Health assessment - abdomen and breasts

mouth

ingestion, mechanical digestion mixing with salivary secretions

pharynx

muscular propulsion of materials into esophagus

esophagus

transport to stomach

stomach

chemical digestion of materials by acid and enzymes, mechanical digestion through muscular contractions

small intestine

enzymatic digestion and absorption of water, organic substrates, vitamins and ions

large intestine

dehydration and compaction of indigestible materials in preparation for elimination

teeth

mechanical digestion by chewing

tongue

assists mechanical digestion by teeth, sensory analysis

salivary glands

secretion of lubricating fluid containing enzymes that break down carbohydrates

liver

secretion of bile (important for lipid digestion), storage of nutrients

gallbladder

storage and concentration of bile

pancreas

exocrine cells secrete buffers and digestive enzymes, endocrine cells secrete hormones

inspection of abdomen

scars, masses, distension, pulsation, stomas, pulsation.

9 quadrants of abdomen

right hypochondriac, epigastric, left hypochondriac, right flank, umbilical, left flank, right iliac fossa, hypogastric (suprapubic), left iliac fossa

auscultation for bowel sounds

bowel sounds normally described as gurgling. Tinkling = obstruction. absent = suggests ileus (disruption of peristalsis). Need to auscultate for at least 3 minutes in each quadrant

auscultation of aorta, renal and iliac arteries

to identify vascular bruits suggestive of turbulent blood flow.

Aortic bruits: 1-2 cm above umbilicus, can be associated with abdominal aortic aneurysm

Renal bruit: 1-2 cm above umbilicus and slightly lateral to the midline on each side. can be associated with renal artery stenosis

peptic ulcer disease

helicobacter pylori infection, causes epithelial damage and inflammation leading to gastric ulcer.

abdominal red flags

sudden onset of pain

hematemesis

unexplained weight loss

change in bowel habits (more than 3 weeks)

post coital bleeding

shortness of breath

dysphagia

rectal bleeding

increased vaginal discharge

testicular pain

pain awakening the patient

haematemesis

vomiting of blood

dysphagia

difficulty swallowing

hematuria

presence of blood in the urine

amenorrhoea

absence of menstruation

breast feeding

1. suckling triggers sensory nerve impulses in areola

2. a) brain releases oxytocin from hypothalamus and posterior pituitary

2. b) lactocytes in mammary alveoli produce milk in response nerve impulses

3. oxytocin triggers myoepithelial cells to squeeze milk from alveoli so it drains into lactiferous ducts

4. milk is pooled in lactiferous sinus before being discharged through nipple pores

red flags in breast exam

thick area, dimple, nipple crust, red or warm, new fluid, skin sores, bump, growing vein, sunken nipple, new shape or size, orange peel skin, hard lump