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Dillon Ch 17

Assessing the Abdomen

Name two developmental considerations in infants ***liver takes up more space *** abd normally protrudes due to weak abd muscles
Name three developmental considerations in children ***abd proportionately larger still ***diaphragmatic breathing is normal ***organs easily palpated due to underdeveloped abd muscles
Name 4 considerations in pregnancy ***GERD/constipation --- ***diminished bowel sounds***linea nigra***striae
Name 4 considerations in older adults ***reduction in digestive secretions---increased abd fat---GI slowing/constipation---general decline in organ function
what are signs of GI bleed? change in stool color/odor---low bp/high HR---orthostatic hypoTN---pale/diaphoretic
What is ileus when (often) a decreased blood suply causes total/complete blockage of intestin. Leads to decreased peristalsis and/or necrosis
what is peritonitis inflamm of peritoneum, usually caused by collection of pus in abd
causes of constipation (besides diet/water/dehydration) medications---lack of exercise---cancer---intestinal obstruction
Solid viscrea is normally encapsulated - name 3 liver---spleen---kidneys
what organ fills most of RUQ liver, which extends to MCL, lower edge may be palpable
Is hollow viscera normally palpable? since it's shape depends on contents, it is not usually palpable
Name 5 hollow organs stomach---gallbladder---small int---colon---bladder
Your pt has audible bruits, what shouldn't you do? never palpate bruits, could be evidence of abdominal aortic aneurysm
What is the most common complaint r/t (related to) the abd abd pain most common complaint - can be visceral, parietal or referred pain
name major organs of RUQ liver---gallbladder---duodenum---ascending/descending colon---kidney/adrenal (retroperitoneal)---also head of pancreas, hepatic flxure of colon
name major organs of LUQ spleen---stomach---body of pancreas---kidney/adrenal---trans/descending colon---AORTA-------also splemic flexure of colon
name major organs of RLQ appendix---asc colon---ovary/enlarged uterus---distended bladder---part of kidney/ureter
Name major organs of LLQ sigmoid colon---ovary/uterus---kidney/ureter---bladder
where do we find tympany upon percussion over air filled organs - loud, high pitched hollow sound
where do we find dullness upon percussion over solid organs
how does muscle sound upon percussion sounds flat
what do you do if bowel sounds are absent? ausculate for 5 minutes, may have slow peristalsis
best position for abd assessment supine with knees flexed if needed---kids sit on parents laps with knees flexed
relevant biographical/subjective data medications---dysphagia/dyspepsia---weight/appetite/elimination changes---n/v---abd pain---past abd surgeries---nutrition
relevant familial hx family hx of colon ca---GI issues
what are we looking for in physical assessment (normal findings) size/shape/symmetry---usual skin stuff---pulsations---have pt elevate head off of bed and assess for herniations
After we inspect, what is the NEXT thing we assess always ausculatate before palpating/percussing in this order RLQ---RUQ---LUQ---LLQ
abnormal finding for abd percussion large dull areas may indicate mass/enlarged organs----we expect to find SCATTERED areas of dullness due to fluid/feces
what would we expect to percuss on Gastric Air bubble would expect tympany unless spleen enlarged
light palpation depth is palpate 1/2 inch or 1 cm---save painful areas til last---observe for gaurding/pain
deep palpation depth is palpate 2-3 inches or 5-8 cm.
where is it normal to have a slightly tender sensation upon deep palpation LLQ sigmoid colon tenderness is normal finding
CVA assessed by percussion of costal/vertebral angle to asses for kidney issue/UTI/pyelonephritis
where do we try to palpate the liver? (not always palpable) under 11th/12th ribs, parallel to midline. push down and under right costal margin. Client take deep breath, may palpate edge on inspiration. But then again, maybe not!
how is visceral pain generally described burning---cramping---diffuse---poorly localized
how is parietal pain generally described severe---localized---aggrevated by movement
With ACUTE abd pain, we change the symptom assessment order to what? RTQSP
a pt presents stating indigestion and points to chest area. what do you assess for first? assess to rule out cardiac disease first
upper GI bleed is evidenced by what type of stool? black, tarry (blood has oxidized through digest process)
Lower GI bleed is evidenced by what type of stool red, bloody stool (hasn't had much time to oxidize to darker color)
clay colored stool might indicate might indicate increased bile in obstructive jaundice
if a pt presents with prolonged diarrhea, what should we assess for? assess for dehydration by skin turgor test, othrostatic hypoTN----also look for hypoKalemia (cardiac arrythmias, muscle weakness)
If a pt complains of indigestion, what should we assess FIRST always assess vital signs ASAP. Pts with MI commonly complain of indigestion
Your pt presents with projectile vomitting, what should we assess first? assess for neurological or vascular changes that may indicate stroke
what would the presence of coffee-ground emesis indicate? blood in the stomach (which takes on this texture with its interaction with stomach acid)
normal bowel sounds rate per min 5-30 clicks/min in each quadrant
normal findings ausculate vasculature no bruits---no venous hums---no friction rub (which could indicate inflammed organs)
what test helps determine where boder of liver is scratch test
the spleen is normally not detectable. If we need to assess position the pt how? position on R side, percuss midaxillary line from resonance to dullness over spleen
when assessing the spleen we should always percuss before we do --- percuss before we palpate so as not to rupture spleen
do not palpate these patients those with organ transplant---child with Wilms' tumor---suspected aortic aneurysm
there are many other tests not covered in lecture, but are in the book. What should you do? Haha - look at pages 594-601 - they are probably more than we need to know right now
Nine year old has ruptured appendix - what would I expect to auscultate with respect to bowel sounds absent bowel sounds due to ruptured contents now in peritoneum which will paralyze GI motility
what is the correct sequence for assessing the abdoment inspect---ausculate---percuss---palpate
to assess pt for hernias, have pt do thisq have them lift head off of bead
what is normal liver span at right MCL 6-12 cm
if a pt has liver disease, where would you most likely hear a venous hum RUQ
What is the best test for assessing ascites shifting dullness on percussion
Created by: MEPN 2013