Abdomen

focuses on conditions associated with each assessment of abnornmal findings

liver, gallbladder, right kidney

3 organs found in the right upper quadrant

stomach, spleen and left kidney

organs in the left upper quadrant

appendix and ureter

organs found in the right lower quadrant

Inspect, Auscultate, Percuss and Palpate

method of assessment for abdomen

small pillow, rolled blanket, centimeter ruler, stethoscope, marking pen

equipment used for abdomen assessment

everted umbilicus

this type of contour of the umbilicus usually suggest an abdominal distention

umbilical hernia

an enlarged everted umbilicus suggests

fat, feces, fetus, fibroids, fluid, flatulence

the major causes of abdominal distention are sometimes referred to as the 6 Fs which are

scaphoid abdomen

this contour of the abdomen usually indicates severe weight loss or cachexia related to starvation or terminal illness

flat, rounded, scaphoid and distended/protuberant

are types of abdominal contours that reflect various underlying conditions.

recessed/protruding and round/conical

contours of the umbilicus

pregnancy

• it causes a generalized protuberant abdomen, protuberant umbilicus

• fetal heart beat that can be heard on auscultation

• tympany over intestinal areas, dullness over the uterus

flatus

• the abdomen distended with gas may appear as generalized protuberance or may be localized

• tympany is the percussion tone over the area

fibroids and other masses

• large ovarian cysts or fibroid tumors appear as generalized distention in the lower abdomen

• distended area is dullness

• tympany with the periphery

• umbilicus is everted

feces

• hard stools in the colon appear as a localized distention

• percussion over area discloses dullness

fat

• obesity accounts for most uniformly protuberant abdomens

• tympany percussion tone

• umbilicus is sunken

ascitic fluid

• fluid in the abdomen causes generalized protuberance, bulging flanks

• everted umbilicus

• dullness over fluid

• tympany over intestines

Umbilical Hernia

• results from the bowel protruding through a weakness in the umbilical ring

• this condition occurs more frequently in infants

• intestine protrudes through abdominal muscles at belly button

Epigastric Hernia

• hernia in the epigastric region of the abdominal wall

• occurs when the bowel protrudes through a weakness in the linea alba

• small bulge appears midline between the xiphoid process and the umbilicus

• may only be discovered during palpation

Diastasis Recti

• occurs when the bowel protrudes through a seperation between the two rectus abdominus

• appears as a midline ridge

• may only appear when the client raises their head or coughs

incisional hernia

• occurs when the bowel protrudes through a defect or weakness resulting from a surgical incision

• appears a bulge near a surgical scar on the abdomen

hepatomegaly

• enlargement of the liver

• greater of 12 cm span MCL

• greater than 8cm span MSL

splenomegaly

• enlargement of the spleen

• defined by an area of dullness exceeding 7cm

abdominal aortic aneurysm

• enlargment of aorta, main blood vessels that delivers blood to body at the level of the abdomen

• prominent laterally pulsating mass above the umbilicus strongly suggests this condition

• accompanied by a bruit and wide bounding pulse

organ enlargement, large masses, hernia diastasis recti, bowel obstruction

asymmetry in the abdomen are seen with what conditions (4)

silvery, pale, faint

striae colors

cushing syndrome or rapid weight gain

• reddish or purple striae may indicate (2) ?

significant tissue stretching or hormonal imbalance

• wide, dark, or deep colored striae can indicate (2)

location, contour and color

what are the characteristics you inspect for in the umbilicus

atrophic striae

• thin, depressed skin that may also resullt from chronic steroid use or medical condtions that affect skin integrity

cullen’s sign

a bluish or puple discoloration around the umbilicus indicating an intra-abdominal bleeding

grey-turner’s sign

bluish of purplish discoloration on the abdominal flanks

deviated umbilicus

location of umibilicus:

___ may be caused by pressure form a mass, hernia, enlarged organs or scar tissue

ultrasound

method of assessment for the aortic pulsations that has good accuracy and is the preferred screening method

epigastrium

which area of the abdomen do u check for the aortic pulsations

peristaltic waves

are increased and progress like a ripple-like fashion from the LUQ to the RLQ with intestinal obstruciton and abdominal distention is usually present

RLQ, clockwise

where do u start to auscultate for the bowel sounds and the direction u follow?

boborygmus

another term for hyperactive bowel sounds characterized by loud prolonged, gurgles characteristics of one’s stomach gurgling

• first few hours

• 24-48 hours

• 3 to 5 days

postop:

• the small intestine functions normally within the ____ post op

• the stomach emptying takes ____ hours to resume

• colon requires ___ days to recover

hyperactive bowel sounds

• rushing, tingling and high pitched bowel sounds that may be abnormal

• indicates rapid motility

heard in:

• early bowel obstruction, gastroenteritis, diarrhea, with the use of laxatives

hypoactive bowel sounds

• indicate diminished motility

• common causes: paralytic ileus

• may also occur in pneumonia

• a type of bowel sound

decreased or absent bowel sound

• type of bowel sound

• indicates absence of motility

• constitutes to a medical emergency and requiring immediate referral

perionitis or paralytic ileus

decreased or absent bowel sounds are indications for two conditions

obstruction

high pitched bowel sounds and rushing or tingling sensations may indicate

intensity, pitch and frequency

what characteristics should u note for bowel sounds

intestinal distention

increasing pitch of bowel sound is most diagnostic of obstruction because it signifies

vascular sound

this is typically auscultated using the bell of the stethoscope if client is suspected to have hypertension or arterial insuffiency

abdominal aorta, renal iliac and femoral arteries

where do u auscultate for vascular sounds in the abdomen

turbulent or obstructed; aneurysm or renal arterial stnosis

a bruit with both systolic and diastolic components occurs when blood flow in the artery is and also indicates;

bruit

when blood flows thru a narrow vessel and it makes a whooshing sound

epigastric and umbilical areas

venous hum is auscultated in which areas of the abdomen

cirrhosis of the liver

accentuated venous hum heard in the epigastric and umbilical areas suggests increased collateral circulation between the portal and systemic venous systems which is what condition

right and left lower ribcage

where do u auscultate for friction rub

hepatic abcess or metases

friction rub heard over the lower right coastal area is associated with

splenic infarctio, abcess, infection or tumor

a rub heard at the anterior axillary line in the lower left costal area are associated with

spleen and liver

when percussing for tone dullness is heard over which areas/organs

tympany

percussion tone that dominates the overall abdomen area

accentuated tympany or hypperresonance

percussion tones heard over a gaseous distended abdome.

6-12cm

normal liver span at the mcl

emphysema

liver in a lower position is often caused by what

abdominal mass, ascites and paralyzed diagram

liver in higher position is caused by (3)?

cirrhosis

enlarged nontender liver suggests

congestive heart failure, acute hepatitis, abcess

enlarged tender liver suggests

cancer, cirrhosis or syphilis

• enlarged firm, hard, nodular liver suggests

acute cholecystitis

• extremely tender, enlarged gallbladder suggests this

• a positive finding is murphy’s sign

85 cm

for men, abodminal girth should be less than

90 cm

for women, abdominal girth should be less than

blumberg’s sign

what is another name for rebound tenderness

rovsing’s sign

pain the RLQ when LLQ is placed with pressure

Psoas sign

pain in the RLQ when the right muscle is stretched or irritated, often indicating appendicitis.

hyperextend the right leg of the client

Obturator’s sign

pain the rlq when the client’s leg is flexed at the hip and knee then the leg is internally rotated, typically indicating appendicitis.