Abdominal Assessment.pptx

Abdomen

1. GENERAL ASSESSMENT OF ABDOMEN Kemfrance Nunez, Sheyne Tobias, Jenny Marie Pairat, Rian Kristia Sausal and April Jean Elicano

2. Objectives: Define Abdomen and the physical Assessment Discuss the abdominal examination Steps Inspect Auscultation Percussion Palpation At the end of the discussion we will be able to understand the assessment process of the abdomen.

3. Abdomen The belly, that part of the body that contains all of the structures between the chest and the pelvis. The abdomen includes a host of organs including the stomach, small intestine, colon, rectum, liver, spleen, pancreas, kidneys, appendix, gallbladder, and bladder.

4. Types of Pain Visceral pain this type of pain is often characterized as dull, aching, burning, cramping, or colicky. Parietal pain This type of pain tends to localize more to the source and is characterized as more severe and steady pain. Referred pain This type of pain travels, or refers, from the primary site and becomes highly localized at the distant site.

5. Abdominal Physical Examination Purpose The abdominal examination is performed for a variety of different reasons: As part of a comprehensive health examination; to explore gastrointestinal complaints; to assess abdominal pain, tenderness, or masses; to monitor the client post operatively.

6. Preparing the client Note: Ask the client to empty the bladder before beginning the examination to eliminate bladder distention and interference with an accurate examination. Instruct the client to remove clothes and to put on a gown.

7. Clinical Tip Raising arms above the head or folding them behind the head will tense the abdominal muscles.

8. Physical Assessment The examination evaluates the following abdominal structures in the abdominal quadrants: skin, stomach, bowel, spleen, liver, kidneys, aorta, and bladder. Note: Remember to Auscultate after inspection and before percussion and, finally, to palpate.

9. Common Abnormal Findings Abdominal edema, or swelling signifying as cites; abdominal masses signifying abnormal growths or constipation unusual pulsations such as those seen with an aneurysm of the abdominal aorta; and pain associated with appendicitis.

10. Physical Assessment Procedure

11. Shape and contour, flank fullness – Scaphoid/flat/rounded/distended: reference will be the level of the abdomen between sternum and symphysis pubis Symmetry/asymmentry and movement with respiration Discoloration – Striae/stretch marks: • Whitish in pregnancy • Pinkish in Cushing syndrome – Localized hyper-pigmentation: Cullen’s sign, Grey-turner’s sign Peristalsis, pulsations Inspection

12. Distended vessels: – Normal direction of flow: above the umbilicus upward and below the umbilicus downward. Portal hypertension-veins draining away from the umbilicus IVC obstruction - reversal of flow in the lower abdomen – i.e draining towards the umbilicus Inspection Umbilicus –location of umbilical/contour umbilicus – Swelling – Discoloration – Nodule around or signs of inflammation Hernia sites 

13. Gross Distention ( 5 F’s) Fat Feces Fetus Fibroids Flatulence Fluid Localized Distension Loculated Fluid Mass Hernia Organomegaly Impacted feces Causes of Distention

14. Cullen’s Sign

15. Discoloration of Skin

16. The vascularity of the abdominal skin

17. Check for Striae (Stretch Marks)

18. Scars

19. Lesion and Rashes

20. Inspect for Umbilicus

21. Abdominal contour

22. Abdominal Symmetry

23. Abdominal Auscultation

24. Auscultation Bowel sounds: four quadrant – Normal range 4-35/min, every 2-5 sec – Hypoactive: eg. Peritonitis – Hyperactive: eg. Obstruction Bruits: – Over enlarged organ – Renal artery: few cm above the umbilicus lateral at the edge of rectus abdominus. – Aneurysmal

25. Auscultation Venus hum: – Heard over collateral veins disappear by hard pressing with stethoscope unlike bruit – Not localized to systole only unlike bruit – May disappear with changing position unlike bruit Friction rub: – seen in infarction, sub-capsular hemorrhage and inflammation of spleen or liver

26. Percussion Starting from the epigastrium umbilical suprapubic rt/lt lumbar region. Look for: – Tympanicity/tone – Dullness- • Direct and shifting • Total vertical liver span • Splenic percussion

27. Traube’s semilunar space – 6th rib superiorly, lt mid axillary line laterally and costal margin inferiorly. – Normal percussion note medial to lateral is resonant. Nixon’s method: – lower border of pulmonary resonance at Lt posterior axillary percuss diagonal 90 degree to mid lt costal margin – Normal 6-8cm. If > 8 cm= splenomegaly A Splenic percussion Delineating the spleen by Percussion

28. If you cannot accurately percuss the liver borders, perform the scratch test. Auscultate over the liver and, starting in the RLQ, scratch lightly over the abdomen, progressing upward toward the liver.

29. Palpating the abdomen

30. Before starting palpation, remember: Relax the abdominal muscles. If necessary, ask the patient to bend the knee to relax the muscle. Ask if any particular area is tender and palpate that area last. Look into patient facial expression while palpating the abdomen.

31. Methods of Palpation Light Palpation Deep Palpation - Slipping Palpation -Press Palpation - Bimanual Palpation - two hand deep

32. Step 1 : ask for any pain and location. Step 2: – Start superficial palpation away from the site. – If none proceed with anticlockwise move starting from the LLQ : – look for tenderness, temperature, crepitus, mass,size, countor, location, consistency, swelling. Assess chest expansion; pulsation Step 3: – Deep palpation starting from the LLQ. – Examine the Left large bowel, Spleen, Epigsatrium, Liver, RUQ, suprapubic and periumblical, Step 4: Bi-manual palpation for both kidneys Step 5: Flank fullness and fluid thrill, Succusion splash Palpation

33. Perform blunt percussion for Kidneys and Liver To assess for tenderness in difficult-to-palpate structures. Percuss the liver by placing your left hand flat against the lower right anterior rib cage. Use the ulnar side of your right fist to strike your left hand.

34. That's all and thank you! :)