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Abdominal Assessment Second Half

Abdominal Assessment Second Half. Age & Condition. Infants Children Pregnancy Older Adult. Pyloric Stenosis. Intussusception. Hirshprung. Abdominal Exam. Landmarks Four quadrants Nine abdominal areas. Inspection. General Respiratory Skin Hands Feces. Inspection. Abdomen “Fs”

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Abdominal Assessment Second Half

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  1. Abdominal AssessmentSecond Half

  2. Age & Condition • Infants • Children • Pregnancy • Older Adult

  3. Pyloric Stenosis

  4. Intussusception

  5. Hirshprung

  6. Abdominal Exam • Landmarks • Four quadrants • Nine abdominal areas

  7. Inspection • General • Respiratory • Skin • Hands • Feces

  8. Inspection • Abdomen • “Fs” • Fat • Fluid • Feces • Fetus • Fibroid • Fatal Tumor • Hernias

  9. Inspection • Hernias • Superficial Veins • Symmetry • Scars

  10. Auscultation • Bowel sounds • Distention sounds • Peritoneal rubs • Bruits

  11. Bruits • A - Aorta • R - Renal • I - Iliac • F - Femoral

  12. Percussion • All quadrants • Liver • Spleen • Kidneys • Other • Ascities

  13. Percussion • Tympany • Hyperessonance • Resonance • Dullness

  14. Palpation • Away from pain • Light then deep • Size & shape • Mobility & consistency • Tension

  15. Abdominal Organs • Liver • Gallbladder • Spleen • Aorta • Abdominal reflexes

  16. Rectal Exam

  17. Special Techniques

  18. Pain • Acute • Sub acute • Location

  19. Substernal • Esophagus • Cardiac

  20. Shoulder • Diaphragm • Subphrenic abscess

  21. Epigastric • Stomach • Duodenum • Gallbladder, bile ducts • Liver • Pancreas

  22. Right Scapula • Biliary tract • Aorta • Pancreas

  23. Midback • Aorta • Pancreas

  24. Hypogastrium • Colon

  25. Sacrum • Rectum

  26. Ectopic Pregnancy

  27. Peritoneal Irritation • Abdominal rigidity • Tenderness & guarding • Absent bowel sounds • Positive obturator test • Positive iliopsoas test

  28. Peritoneal Irritation • Rebound tenderness (Blumberg sign) • Abdominal pain on walking • Positive heel jar (Markle sign) • Positive Rovsing sign (LLQ pressure/RLQ pain

  29. Tests to consider • CBC & Differential • UA • Pregnancy • Stool for WBC, culture, O & P, H & H, fat • Liver chemistries • Sedimentation Rate

  30. Tests • Sed rate • Serum Amylase & Lipase • Electrolytes • Radiology

  31. Case Examples

  32. Case #1 • Epigastric pain 2 hours after eating

  33. Case #2 • Vomiting & Diarrhea • Abdominal cramping pain

  34. Case #3 • Periumbilical pain

  35. Case #4 • Abdominal pain • Radiates to left shoulder

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