Wellness & Health Assessment Exam 3

Abdominal Inspection Normal Findings

• Contour (flat or rounded)

• Bilaterally symmetrical

• Umbilicus midline

• Skin smooth and intact without pulsations or visible peristalsis

• Should NOT be scaphoid, distended, or protuberant

Abdominal Inspection Abnormal Findings

• Increased peristaltic waves

• Pulsations

• Distension

• Ascites

• Diastasis Recti

• Hernia

Abdominal Inspection - Assessment for Ascites

Ascites: free fluid in the peritoneal cavity

Signs = distended abdomen, bulging flanks, protruding umbilicus that is displaced downward

What are the two tests to differentiate ascites from gaseous distention?

• Fluid wave test

• Shifting dullness test

What is the order/sequence for assessing the abdomen?

• Inspection

• Auscultation (always before palpation)

• Palpation/Percussion

Abdominal Auscultation - Location

Holding the stethoscope lightly against the skin (as pushing hard may stimulate more bowel sounds), begin in the Right Lower Quadrant at the ileocecal valve area because sounds are normally present here and continue clockwise.

Abdominal Auscultation - Types of Bowel Sounds

• Borborygmus = loud gurgling sounds made by the movement of gas through the intestines

• Hyperactive = loud, high-pitched sounds, >30/min (high)

• Active/Normal = 5-30/min

• Hypoactive = slow, decreased sounds, </5mins (slow)

• Absent = no sounds are heard

Abdominal Auscultation - Auscultating Vascular Sounds

Purpose:

• To assess a normal pattern of blood flow in abdominal vasculature

Equipment:

• Stethoscope, PPE (if needed)

• With the bell of the stethoscope, press down firmly to listen over the aorta, renal, iliac, and femoral arteries

**Auscultate over the liver (bell) for a venous hum

Why do we perform Abdominal Percussion? How is it performed?

Purpose: to assess the density and size of abdominal structures, air, solid or fluid-filled masses in abdomen

• Using indirect percussion, percuss over each quadrant and note quality of sounds to determine tympany or dullness

• Move clockwise

  • Tympany should predominate, air in intestines rises to surface while supine

Abdominal Percussion - CVA Tenderness Test

• Performed sitting upright

• Assessment

  • Place non-dominant hand over 12th rib at costovertebral angle on back, thump that hand w/ ulnar edge of your dominant fist

  • Normal = vibration, no pain

  • Tenderness indicated inflammation or infection (pyelonephritis, renal calculi, or hydronephrosis)

Abdominal Percussion - What two tests are used to differentiate ascites from gaseous distension?

Fluid Wave Test

• Standing by the person’s right side, place the ulnar edge of a hand midline on the abdomen. Tap/strike one side of flank.

  • If ascites is present, you will feel the wave of fluid hit your left hand.

Shifting Dullness Test

• The fluid from ascites shifts according to gravity and air/gas is above heavier fluid.

• When percussing, you can hear tympanic sounds (gas/air) at the top, but dull sounds below (fluid)

  • Dullness shifts to the more dependent side, while tympany shifts to the top

Abdominal Palpation - Purpose? What are the two types and how are they performed?

**Assess for pain prior to palpation, palpate those areas last

Purpose: palpation assesses tenderness and muscle tone

• Light Palpation: 1 cm in a dipping motion → prevents guarding

• Deep Palpation: 5-6 cm → detect masses, assess organs

  • Liver, spleen, kidney

**mild tenderness is normal in the sigmoid colon

What is a hernia? Findings of a hernia assessment?

Hernia: protrusion of an organ (usually bowel) through a weakened abdominal muscle

• Visible bulge or protrusion in abdomen or groin

• Bulge may increase with coughing or straining

• Indicated weakness in abdominal wall muscles

Reducible Hernia = early stage condition where hernia can be pushed back into place or disappears when laying down.

Non-reducible Hernia = abdominal tissue becomes trapped outside muscle wall & cannot be pushed back in

What are the common causes of ascites?

Cirrhosis (most common), hepatitis, fatty liver disease, alcohol use

What is Constipation? Common causes?

→ Infrequent or difficult bowel movements

• Low fiber intake

• Low fluid intake

• Sedentary lifestyle

• Ignoring urge to defecate (holding in feces)

• Change in daily routine

• Medications (especially narcotics)

• IBS

• Laxative abuse

• Diverticulitis

• Obstruction

What is Diarrhea? Common causes?

→ Frequent loose or watery stools caused by increased GI motility

• Infections (virus, bacteria, gastroenteritis, etc.)

• Food intolerance (ie. lactose)

• Medications (antibiotics, etc.)

• Chronic bowel diseases (ie. IBS)

What are some normal/abnormal abdominal shape findings?

Normal:

• Contour (flat/rounded)

• Bilaterally symmetrical abdomen

• Umbilicus midline

• Smooth and intact skin

Abnormal:

• Scaphoid (sunken)

• Distended (swollen outward)

• Protuberant (bulging)

• Visible pulsations

• Increased peristaltic waves

• Ascites

• Hernia

• Diastasis Recti (abdominal muscles separate around umbilicus, common in pregnancy)

What are the recommendations for abdominal cancer screening?

• American Cancer Society recommends beginning colorectal cancer screening at age 45

• Earlier screening (20-25yo) if:

  • Pt has 2 or more 1st degree relatives w/ colorectal cancer

  • Genetic testing is done for increased risk