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* Abdominal Pain
- - Location
- - Quality
- - Chronology
- - Quantity
- - Setting
- - Associated symptoms
- - Aggravating/Alleviating factors
- - Patient perception
- - Weight Loss or Gain
- - Change in Appetite (subjective)
- - Nausea, Vomiting (subjective)
- - Diarrhea
- - Constipation (subjective)
- - Abdominal distention
- - Flatus (subjective)
- - Indigestion < Dyspepsia> (subjective)
- - Jaundice
- - Food allergies
- a. Lactose Intolerant
- - Surgeries
- a. Appendectomy
- b. Colon
- c. Gastrectomy
- d. Hysterectomy
- e. Bladder Repair
- Hospitalizations/Adult Illness
- Medications: Over the counter, Rx, Herbal
- - Dietary Habits
- - Alcohol Intake
- - Smoking Habits
Other Symptoms (related symptoms) associated with Abdominal Pain
Genitourinary (urinary tract infections, bladder tumors)
Reproductive (menstrual discomfort -> Dysmenorrhea mittelschmerz) (ovarian cysts, PID, STD)
- Gallbladder disease
- Kidney disease
-Malabsorption syndrome (cystic fibrosis, celiac disorder)
- Polypesis ,Colon cancer
- INFLAMMATORY BOWEL DISORDERS:
- PUD (peptic ulcer disease)
- Hiatal nernia
- Gastroesophageal Reflex Disease (GERD)
- Ulcerative Colitis
Physical Exam: Preparation
Proper exposure (all quandrants must be visible)!
Four quadrants of Abdomen & what organs are located there
- Gall bladder with biliary tree
- Head of pancreas
- Hepatic flexure of colon
- StomachSpleenLeft lobe of liverBody of pancreasLeft kidney and adrenal glandSplenic flexure of colonParts of transverse and descending colon
- CecumAppendixAscending ColonRight ovary and Fallopian tubeRight ureter
- f descending colon, sigmoid colon, left ovary and Fallopian tube or left ureter.
part of the stomach, the head of the pancreas, the duodenum, a section of the transverse colon and the lower aspects of the left and right kidney.
Rectum, Urinary Bladder,
- - Color (Normal: smooth even color)
- -> look for skin abnormalities
- Umbilicus (inverted or everted)
- - Surface characteristics
- -> Respirations, Pulsations for the aorta, Peristalsis
- Demeanor ( comfortable, relaxed position)
- ->Performed for detection of altered bowel
- sounds, rubs, or vascular bruits
- Bowel Sounds
- - Quiet Setting
- - Use DIAPHRAGM of stethoscope
- - Listen in ALL quadrants (4)
- - Gurgling/clicking every 5-15 seconds is considered Normoactive
- bell diaphram
- Vascular Sounds (bruits)
- -use BELL of stethoscope
- - Aorta, Renal, and Iliac arteries
Normoactive Bowel Sound
Sounds every 5-15 seconds
Hypoactive Bowel Sounds
Sounds every 20-60 seconds
Hyperactive Bowel Sounds
Sounds every 2-3 seconds
Absent Bowel Sounds
NO sounds heard for 5 minutes
- ->Used to assess the density of abdominal
- contents, locate organs, and screen for masses and abnormal fluid
-> Person should be in a supine position
->Tones in All 4 quadrants (Percuss 2-3 sites per quadrant of the abdomen)
- - Tympany predominant (due to air rising to the
- surface in the intestines
- - Dullness percussed:
- * over organs (liver)
- * Full bladder
- * Over feces-filled colon
- - Costovertebral Angle (assess for tenderness)
- Use the heel of your closed fist to strike the patient firmly over the costovertebral angles.
- (Place hand over the 12th rib at the costovertebral
- angle on the back)
- -> Common practice to start percussing in a quadrant where there is no pain/discomfort and to percuss the painful quadrant(s) last
- -> Palpate for crepitus of the abdominal wall, abdominal tenderness,or abdominal masses -> Liver & kidney can be palpable but no other masses normal.
- Light- palmar surface of fingers (Using
- a circular motion, move clockwise to assess the entire abdomen)
- * Tenderness, Muscle tone, and Distention or Not
- ->At this point you are mostly looking for areas of tenderness. The most sensitive indicator of tenderness is the patient's facial expression. Voluntary or involuntary guarding may also be present.
- -> Place the flat of the hand on the abdominal
- wall and apply firm, steady pressure.
- -> Begin deep palpation in the quadrant directly
- opposite any area of pain and carefully examine each quadrant.
- * Tenderness, Masses, Pulsations, and Liver Edge
- * Umbilicus: hernias, Inverted/Everted
- -> occurs when part of the intestine protrudes through an opening in the abdominal muscles.
* Inguinal lymph nodes
* Femoral pulse
- Muscle wall- intact, no bulging
Masses- none present
No enlarged organs
Gastroesophageal Reflux Disease (GERD)
- -> Alimentary Tract
- -> Chronic symptoms ormucosal damage caused by stomach acid coming up from the stomach into the esophagus.
-> A typical symptom is heartburn.
->Signs/Symptoms: Heartburn,Regurgitation,Trouble swallowing (dysphagia)
-> Regurgitation after eating/ Problems eating.
-> Alimentary Tract
-> occurs when part of your stomach pushes upward thru diaphragm. Your diaphragm normally has a sm. opening (hiatus) that allows your food tube (esophagus) to pass thru on its way to connect to your stomach.
Small hiatal hernias Most small hiatal hernias cause no signs or symptoms.
Large hiatal hernias Larger hiatal hernias can cause signs and symptoms such as : Heartburn,Belching,Chest pain,Nausea
Peptic Ulcer Disease (PUD)
- -> Alimentary Tract
- A peptic ulcer is a sore or hole in the lining of the stomach or duodenum (the first part of the small intestine).
- Hylobacter pylori
- -> Alimentary tract
- *Inflammatory Bowel disease
- * It causes inflammation of lining of your digestive tract which can lead to abdominal pain, sever diarrhea, and even malnutrition.
Ulcerative Colitis (chronic inflammation of bowel)
-> Alimentary tract
-> an inflammatory bowel disease (IBD) that causes chronic inflammation of the digestive tract, is characterized by abdominal pain and diarrhea
-> Alimentary tract
-> when one or more diverticula in your digestive tract become inflamed or infected. Diverticula are small, bulging pouches that can form anywhere in your digestive system, including your esophagus, stomach and small intestine. However, they're most commonly found in the large intestine.
- ->The most common sign on examination is tenderness in the lower left side of the abdomen.
- ->Usually, the pain is severe and comes on suddenly, but it can also be mild and become worse over several days. The intensity of the pain can fluctuate.
- -> A person may experience cramping, nausea, vomiting, fever, chills, or a change in bowel habits.
Hepatobiliary System Problems
-> Viral hepatitis (inflammation of liver)
-> Cirrhosis (degenerative disease of liver)
-> Cholecystitis with Cholelithiasis (gallbladder)
Pancreas Common Problems
Acute or Chronic Inflammation of the pancreas
Urinary System Problems
-> Urinary Tract Infections (UTI)
-> Nephrolithiasis (kidney stones)
Organs in Right Upper Quadrant (RUQ)
Head of pancreas
Right kidney and adrenal
Part of ascending and transverse colon
Organs in Left Upper Quadrant (LUQ)
Left lobe of liver
Body of pancreas
Left kidney and adrenal
Part of transverse and descending colon
Organs in Right Lower Quadrant (RLQ)
Right ovary and tube
Right spermatic cord
Organs in Left Lower Quadrant (LLQ)
Part of descending colon
Left ovary and tube
Left spermatic cord
Subjective information in Abdomen
- Changes in appetite
- -> Changes in weight- loss/gain
Foods that are not tolerated
- Bowel movements
- -> Frequency, color, diarrhea, constipation
Past history of GI disease
- -> Alcohol, cigarette use
24 hour dietary recall
Inspection of the abdomen
- Shape of abdomen
- - flat
- - Rounded
- - scaphoid (sunken abdomen, seen as starvation)
- - protuberant
Abdominal Rub Causes
- Irritation of serosal surfaces may produce a sound (rub) as an organ moves against the serosal
Altherosclerosis Causes what in abdomen??
Atherosclerosis may alter arterial blood flowso that a bruit is produced
- -> Bruits are "swishing" sounds heard over major arteries during systole. The area over the aorta, both renal arteries. and the iliac arteries should be
- examined carefully for bruits.
- Place the patient in a comfortable supine
- The stethoscope is used to listen over
- several areas of the abdomen for several minutes for the presence of bowel
- Start in the RLQ- bowel sounds are normally
- always present here
- The diaphragm of the stethoscope should be
- applied to the abdominal wall with firm but gentle pressure.
- When bowel sounds are not present, one should
- listen for a full 5 minutes before determining that bowel sounds are, in fact,
- - Hypoactive
- - Normoactive
- - Hyperactive