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General symmary of the chapter
- Assessment: ask patient to empty his bladder. Assess supine with flexed knees(relaxes abd muscles). Ask patient if there is any painful areas and asses it last.
- Inspection: usually should see no movement. Peristalsis and aortic pulsations on a very thin client.
- Skin of stomach is paler
- "Normal" symmetrical with a rounded contour and sunken umbilicus.
- Normal contour: Flat, Rounded, Scaphoid, Protuberant.
- Taut skin: normal in pregnancy, or it may be due to gas or fluid retention or to bowel obstruction.
Auscultating for bowel sounds
- Normal: high pitched, irregular gurgles or clicks lasting 1 to several seconds and every 5-15 sec (or 5-30min)
- Absent: non heard after listening for 5 min
- Hypoactive: very soft and infrequent, 1 per min (slide: less than 5 sounds/min)
- Hyperactive: loud rushing sounds occuring everry 2 or 3 sec with diarrhea, early bowel obstruction, or gastroenteritis
- Vascular Sounds: no sounds should be present (no bruits)
- assessing for fluid, air, organs, or massess and to estipate the size of the liver and spleen.
- Normally, there is generelized tympany(high-pitched over the bowels (due to presence of gas)
- It is nontedner, soft, without massess.Dullness(madium pitched, softer)when percussing organs, masses or fluids.
- Notice tenderness and percuss last.
- Begin with light palpation
- Palpate for tendernes and guarding(zashitnaya fiksaziya spazm mushz, umen'shayushii podvizhnost' parazhenix otdelov tela.
- Depress to a deph of 1/2 to 1 inch.
In preperation of physical assessment of the abdomen
aske patient to empty his or her bladder and tehn to lie in a supine position with knes bent, eeping the arms at the sides to prevent tensing of teh abdominal muscles.
Patient topics which need to be reviews during assessment and interview of the abdomen
- PATIENT HISTORY
- Priveous GI disorders or abdominal surgeries
- Prescription medication being aken,OTC, aspirin, lexatives, enemas, herbal preparations
- Smoking hisotory
- Ask travel history
- NUTRITION HISTORY (how well pt's nutritionoal needs are being met)
- special diet, food allergies, usual foods are eaten daily
- changes in eating habits
- changes in taste or difficulty with swallowing (dysphagia)
- Pain or discomphort associated with eating, nausea, vomiting, dyspepsia(indigestion or heartburn)
- PT's socioeconomic status - impact on nutritional status
- FAMILY HISTORY AND GENETIC RISC
- CURRENT HEALTH PROBLEMS
- bowel habits: patter, color
- and consistency of teh feces, occurrence or diarrhea or onstipation, acctions taken to relieve, blood or tarry stools, presence of abdominal distention or gas weight gain or loss
- PQRST - current problem assessment. pg. 1221
- P: Precipitating or palliative. What brings it on? What makes it better? Worse? When did you first notice it?
- Q: Quality or quantity. How does it look, feel, or sound? How intense/severe is it?
- R: Region or radiation. Where is it? Does it spread anywhere?
- S: Severity scale. How bad is it (on a scale of 1 to 10)? Is it getting better, worse, or staying the same?
- T: Timing. Onset—Exactly when did it first occur? Duration—How long did it last?Frequency—How often does it occur?
- Contour: rounded, flat, concave, distended
- a bulging, pulsating mass is present, do not touch the area because the patient may have an abdominal aortic aneurysm, a life-threatening problem. Notify the health care provider of this finding immediately! Peristaltic movements are rarely seen unless the patient is thin and has increased peristalsis. If these movements are observed, note the quadrant of origin and the direction of peristaltic flow. Report this finding to the health care provider because it may indicate an intestinal obstruction.
- Begin in the RLQ at the ileocecal valve area. Then RUQ, LUQ, LLQ.
- Normal: irregular gurgles, every 5-15 sec.
- Absence of sounds after abdominal surgery or in the pt with peritonitis or paralytic ileus.
- Postoperation: ask patient if he or she has passed flatus within the past 8 hr or a stool within the past 12-24 hr.
- loudest 5-6 hr after the person eats at the iliocecal valve
Changes in GI system related to aging
- Stomach: atrophy of the gastric mucosa which leads to hypochlorhydira - decreased hydrochloric acid levels lead to decreased absorption of iron and vitamin B12 and to proliferation of bacteria. Atrophic gastritis occurs as a consequence ob bacterial overgorwth.
- Large intestine: peristalsis decreases, and nerve impulses are dulled.- decreased sansation to defecate.
- Pancreas: destention and dilation of pancreatid ducts change. Calcification of pancreatic vessels occurs with a decrease in lipase production- results in decreased fat absorption and digestion. Seatorrhea, or excess fat in the feces, occurs becuase of decreased fat digestion.
- Liver: A decreas in the number and sized of hepatic cells leads to decreased liver weight and mass. This change and increase in fibrous tissues lead to decreased potein synthesisi and changes in liver enzymes. enzyme octivity and cholesterol synthesis are deminished. - lead to depresses drug metabolism, which leads to occumulation of drugs.
Organs located in each of the quadrant
- most of the liver
- head of the pancreas
- hepatic flexure of the colon
- part of the ascending and transverse colon
- Left lobe of the liver
- Body and tail of the pancreas
- Splenic Flexure of the colon
- Part of the transverse and descending colon
- Part of the descending colon
- Sigmoid colon
- LEft ureter
- left ovary and fallopean tube
- left spermatic cord
- ileocecul valve
- right ureter
- right ovary and fallopian tube
- right spermatic cord
- abdominal aorta
- uterus if enlarged
- bladder if distended
Normal and abnormal finding of the abdomen
- skin color consistant, no lesions, striae, superficial veins, scars, rashes, or discoloration
- Hair distributed apporpriate for age and gender of patient
- Abdomen flat or slightly rounded and symmetrical, no bulges or hernias
- Respiratory movements, slight pulsation noted in epigastric region, no peristaltic waves
- Umbelicus midine, invered, no discoloration or discharge.
- Sounds: soft, medium pitched bowel sounds every 5-15 sec in all four quadrants
- No bruits, hums or rubs should be present when you listen over aorta, renal, iliac and femoral arteries. pg.219 in dillon
- Tympany in all four quadrants, dullness over organs.
- Sounds: more than 30 clicks per min hyper
- less than 5 clicsk per min -hypoactive
- absent bowel sounds after listening for 5 min.
- rendess, cyanosis, bruises, pink-purple striae
- rash on lower rib cage in upper quadrants
- bulges - hernias
- Protrusion of ubelicus
- Concabe abdomen - mulnutrition
- Increased peristaltic waves
- Reverse peristaltic waves
- Increased pulsations: aoritc aneurysm