Abdomen Assessment

1. Abdomen Assessment D. Tanner, RN, MSN NUR 211 Fall Semester

2. Anatomy of the Abdomen • 4 Quadrants RUQ, RLQ, LUQ, LLQ • Midline • 9 Regions- epigastric, umbilical, suprapubic The word "abdomen" has a curious story behind it. It comes from the Latin "abdodere", to hide. The idea was that whatever was eaten was hidden in the abdomen.

3. 4 Quadrants

4. 9 Regions

6. Location! Location! Location! • RUQ liver gallbladder duodenum (small intestine) pancreas head right kidney and adrenal

7. Location! Location! Location! • RLQ cecum appendix right ovary and tube

8. Location! Location! Location! LLQ sigmoid colon left ovary and tube LUQ stomach spleen pancreas left kidney and adrenal

9. GI Variations Due to Age • Aging- should not affect GI function unless associated with a disease process • Decreased: salivation, sense of taste, gastric acid secretion, esophageal emptying, liver size, bacterial flora • Increased: constipation!

10. GI Variations with pregnancy • Decrease in gastric motility • High incidence of N, V (r/t pregnancy hormones) and “heartburn” or acid reflux • Bowel sounds diminished r/t enlarged uterus displacing intestines • Linea nigra- increased pigmentation of abd midline • Striae Gravidarum

11. Nursing History - Abdomen • Subjective Data: Ask about: Appetite Wt gain or loss Dysphagia Intolerance to certain foods Any Abdominal Pain of Nausea and Vomiting Bowel movements Any past abdominal problems

12. Nursing History • Infants and Children – • Ask: bottle or breast fed, any table foods, how often & how well & how much the baby eat, any problems with constipation, c/o of any abdominal pain • Teenagers- • Ask: nutritional assessment, activity & exercise patterns, recent wt. loss or gain

13. Nursing History • Older Adults • Ask: how do you get your groceries? prepare your meals? do you have any trouble swallowing? how often do your bowels move? how often do you take anything for constipation? Rx / OTC/ herbs what meds do you take?

14. Nursing Assessment • Objective Data: General Observation Inspect Auscultate Percuss Palpate (always last)

15. Focused Health History • Nutrition • Allergies • Medications • Cigarette/tobacco • ETOH intake • Recreational drug use • Stool characteristics • Urine characteristics • Exposure to infectious dz. • Recent stressful life events • Possibility of Pregnancy

16. Techniques for Exam • Provide privacy • Good lighting/appropriate temp in rm • Expose the abdomen • Empty bladder • Position pt supine, arms by side & head on pillow with knees slightly bent or on a pillow • Warm stethoscope & hands • Painful areas last • Distraction techniques

17. Inspection • Overall observation • Abd contour- flat, scaphoid, round, protuberant • Abd symmetry and skin color - note any masses, striae, scars, veins, pigmentation • Pulsations

18. Auscultation • Always done before percussion & palpation • Use diaphragm of stethoscope • Listen lightly • Start with RLQ

19. Auscultation • What makes a 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

20. Percussion • Gently tapping on the skin to create a vibration • Detect fluid, gaseous distention and masses • Tympany- gas (dominant sound because of air in sm intestine) • Dullness- solid masses, distended bladder • Percuss liver, spleen ,kidneys

21. Palpation of Abdomen • Light palpation- depress about 1 cm. Assess skin pulsations. Always done first- clockwise • Deep palpation- depress skin about 5-8 cm. • Always assess tender areas last. • Watch pt’s expression during palpation

22. Inspection Abnormal Findings • Visible or distended veins- ascites • Visible peristalsis- obstruction • Spider nevi (cutaneous angiomas)- cirrhosis • Asymmetry/ Distention- mass or intestinal obsruction • Color changes- jaundice, bluish/cyanotic

23. Abnormal Auscultation • Absence/Hyperactive bowel sounds- “borborygmi” • Bruits- “swoosh” • Peritoneal Friction Rub- rough, grating heard over liver & spleen- inflammation of peritoneal surface from tumor, infection, etc.

24. Percussion Abnormal Findings • Enlarged organs, palpable masses, distention, ascites • Marked tenderness

25. Palpation Abnormal Findings • Tenderness- rebound- done away from painful area- done at end of exam • Masses- document location, size, shape, mobile, pulsating, smooth, nodular, firm • Firmness or muscle guarding/rigidity- intraabdominal bleeding- DO NOT CONTINUE TO PALPATE!!!!!!

26. Special Procedures • Fluid Wave- need 3 hands- feel for impulse of the wave of fluid across the abdomen= ascites • Rebound Tenderness- Blumberg’s Sign • Iliopsoas Muscle Test- thigh muscle lift R leg and push down on R thigh= appendicitis • Obturator Test- lift R leg and rotate at 90 degrees= muscle is irritated by appendicitis • Murphy’s Sign- “inspiratory arrest” palpate the liver should be painless= cholecystitis

27. Special Procedures • McBurney’s Point- RLQ midclavicular= appendicitis • Referred pain- location of pain is not necessarily where the involved organ is! May be felt where the organ was located in fetal development ex: spleen= L shoulder pain/ kidney= groin pain • Hooking technique- palpate the liver- feeling for the liver edge

28. Special Procedures • Cullen’s Sign- bluish discoloration around the umbilicus EMERGENCY!!! • Kehr’s Sign- abd pain radiating to R shoulder= spleen or pancreatitis

29. Sample Documentation • Normal Exam- 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 herniation; 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.