abdomen assessment and anatomy
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| Abdomen Surface Landmarks | show 🗑
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| Four layers of large, flat muscles form the ventral abdominal wall | show 🗑
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| Rectus abdominis | show 🗑
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| show | All the internal organs are the viscera, Helpful to be able to visualize each organ that one listens to or palpates through the abdominal wall, The solid viscera are those that maintain a characteristic shape (liver, pancreas, spleen, adrenal glands, kid
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| Solid Viscera (continued) | show 🗑
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| show | The abdominal aorta is just to the left of midline in the upper part of the abdomen , It descends behind the peritoneum and at 2 cm below the umbilicus, it bifurcates into the right and left common iliac arteries opposite the 4th lumbar vertebra. You can
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| Solid Viscera (continued) | show 🗑
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| show | The 12th rib forms an angle with the vertebral column
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| show | Usually are not palpable, The stomach is just below the diaphragm, between the liver and spleen, The gallbladder rests under the posterior surface of the liver just lateral to the right midclavicular line.
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| show | Extends from the stomach's pyloric valve to the ileocecal valve in the right lower quadrant (RLQ)
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| The abdominal wall is divided into four quadrants by a vertical and a horizontal line bisecting the umbilicus | show 🗑
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| show | Aging alters the appearance of the abdominal wall, During and after middle age, some fat accumulates in the suprapubic area in females due to decreased estrogen levels, Males show some fat deposits in the abdominal area, resulting in the "spare tire," or
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| show | Changes of aging occur in the gastrointestinal system but do not significantly affect function as long as no disease is present
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| show | Salivation decreases causing the aging person to have a dry mouth and a decreased sense of taste
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| show | Esophageal emptying is delayed, Increases risk of aspiration
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| show | Gastric acid secretion decreases with aging, This may cause pernicious anemia (because it interferes with vitamin B12 absorption), iron deficiency anemia, and malabsorption of calcium
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| The Aging Adult | show 🗑
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| show | Liver size decreases with age, particularly after 80 years, although most liver function remains normal, Drug metabolism by the liver is impaired d/t blood flow through the liver decreased by 55% to 60% , Liver metabolism responsible for the enzymatic oxi
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| Constipation | show 🗑
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| show | Decreased physical activity, Inadequate intake of water, Low-fiber diet, Side effects of medications, Irritable bowel syndrome, Bowel obstruction, Hypothyroidism, Inadequate toilet facilities (i.e., difficulty ambulating to the toilet may cause the perso
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| Lactose intolerant (or lactase deficiency) | show 🗑
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| Lactose intolerant (or lactase deficiency)Symptoms: | show 🗑
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| Appetite | show 🗑
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| show | Any difficulty swallowing? When did you first notice this?Dysphagia occurs with disorders of the throat or esophagus
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| show | Example: lactase deficiency resulting in bloating or excessive gas after taking milk products.Are there any foods you cannot eat? What happens if you do eat them: allergic reaction, heartburn, belching, bloating, indigestion? Do you use antacids? How ofte
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| show | Any abdominal pain? Please point to it.Abdominal pain may be visceral from an internal organ (dull, general, poorly localized), Parietal from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement), Referred from a disord
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| Referred Pain Liver | show 🗑
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| Referred Pain Esophagus | show 🗑
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| show | Cholecystitis is biliary colic, sudden pain in right upper quadrant that may radiate to right or left scapula, and which builds over time, lasting 2 to 4 hours, following ingestion of fatty foods, alcohol, or caffeine. Associated with nausea and vomiting
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| show | Pancreatitis has acute, boring midepigastric pain radiating to the back and sometimes to the left scapula or flank, severe nausea, and vomiting
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| Referred Pain Duodenum | show 🗑
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| Referred Pain Stomach | show 🗑
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| Referred Pain Appendix | show 🗑
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| show | Kidney stones prompt a sudden onset of severe, colicky flank or lower abdominal pain
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| show | Gastroenteritis has diffuse, generalized abdominal pain, with nausea, diarrhea
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| show | Large bowel obstruction has moderate, colicky pain of gradual onset in lower abdomen, bloating. Irritable bowel syndrome (IBS) has sharp or burning, cramping pain over a wide area; does not radiate, Brought on by meals, relieved by bowel movement
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| Medications | show 🗑
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| Striae (lineae albicantes) -common pigment change | show 🗑
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| show | Ascites,Cushing's syndrome - striae look purple-blue with (excess adrenocortical hormone), Causes the skin to be fragile and easily broken from normal stretching
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| Aortic aneurysm— | show 🗑
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| Renal artery stenosis— | show 🗑
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| show | occurs rarely,Heard in periumbilical region, Originates from inferior vena cava, Medium pitch, continuous sound, pressure on bell may obliterate it. May have palpable thrill, Occurs with portal hypertension and cirrhotic liver
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| show | Percuss to assess the relative density of abdominal contents, to locate organs, and to screen for abnormal fluid or masses, First, percuss lightly in all four quadrants to determine the prevailing amount of tympany and dullness,
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| General tympany throughout is normal | show 🗑
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| show | Percuss to map out the boundaries of certain organs , Measure the height of the liver in the right midclavicular line. Begin in the area of lung resonance, and percuss down the interspaces until the sound changes to a dull quality, Mark the spot, usuall
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| Liver Span | show 🗑
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| show | Accurate detection of liver borders is confused by dullness above the fifth intercostal space, which occurs with lung disease, e.g., pleural effusion or consolidation (most common inaccuracy), Accurate detection at the lower border is confused when dulln
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| show | Locate the spleen by percussing for a dull note from the 9th to 11th intercostal space just behind the left midaxillary line
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| Splenic Dullness | show 🗑
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| show | A dull note forward of the midaxillary line indicates enlargement of the spleen, as occurs with mononucleosis, trauma, and infection
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| show | Now percuss in the lowest interspace in the left anterior axillary line. Tympany should result. Ask the person to take a deep breath. Normally, tympany remains through full inspiration.
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| show | In this site, the anterior axillary line, a change in percussion from tympany to a dull sound with full inspiration is a positive spleen percussion sign, indicating splenomegaly
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| Splenic Dullness | show 🗑
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| show | Indirect fist percussion causes the tissues to vibrate instead of producing a sound
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| show | To assess the kidney, place one hand over the 12th rib at the costovertebral angle on the back
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| show | Thump that hand with the ulnar edge of your other fist. The person normally feels a thud but no pain. Sharp pain occurs with inflammation of the kidney or paranephric area
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| ascites (free fluid in the peritoneal cavity) | show 🗑
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| Fluid Wave | show 🗑
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| show | In a supine person, ascitic fluid settles by gravity into the flanks, displacing the air-filled bowel upward, You will hear a tympanitic note as you percuss over the top of the abdomen because gas-filled intestines float over the fluid, Then percuss down
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| show | Now turn the person onto the right side (roll the person toward you)
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| show | The fluid will gravitate to the dependent (in this case, right) side, displacing the lighter bowel upward.
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| Shifting Dullness | show 🗑
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| Shifting Dullness | show 🗑
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| Shifting Dullness | show 🗑
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| Shifting Dullness | show 🗑
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| show | (blank)
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| Perform palpation to judge the size, location, and consistency of certain organs and to screen for an abnormal mass or tenderness | show 🗑
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| Techniques for relaxing during palpation | show 🗑
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| Keep your palpating hand low and parallel to the abdomen. Holding the hand high and pointing down would make anyone tense up | show 🗑
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| Teach the person to breathe slowly (in through the nose, and out through the mouth) | show 🗑
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| Techniques for relaxing during palpation | show 🗑
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| Try "emotive imagery." For example, you might say, "Now I want you to imagine you are dozing on the beach, with the sun warming your muscles and the sound of the waves lulling you to sleep. Let yourself relax." | show 🗑
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| Alternatively, perform palpation just after auscultation. Keep the stethoscope in place and curl your fingers around it, palpating as you pretend to auscultate. People do not perceive a stethoscope as a ticklish object. You can slide the stethoscope out w | show 🗑
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| show | (blank)
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| Begin with light palpation | show 🗑
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| show | Make a gentle rotary motion, sliding the fingers and skin together. Then lift the fingers (do not drag them) and move clockwise to the next location around the abdomen
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| Begin with light palpation | show 🗑
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| Begin with light palpation | show 🗑
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| Abnormal Finding | show 🗑
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| show | (blank)
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| show | occurs when the person is cold, tense, or ticklish. It is bilateral, and you will feel the muscles relax slightly during exhalation
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| show | is a constant board-like hardness of the muscles, It is a protective mechanism accompanying acute inflammation of the peritoneum, May be unilateral, Same area usually becomes painful when the person increases intraabdominal pressure by attempting a sit-u
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| show | Push down about 5 to 8 cm (2 to 3 inches) , Moving clockwise, explore the entire abdomen, To overcome the resistance of a very large or obese abdomen, use a bimanual technique, Place your two hands on top of each other , The top hand does the pushing; th
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| Deep Palpation If a mass is identified distinguish it from a normally palpable structure or an enlarged organ (see previous slide). Then note the following: | show 🗑
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| Liver (2 techniques) | show 🗑
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| Liver (2 techniques) | show 🗑
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| show | Ask the person to take a deep breath. It is normal to feel the edge of the liver bump your fingertips as the diaphragm pushes it down during inhalation
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| show | It feels like a firm regular ridge. Often, the liver is not palpable and you feel nothing firm. Except with a depressed diaphragm, a liver palpated more than 1 to 2 cm below the right costal margin is enlarged, Record the number of centimeters it descends
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| show | An alternative method of palpating the liver is to stand up at the person's shoulder and swivel your body to the right so that you face the person's feet ,Hook your fingers over the costal margin from above. Ask the person to take a deep breath. Try to f
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| show | Normally, the spleen is not palpable and must be enlarged three times its normal size to be felt
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| Spleen | show 🗑
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| show | Lift up for support. Place your right hand obliquely on the LUQ with the fingers pointing toward the left axilla and just inferior to the rib margin.
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| Spleen | show 🗑
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| Spleen Abnormal Findings | show 🗑
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| show | Search for the right kidney by placing your hands together in a "duck-bill" position at the person's right flank
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| Kidneys | show 🗑
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| Kidneys | show 🗑
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| The left kidney | show 🗑
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| The left kidney | show 🗑
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| show | Push your right hand deep into the abdomen and ask the person to breathe deeply
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| show | You should feel no change with the inhalation
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| show | ***Do not do this if you auscultated a bruit!***, Using your opposing thumb and fingers, palpate the aortic pulsation in the upper abdomen slightly to the left of midline, Normally, it is 2.5 to 4 cm wide in the adult and pulsates in an anterior directio
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| Rebound Tenderness (Blumberg's Sign) | show 🗑
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| Rebound Tenderness (Blumberg's Sign) | show 🗑
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| show | Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation, Common finding with appendicitis
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| Inspiratory Arrest (Murphy's Sign) | show 🗑
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| Inspiratory Arrest (Murphy's Sign) | show 🗑
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| show | Ask the person to take a deep breath. A normal response is to complete the deep breath without pain
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| show | Positive Murphy’s sign: As the descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway
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| Iliopsoas Muscle Test (Psoas Sign) | show 🗑
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| show | When the iliopsoas muscle is inflamed (which occurs with an inflamed or perforated appendix), pain is felt in the right lower quadrant
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| Obturator Test. | show 🗑
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| Summary Checklist: Abdomen Exam | show 🗑
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| show | Contour, Symmetry, Umbilicus, Skin, Pulsation or movement, Hair distribution, Demeanor
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| Auscultation | show 🗑
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| Percussion | show 🗑
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| Palpation | show 🗑
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