Assessment of the Abdomen Gastrointestinal System Health Assessment

Assessment of the Abdomen (Gastrointestinal System) Health Assessment Across the Lifespan Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 21: Abdomen Structure and Function Subjective Data—Health History Questions Objective Data—The Physical Exam Abnormal Findings Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -2

Chapter 21: Abdomen Structure and Function Surface landmarks Borders of abdominal cavity Ø Abdominal muscles Ø Internal anatomy (viscera) Ø Solid viscera • Liver • Pancreas • Spleen • Adrenal glands • Kidneys • Ovaries • Uterus Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -3

Chapter 21: Abdomen Structure and Function (cont. ) Internal anatomy (viscera) (cont. ) Ø Hollow viscera • Stomach • Gallbladder • Small intestine • Colon • Bladder Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -4

Chapter 21: Abdomen Internal Anatomy © Pat Thomas, 2006. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -5

Chapter 21: Abdomen Deep Internal Anatomy © Pat Thomas, 2006. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -6

Chapter 21: Abdomen Structure and Function (cont. ) Abdominal wall divided into four quadrants Ø Right upper (RUQ) Ø Left upper (LUQ) Ø Right lower (RLQ) Ø Left lower (LLQ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -7

Chapter 21: Abdomen Quadrants Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -8

Chapter 21: Abdomen Subjective Data— Health History Questions Appetite Dysphagia Food intolerance Abdominal pain Nausea/vomiting Bowel habits Abdominal history Medications Nutritional assessment Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -9

Chapter 21: Abdomen Objective Data—The Physical Exam Preparation Ø Lighting and draping Ø Measures to enhance abdominal wall relaxation Equipment needed Ø Stethoscope Ø Small centimeter ruler Ø Skin-marking pen Ø Alcohol swab Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -10

Chapter 21: Abdomen Objective Data—The Physical Exam (cont. ) Inspect the abdomen Contour Symmetry Umbilicus Skin Pulsation or movement Hair distribution Demeanor Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -11

Chapter 21: Abdomen Contour Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -12

Chapter 21: Abdomen Objective Data—The Physical Exam (cont. ) Auscultate the abdomen Bowel sounds Vascular sounds (bruits) Percuss the abdomen General tympany Liver span Usual technique Ø Scratch test Ø Splenic dullness Costovertebral angle tenderness Special procedures Fluid wave Ø Shifting dullness Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -13

Chapter 21: Abdomen Objective Data—The Physical Exam (cont. ) Palpate the liver Measures to enhance muscle relaxation Light palpation Deep palpation Bimanual palpation Normally palpable structures Liver Spleen Kidneys Aorta Usual technique Ø Hooking technique Ø Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -14

Chapter 21: Abdomen Special Procedures for Advanced Practice Rebound tenderness (Blumberg’s sign) Inspiratory arrest (Murphy’s sign) Iliopsoas muscle test Obturator test Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -15

Chapter 21: Abdomen Normally Palpable Structures Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -16

Chapter 21: Abdomen Sample Charting Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -17

Chapter 21: Abdomen Sample Charting (cont. ) Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -18

Chapter 21: Abdomen Abnormal Findings Abdominal Distention Obesity Air or gas Ascites Ovarian cyst Pregnancy Feces Tumor Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -19

Chapter 21: Abdomen Abnormal Findings Abnormalities on Inspection Umbilical hernia Epigastric hernia Incisional hernia Diastasis recti Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -20

Chapter 21: Abdomen Abnormal Findings Abnormal Bowel Sounds Succussion splash Hypoactive bowel sounds Hyperactive bowel sounds Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -21

Chapter 21: Abdomen Abnormal Findings Abnormalities on Palpation of Enlarged Organs Enlarged liver Enlarged nodular liver Enlarged gallbladder Enlarged spleen Enlarged kidney Aortic aneurysm Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Slide 21 -22