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

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 21: Chapter 21: Abdomen Slide 21-2  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. Chapter 21: Chapter 21: Abdomen Slide 21-3 Structure and Function  Surface landmarks  Borders of abdominal cavity  Abdominal muscles  Internal anatomy (viscera)  Solid viscera Liver Liver Pancreas Pancreas Spleen Spleen Adrenal glands Adrenal glands Kidneys Kidneys Ovaries Ovaries Uterus Uterus

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

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

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

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

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

Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 21: Chapter 21: Abdomen Slide 21-9 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. Chapter 21: Chapter 21: Abdomen Slide Objective Data—The Physical Exam  Preparation  Lighting and draping  Measures to enhance abdominal wall relaxation  Equipment needed  Stethoscope  Small centimeter ruler  Skin-marking pen  Alcohol swab

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

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

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

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

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

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

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