Abdomen

Dyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MANDyana M. M. Saplan, RN, MAN

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The AbdomenThe nurse locates and describes abdominal findings using 2 common methods of subdividing the abdomen:Quadrants

Regions


Abdominal LandmarksPractitioners often use certain landmarks to locate abdominal signs and symptoms


Organs in the 4 Quadrants (Box 30-7)


Methods of Abdominal Examination

Involves all 4 methods of examination:

Inspection

Auscultation

Palpation

Percussion

Cause movement or stimulation of the bowel, w/c can �� bowel motility and thus heighten bowel sounds = false results


AssessmentInspection of the abdomen

Skin integrity

Contour and symmetry

Observe the abdominal contour (profile line from

the rib margin to the pubic bone) while standing

at the client’s side when the client is supine

Ask the client to take a deep breath and to hold it

(makes an enlarged liver or spleen more obvious)

If distention is present – measure abdominal girth

Place tape measure around the abdomen @ the

level of the umbilicus


Measuring abdominal girth


Inspection of the AbdomenObserve abdominal movements associated w/ respiration, peristalsis, or aortic pulsationsSymmetric movements (respi); visible peristalsis (very lean); aortic pulsations @ epigastric area (thin persons)

Limited movement (pain, dse); visible peristalsis (bowel obstruction); marked aortic pulsations

Observe the vascular patternDilated veins = liver dse, ascites, venocaval obstruction


Ascites


Auscultation of the AbdomenFor bowel sounds, vascular sounds, peritoneal friction rubs

Warm hands and stethoscope

Cold hands and stethoscope = client will contract abdl muscles, w/c may be heard during auscultation

N: audible bowel sounds; (-) arterial bruits and friction rub


Deviations:Hypoactive bowel sounds

Extremely soft and infrequent (1/min)

Indicate ��ed motility associated w/ manipulation of bowel during surgery, inflammation, paralytic ileus, or late bowel obstruction

Hyperactive (��ed) bowel sounds

High-pitched, loud, frequent, rushing sounds (q3 sec.) = borborygmi

��ed intestinal motility = diarrhea, early bowel obstruction, use of laxative

True absence of sounds (none heard in 3 –5 min) = cessation of intestinal motility


Auscultating bowel sounds

Use the flat-disc diaphragm

Ask when the client last ate

Shortly after or shortly before = normally ��ed

Loudest when meal is long overdue


Auscultating bowel soundsPlace diaphragm in each of the 4 quadrants over all of the auscultatory sites

Listen for active bowel sounds

Irregular gurgling noises occurring about q5 – 20 secs.

May range from < 1 sec – more than several secs.


For Vascular soundsUse bell of the stethoscope over aorta, renal arteries, iliac arteries, and femoral arteries

Listen for bruitsLoud bruit over aortic area = possible aneurysm

Over renal or iliac arteries


Abdominal aneurysm


Peritoneal Friction Rubs

Rough, grating sounds like 2 pcs of leather rubbing together

May be caused by inflammation, infection, or abnormal growths

Auscultate splenic site – stethoscope over LL rib cage, ant. axillary line

Ask to deep breathe = accentuate sound of friction rub

Liver site

over LR rib cage


Percussion of the abdomen

Percuss different areas in each of the 4 quadrants – to det. presence of:

Tympany = gas in stomach and intestines

Dullness = ��, absence, or flatness of resonance over solid masses or fluid

Use systematic pattern:

Begin in RLQ �� RUQ �� LUQ �� LLQ


Percussion of the abdomen

Normal:

Tympany over stomach and gas-filled bowels

Dullness = over liver or spleen, or full bladder

Deviation:

Large dull areas = associated w/ presence of fluid or a tumor


Percussion of the liver

To det. its size – begin in the rt. midclavicular line below the level of the umbilicus

Measure distance between lower liver border and upper liver border in centimeters (cm) = liver size

6 – 12 cm (2 ½ - 3 ½ in.) = midclavicularline

4 – 8 cm (1 ½ - 3 in.) = midsternal line

Enlarged size: liver dse.


Palpation of the AbdomenLight palpation 1st –to detect areas of tenderness and/or muscle guardingSystematically explore all 4 quadrants

N: no tenderness; relaxed w/ smooth consistent tension

D: tenderness, hypersensitivity; superficial masses; localized areas of ��ed tension


Palpation of the Abdomen

Deep palpation over all 4 quadrants

Sensitive areas last

Depress about 4 – 5 cm (1 ½ - 2 in.)

Note masses and structure of underlying contents

If mass present – size, location, mobility, contour, consistency, tenderness

Check for rebound tenderness – in areas where client complains of pain

(+) rebound tenderness – pain upon release of pressure = peritoneal inflammation


Bimanual deep palpation


Palpation of the liverPalpate liver to detect enlargement and tenderness

Normal: not palpable; border feels smooth

Deviation: enlarged; smooth but tender; nodular or hard


Palpation of the Bladder

Palpate area over symphysis pubis if client’s history indicates possible urinary retention

Normal: bladder not palpable

Deviation: distended; and palpable as smooth, round, tense mass = urinary retention


Lifespan considerationsInfantsInternal organs proportionately larger than older children and adults = abdomen rounded and tend to protrude

Liver palpable – 1 – 2 cm below rt. intercostal margin

Umbilical hernias – may be present @ birth


Umbilical hernia


Children Toddlers – characteristic “pot belly” appearance until 3 – 4 years Late pre-school and school-age – leaner and have flat abdomenVisible peristaltic waves than in adultsMay not be able to pinpoint areas of tenderness Observe facial expressions to det. Areas of maximum tenderness

If ticklish, guarding, or fearful – use task that requires concentration to distract, or have child place hands on examiners hands = “helping” do exam”


“Potbelly”


Elders Rounded abdomens = due to �� adipose tissue, �� muscle tone

Abdominal wall slacker and thinner

Palpation easier and more accurate

Pain threshold higher

Major abdominal problems such as appendicitis or other acute emergencies – may go undetected

GI pain (chest or abdomen) needs to be differentiated from cardiac pain (chest)

GI pain: relieved by food, antacid, upright position

Cardiac pain: aggravated by activity, stress; relieved by rest or nitroglycerine


EldersFecal incontinence in confused or neurologically impaired older adults

Colon cancer higher incidence

Change in bowel fxn, rectal bleeding, weight loss

��ed absorption of oral meds


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