Abdominal Assessment

1
Abdominal Assessment

• Week 8

2
Surface Landmarks of the Abdomen
3
Internal Anatomy of the Abdomen
4
Related Organs in the Abdominal Cavity
5
Costovertebral Angle
6
Four Quadrants of the Abdomen
Figure 19-6. p. 585.
7
Transcultural Considerations

• Lactase digestive enzyme necessary to absorb
  carbohydrate lactose (milk sugar)
• 70 - 90 blacks, Native Americans, Asians,
  Mediterranean groups have declining activity of
  lactase by adulthood
• Only 15 of North Americans Northern Western
  Europeans are lactose intolerant.

8
Subjective Data Collection

• Appetite
• Dysphagia
• Food intolerance
• Abdominal pain
• Nausea/vomiting.

• Bowel habits
• Past abdominal history
• Medications
• Nutritional assessment.

9
Preparation for Physical Exam

• Strong overhead light secondary stand light
• Proper draping
• Promote abdominal wall relaxation
• Empty bladder
• Room warm
• Position person supine, head on pillow, knees
  bent, arms at sides or on chest
• Warm stethoscope hands, fingernails short
• Ask about any painful areas before you start
  leave till end of exam
• Learn to use distraction.

10
Inspection

• Contour
• Symmetry
• Umbilicus
• Skin
• Pulsation movement
• Hair distribution
• Demeanour.

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Auscultate Bowel Sounds

• Caused by air fluid moving through small bowel
•  Use diaphragm hold lightly against skin
• Begin at RLQ move in clockwise direction  
• Note character frequency
• Heard irregularly 5 to 30 times per minute
  dont count, judge if normal, hypoactive or
  hyperactive
• Stomach growling borborygmus
•  Perfectly silent abdomen is uncommon listen
  for 5 minutes by watch before deciding bowel
  sounds are completely absent.

12
Auscultate Vascular Sounds
13
Percussion

• Done to assess density of abdominal contents to
  locate organs screen for abnormal fluid/masses
• Percuss lightly over 4 quadrants 1st, to
  determine prevailing tympany
• Percuss organ boundaries
• Liver span hepatomegaly?
• Splenic dullness splenomegaly?
• Costovertebral angle tenderness assesses kidney
• Fluid wave/Shifting dullness.

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Percuss 4 Quadrants
Figure 19-13. p. 596.
15
Liver Span

• Measure Liver Span

13
Figure 19-15. p. 597.
16
Costovertebral angle tenderness
13
Figure 19-18. p. 599.
17
Fluid Wave test for ascites
Figure 19-19. p. 600.
18
Shifting Dullness test for ascites

• Percuss for Shifting Dullness

Figure 19-20. p. 600.
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Palpation

• Judge size, location consistency of certain
  organs screen for abnormal mass or tenderness
• Promote relaxation of abdominal musculature,
  similar measures as before plus
• Bend persons knees
• Keep palpating hand low parallel to abdomen
• Teach client to breathe slowly
• Keep own voice low soothing conversation may
  help
• Try emotive imagery
• If person ticklish keep their hand under your own
  or palpate after auscultation use stethoscope.

20
Light Deep Palpation

• Light palpation 1st, obtain overall impression of
  skin surface, superficial musculature, get client
  use to being touched
• Assess involuntary rigidity (constant board-like
  hardness) vs voluntary guarding
• Gentle rotary motion, lift fingers to move to new
  area
• Clockwise coverage
• Deep organ palpation - same general technique but
  push down about 5 8 cm (2 3) .

21
Normally Palpable Structures
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If identify a mass note

• Location
• Size
• Shape
• Consistency
• Surface (smooth, nodular)
• Mobility
• Pulsatility
• Tenderness.

23
Liver Palpation
Figure 19-26. p. 604.
24
Spleen Palpation
Figure 19-28A. p. 605.
25
Right Kidney Palpation
Figure 19-29A. p. 606.
26
Left Kidney Palpation
Figure 19-29B. p. 606.
27
Aorta

• Use opposing thumb fingers palpate aortic
  pulsation in upper abdomen slightly to the left
  of midline
•  Normally 2.5 to 4 cm wide in adult pulsates in
  anterior direction.

28
Special Procedures

• Rebound Tenderness insert hand at 90 degree
  angle slowly and deeply, lift up quickly
  shouldnt hurt
• Inspiratory Arrest (Murphys sign) - Hold fingers
  under liver border, have client take deep breath,
  normal response is to finish breath without pain.

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Special Procedures (cont.)

• Iliopsoas Muscle Test test for appendicitis
  person supine, lift R leg straight up, flexing at
  hip, push down over lower part of right thigh as
  person tries to hold leg up shouldnt hurt
  (Fig. 21-32)
• Obturator test also to test for appendicitis -
  person supine, lift R leg, flexing at hip 90
  degrees at knee, hold ankle rotate the leg
  internally externally should not hurt. (Fig.
  21-33)

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Dev. Considerations of Aging Adult

• Fat accumulates
• Abdominal musculature relaxes
• Salivation decreases
• Esophageal emptying is delayed - ? risk
  aspiration
• Gastric acid secretion decreases with aging
• Incidence of gallstones increases with age
• Liver size ? - Blood flow ? 55 60
• Increased risk of constipation
• Because of thinner abdominal walls easier to
  palpate organs - normally feel liver edge
  kidneys easier to palpate .

31
Supporting Lab Work

• Stool
• C S
• Occult blood
• Ova parasites
• X-rays
• abdomen
• Barium swallows or enemas
• IVPs