Delmar, A division of Thomson Learning Common Chief Complaints Abdominal distension Abdominal pain Increased eructation or flatulence Dysuria Nocturia Copyright 2002, Delmar, A division of Thomson Learning Characteristics of Chief Complaint Quality Associated manifestations Aggravating factors Alleviating factors Timing Copyright 2002, Delmar, A division of Thomson Learning Past Health History Medical Abdomen specific Nonabdomen specific Surgical GI procedures Copyright 2002, Delmar, A division of Thomson Learning Common Medications Histamine: two antagonists Antibiotics Lactulose Antacids Antiemetics (continues) Copyright 2002, Delmar, A division of Thomson Learning Common Medications Antidiarrheals Laxatives or stool softeners Pancreatic enzymes Steroids Chemotherapeutics Antiflatulents Copyright 2002, Delmar, A division of Thomson Learning Past Health History Communicable diseases Allergies Injuries/accidents Family health history Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis Copyright 2002, Delmar, A division of Thomson Learning Social History Alcohol use Drug use Travel history Work environment Hobbies/leisure activities Stress Economic status Copyright 2002, Delmar, A division of Thomson Learning Health Maintenance Activities Sleep Diet Exercise Stress management Use of safety devices Health checkups Copyright 2002, Delmar, A division of Thomson Learning Past Health History Allergies Injuries/accidents Family health history Social history Health maintenance activities Copyright 2002, Delmar, A division of Thomson Learning Assessment of the Abdomen Equipment Order Inspection Auscultation Percussion Palpation Copyright 2002, Delmar, A division of Thomson Learning Inspection Contour Symmetry Rectus abdominis muscles Pigmentation and color Scars (continues) Copyright 2002, Delmar, A division of Thomson Learning Inspection Striae Respiratory movement Masses or nodules Visible peristalsis Pulsation Umbilicus (continues) Copyright 2002, Delmar, A division of Thomson Learning Inspection Normal findings Abdomen is flat or round, symmetrical Uniform in color and pigmentation No scars or striae present No respiratory retractions No masses or nodules Ripples of peristalsis may be visible Nonexaggerated pulsation of the abdominal aorta may be present Umbilicus is depressed Copyright 2002, Delmar, A division of Thomson Learning Auscultation Assess all four quadrants Listen for at least 5 minutes before concluding bowel sounds are absent (continues) Copyright 2002, Delmar, A division of Thomson Learning Auscultation Normal findings Bowel sounds are heard in all quadrants Usually sounds are high pitched Occur 5 to 30 times per minute (continues) Copyright 2002, Delmar, A division of Thomson Learning Auscultation Abnormal findings: absent, hypoactive or hyperactive bowel sounds Pathophysiological indications Absent and hypoactive bowel sounds may indicate decreased motility and possible obstruction Hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis Copyright 2002, Delmar, A division of Thomson Learning Percussion Percuss all four quadrants Assess liver span, liver descent, margins of spleen, stomach, kidneys, bladder Sounds heard: tympany or dullness Copyright 2002, Delmar, A division of Thomson Learning Normal Findings Tympany heard over air-filled areas, such as stomach and intestines Dullness heard over solid areas, such as liver, spleen, or a distended bladder No tenderness elicited over kidneys and liver Empty bladder is not percussable above the symphysis pubis Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Dullness over areas where tympany is normally heard This finding may indicate a mass or tumor, ascites, full intestine, pregnancy Liver span > 12 cm or < 6 cm This finding may indicate hepatomegaly or cirrhosis (continues) Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Liver descent > 2 to 3 cm Dullness > 8 cm line May indicate splenic enlargement Costovertebral angle tenderness May indicate hepatomegaly or cirrhosis May indicate pyelonephritis Ability to percuss a recently emptied bladder May indicate urinary retention Copyright 2002, Delmar, A division of Thomson Learning Palpation Light vs. Deep Palpate all quadrants Normal findings No tenderness Abdomen feels soft No muscle guarding Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Tenderness on palpation Muscle guarding on expiration May indicate inflammation, masses, or enlarged organs May indicate peritonitis Presence of masses, bulges, or swelling May indicate enlarged organs, tumors, cholecystitis, hepatitis, cirrhosis (continues) Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Liver is palpable below the costal margin Spleen is palpable May indicate CHF, hepatitis, cirrhosis, encephalopathy, cancer May indicate inflammation, CHF, cirrhosis, mononucleosis Kidneys are palpable May indicate hydronephrosis, neoplasms, polycystic kidney disease (continues) Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Aorta width > 4 cm Able to palpate recently emptied bladder May indicate abdominal aortic aneurysm May indicate urinary retention Palpable inguinal lymph nodes > 1 cm in diameter or tender nodes May indicate systemic infections, cancer Copyright 2002, Delmar, A division of Thomson Learning Advanced Techniques Rebound tenderness Rovsing’s sign Cutaneous hypersensitivity Iliopsoas muscle test Obturator muscle test Ballotment Copyright 2002, Delmar, A division of Thomson Learning Gerontological Variations Abdominal musculature diminishes in mass and tone Increased fat deposition in abdominal area Altered GI motility resulting in indigestion and altered absorption Decreased gastric acid secretion Increased incidence of malignant disease Changes in bowel habits Copyright 2002, Delmar, A division of Thomson Learning