L / Hanaa Hammad

Abdomen Assessment

2015 - 2016

Learning outcome

At the end of this Lesson the study will be able to:1. Assess patient with gastrointestinal complaint.3. Demonstrate the techniques of gastrointestinal assessment.

4. Relate abnormal physical gastro-intestinal findings to pathological processes.5. Outline the gastrointestinal variations associated with the aging process.

Anatomy of the Abdomen

1.Abdominal cavity

2.Peritoneum

3.Abdominal vasculature

4.Abdominal quadrants» Right upper» Right lower» Left upper» Left lower

•Stomach ,Small

intestine ,Large intestine

Liver ,Gall bladder

Pancreas ,Spleen,

Appendix , kidneys,

ureters, &

bladder ,lymph nodes

Anatomy of the Abdomen

Health history

Patient profile» Age» Child to young adult: appendicitis» Adult: peptic ulcers, cholecystitis , DM,

gastrointestinal malignancies» Gender» Female: gallbladder disease» Male: GI cancers, cirrhosis, duodenal ulcers

Health history cont’d

Common chief complaints :

Nausea and vomiting ,anorexia , dysphagea ,diarrhea or constipation , abdominal distension, abdominal pain , Increased eructation or flatulence , dysuria , nocturia.

Characteristics of Chief Complaint :» Quality, associated manifestations ,aggravating

factors , alleviating factors ,timing

Past Health History

a. Medical» Abdomen specific , Non-abdomen specific» Surgical or GI procedures

b. Common Medications:» Histamine: two antagonists ,Antibiotics , Lactulose» Antacids , Antiemetic , Antidiarrhea » Laxatives or stool softeners , Pancreatic enzymes» Steroids ,Chemotherapeutics , Antiflatulents

Health history cont’d

Health history cont’d

Past Health History :– Communicable diseases ,Allergies Injuries/accidents– Family health history , Malignancies of stomach, liver,

pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis.

Social History:– Alcohol use , Drug use ,Travel history ,Work

environment ,Hobbies/leisure activities ,StressEconomic status

Health Maintenance Activities:•Sleep , Diet , Exercise ,Stress management , Use of safety devices ,Health checkups.

Techniques for Abdominal Assessment:• Provide privacy and good lighting ,appropriate

temperature , expose the abdomen , empty the bladder• Position patient supine, arms by side & head on pillow

with knees slightly bent or on a pillow• Warm stethoscope & hands , Painful areas assess last

Health history cont’d

Implementation

1. Inspection : Inspect abdominal contour- Symmetry , rectus abdominals muscles, Pigmentation and skin color , scars - note any masses, striae, veins, visible pulsations or peristalsis , respiratory movement , masses or nodules ,umbilicus

Normal findings :Abdomen is flat or round, symmetrical uniform in color and pigmentation ,no scars or striae present No respiratory retractions ,no masses or nodules , umbilicus is depressed

Inspection

Deviations from Normal : distended veins- ascites, Visible peristalsis- Asymmetry Distention-,Color changes-scar

Implementation

2. Auscultation : Always done before percussion & palpation Use diaphragm of stethoscope Listen lightly Start with RLQ , Auscultate bowel sound? Note character & frequency of bowel sounds (5-30 times/minute) Sounds like…..Listen for 5 minutes before documenting absent bowel sounds Listen for bruits- aortic, renal, iliac, femoral Hyper- gastroenteritis, obstruction, hungry Hypo- pregnancy, peritonitis

Auscultation

Normal findings:Bowel sounds are heard in all quadrants ,usually sounds

are high pitched occur 5 to 30 times per minuteAbnormal findings: absent, hypoactive or hyperactive bowel sounds

Pathophysiological indications ,absent and hypoactive bowel sounds may indicate decreased motility and possible obstruction, hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis

Implementation

Percussion: Percuss all four quadrants ,assess liver span, liver descent, margins of spleen, stomach, kidneys, bladderSounds heard: tympany or dullness

Normal Findings:o Tympany heard over air-filled areas, such as stomach

and intestinesoDullness heard over solid areas, such as liver, spleen, or a distended bladder

Implementation

4. Palpation: Light palpation:- depress about 1 cm. Assess skinpulsations. Always done first- clockwise Deep palpation:- depress skin about 5-8 cm . Always assess tender areas last. Watch pt’s expression during palpation

Light vs. DeepPalpate all quadrantsNormal findings : No tenderness ,abdomen feels soft

No muscle guarding

Abnormal Findings

Dullness over areas where tympany is normally heardThis finding may indicate a mass or tumor, ascites, full intestine, pregnancy , Ability to percuss a recently emptied bladder ,May indicate urinary retention

Tenderness , May indicate inflammation, masses, or enlarged organs Muscle guarding on expiration, may indicate peritonitis, Presence of masses, bulges, or swelling ,may indicate enlarged organs, tumors, cholecystitis, hepatitis, cirrhosis

Abnormal Findings

Liver is palpable below the costal margin ,may indicate CHF, hepatitis, cirrhosis, encephalopathy, cancerSpleen is palpable , may indicate inflammation, CHF, cirrhosis, mononucleosisKidneys are palpable , may indicate hydronephrosis, neoplasms, polycystic kidney disease,Palpable inguinal lymph nodes > 1 cm in diameter or tender nodes ,May indicate systemic infections, cancer

Gerontological Variations

» Abdominal musculature diminishes in mass and tone

» Increased fat deposition in abdominal area» Altered GI motility resulting in indigestion and

altered absorption» Decreased gastric acid secretion» Increased incidence of malignant disease» Changes in bowel habits

Sample Documentation

Normal EAssessment:• Abdomen soft, rounded and symmetric without

distention; no lesions or scars, or visible peristalsis. Aorta midline without bruit or visible pulsation; umbilicus inverted and midline without herniatino; bowel sounds present in all 4 quadrants. Liver, kidney and spleen non-palpable; no tenderness on palpation. Reports good appetite; no constipation, nausea or diarrhea. Voiding well and denies laxative use.

Thank you