Physical Assessment: Abdomen

Front 1

Internal Anatomy of Abdomen

Back 1

-abdomen is large, cavity extends diaphragm-->brim of pelvis
-bordered by spine and paravertebral muscles in back
-bordered by lower rib cage and abdominal muscles in front
-all internal organs in ab cavity=viscera

Front 2

Surface Landmarks of Abdomen

Back 2

-4 Layers of large, flat muscles form ventral ab wall=6 pack:
*external oblique
*internal oblique
*transversus muscles
*rectus abdominus
-all ab muscles joined at midline by tendon seam-linea alba
-wont feel 6 pack in everyone

Front 3

Landmarks on Abdomen

Back 3

4 quadrants (Right upper, Left lower, etc)
-epigastric (below chest)
-umbilical (belly button)
-suprapubic (above pubes)
-R and L hypochondrium
-R and L lumbar
-R and L inguinal

Front 4

Location of liver

Back 4

upper right quadrant
goes to left midclavicular (L. upper quad)

Front 5

Not palpable organs of abs

Back 5

-gallbladder-cant separate from liver
-duodenum
-pancreas, spleen
-appendix (LWQ)

Front 6

Related organs of abdomen: Vagina

Back 6

bimanual palpation
one hand into vagina
other hand palpates vagina

Front 7

Related organ of abdomen: aorta

Back 7

bifurcates
usually palpable in most people
often feel sensations in upper gastric area

Front 8

Related organs of abdomen: kidneys

Back 8

posterior of body
protected by ribs
lower pole of right kidney can be palpable when you inhale deeply and liver pushes it down

Front 9

Constripation

Back 9

if no bowel movement in 3 days
need to consider what is normal for patient

Front 10

Visceral Abdominal Pain

Back 10

-from an internal organ
-dull, poorly localized

Front 11

Parietal abdominal pain

Back 11

-from inflammation of the overlying peritoneum
-sharp, precisely localized, aggrevated by movement

Front 12

Referred abdominal pain

Back 12

-history of ab pain-but pain located not directly over the organ involved
-GERD-mimic heart attack
-stomach acid coming underneith sternum
-can even go up to jaw
-cholestysis-pain comes into back below scapula
-kidney stones-pain down into groin
-rectal lesions-hurt over sacrum

Front 13

General Prepatation for Abdominal Exam

Back 13

-warm room w good lighting
-empty bladder(urine causes dull sound)
-supine position (knees bent, arms at side or folded over chest)
-examine area patient points to for pain last

Front 14

Order for abdominal exam

Back 14

-inspection
-asculation
-percussion
-palpation
-->percussion and palpation create bowl movement

Front 15

Umbilical hernia

Back 15

puching out
-pushes colon out

Front 16

Incisional hernia

Back 16

-from an incision
-bulding at incision

Front 17

Epigastric hernia

Back 17

-through linea alba

Front 18

Ausculate Bowel Sounds

Back 18

bowl sounds are high pitch
-begin at ileocecal valce in RLQ

Front 19

Bowel Sound Observations

Back 19

5-30 bowel sounds/min normal
-don't count but note they are present
hyperactive-more bowl sounds
-diarhea, obstruction
hypoactive-less than 5-30
-after ab surgery, peritinitus
-no bowl sounds-->have to listen for 2-5 mins
botborygmi-prolonged gurgles of peristalsis heard w out stethoscope

Front 20

Auscultate Vascular Sounds

Back 20

listen to:
-aorta
-L and R renal arteries
-L and R iliac arteries
-L and R femoral arteries
-Arterial bruits w both systolic and diastolic-->partial occlusion of aorta or arteries
-bad!
-epigastric systolic bruit can be normal

Front 21

Percuss Abdomen

Back 21

should hear tympanic dullness
start illeocecal-do zigzag down
constipated-dullness over colon
ascitis-fluid in abdomen
large area of dullness-mass, tumor, fetus, feces, etc

Front 22

When patient has fluid in abdomes

Back 22

-on back-dullness on side
--lay patient on side-->air-->dullness will go away as fluid goes down-->tympany

Front 23

Percussion of liver span

Back 23

start midclavicular line-->percuss in the abdomen up from tympany to fullness
-start at top and percuss resonance down to dullness
resonance to dullness 6-12 cm
enlarged-larger inflammed
cirhossis-smaller size
COPD-normal span but lower down

Front 24

Liver Scratch Test

Back 24

-when abdomen is distended or muscles tense
-when pregnant or a lot of ascitis-hard to percuss liver
-defines liver border
-stethoscope over liver
-start is RLQ and scratch w finger top or scratch blade from tympany
-when sound magnified--went from hollow orgin to solid (liver edge)

Front 25

Percussion of spleen

Back 25

percuss lowest interspace in L anterior axillary line
-should hear tympany
-take deep breath
-shuld still hear tympany
--dull->+ splenic percussion
splenomegaly (enlarged)
-mono, malaria, cirhossis

Front 26

Assessment of Kidneys

Back 26

Costovertebral tenderness (CVA)
thrust fist below ribs
tenderness-muscoloskeletal or kidney problem

Front 27

Light Abdominal Palpation

Back 27

dominant hand-feel quadrants
look at patient for pain and discomfort and superficial masses
-viscera-hollow fluid filled or solid
-solid-still mantain shape when enlarged

Front 28

Deep Abdominal Palpation

Back 28

feel with dominant hand-press w non dominant hand
identify masses
correlate dullness to palpation
ticklish-have patient put hand on stomach while you palpate

Front 29

Notably palpable structures

Back 29

-pulsations from aorta
-xiphoid process, normal liver outline
-lower colon
-6 pack-rectus muscle borders
sacral
sigmoid or ascending colon

Front 30

Tenderness in abdomen

Back 30

-voluntary muscle guarding-often when ticklish-tightening of muscles
-involuntary rigity-constant, board ike hardness of abs
-protective mechanism when parateneal is inflammed
-ask to cough-give a localized feeling where tenderness is
-diverticulitis-food particle
peritoneal irritation
-rebound tenderness-push down on peritoneal
-let go-->bad pain
indicative of inflammed pitoneal

Front 31

Palpation of liver

Back 31

place left hand under persons back under ribcage
right hand parallel to midline lateral muscle
push gently in and up-->pation take deep breath
-should feel sharp edge
-if 1-2 cm below costal margin-abnormal
-dont want nodules or tenderness
hook method-for pregnant or overweight peeps

Front 32

Palpate spleen

Back 32

-don't want to palpate a lot because to delicate
-will know spleen enlarged bc of earlier percussion
-spleen 3x normal size to be felt

Front 33

Kidney Palpation

Back 33

-hands lateral to rectus muscle
-take deep breath-try to catch kidney in btw fingers
-most likely will not feel it

Front 34

Palpation of aortic pulsation

Back 34

wideness of pulsations
move fingers out at pulsation
stop when no longer feel pulsation
-2-3 cm normal
3-4 watchable
6 cm surgery

Front 35

Assessing for appendicitis

Back 35

-rebound tenderness
-rovsings sign-press deeply in lower quad and let go-feel it in right lower quad id anormal
-psoas sign-psoas muscle irritated
obdurator test

Front 36

Assessing for acute cholecystitis

Back 36

murphy's sign
-test for englarged gallbladder
-go below ribs for liver-take deep breath-
-will stop mid breath because so painful
-positive murphy test

Front 37

Iliopsoas muscle test

Back 37

perritinitis-lifting leg against pressure will cause

Front 38

Obdurator muscle test

Back 38

moving hop for internal and external rotation
-irritate muscles attach nearing appendix