1. Abdominal Assessment Lisa Pezik, RN, BScN Clinical Educator

2. Objectives  Review basic anatomy of the abdominal system.  Discuss assessment techniques.  Critically think through common problems.  Discuss treatment plans for these problems.

3. GI System  Gastrointestinal System  30 Feet Long  Muscles, vessels, organs  From mouth to anus  Turns food into energy, growth, cell repair  Hormones of digestion  Gastrin  Secretin  Cholecystokinin  Gastric inhibitory peptide

4. Hormones

5. Digestion

6. Outside Muscles

7. Inside Muscles  Muscles  Support the abdominal cavity  Protect organs  Weakness leads to:  Hernias  Distention  Postural problems  Back pain  Risk of Falls

8. Vessels  Arteries carry oxygenated blood away from the heart.  Veins carry de-oxygenated blood to the heart.

9. Organs  Upper GI  Esophagus  Pancreas  Gallbladder  Stomach  Spleen  Liver  Duodenum  Lower GI  Small Intestine  Large Intestine  Appendix

10. Functions of The Organs  Esophagus  Carries liquids and saliva to the stomach  Pancreas  Digestive enzymes to control insulin and glucagon  Stomach  Secretes enzymes to digest food  Muscles churn to process food  Pyloric sphincter pushes food to the small intestine

11. Functions of the Organs  Spleen  Stores and produces lymphocytes to aid immunity  Gallbladder  Aids in fat digestion and stores bile  Liver  Bile production  Immune functions  Blood clotting  Stores sugar  Metabolizes drugs

12. Functions of the Organs  Small intestine  Chemical digestion occurs  Absorbs nutrients  21 feet long  Large intestine  Absorbs water and lubricates contents  Neutralizes acids and bacteria  5 feet long  Appendix  4 inches long  Junction of small and large intestine  Stores good bacteria in the gut?

13. Assessment Basics  Inspection  Auscultation  Percussion  Palpation

14. Inspection and Palpation  Look for distention or un-evenness of the umbilicus  Palpate 1cm for any painful areas  Measure abdominal growth if applicable

15. Organs Per Quadrant

16. Auscultation  Where to begin  Start in RUQ and listen 2 minutes in each quadrant  Absent, hypo/hyper/normoactive  Normal sounds in the small intestine  High pitched and gurgling  Normal sounds in the large intestine  Low pitched and rumbling  Normal Rate  5-35 sounds a minute

17. Percussion  Percuss all quadrants for dullness  Percuss for tympany  Low drum like sound caused by gas  Percuss for hyper-ressonance  Increased lower pitch due to distended bowel  Percuss bladder volume  Fullness causes pressure upwards

18. Interpretation of Results

19. Constipation  Mild Concern  Inability to pass stool, hard stool, or self impaction  Complaints of fullness  Can cause hemorrhoids

20. Constipation  Moderate Concern  Leaking, small stools  Cramping, bloating  Straining  Blood tinged stool  Vomiting  Fecal impaction  A large lump of dry stool  Caused by chronic constipation

21. Stool

22. Constipation  Severe Concern  Bowel Obstruction  Complete blockage of the small and large intestines  Distended tympanic abdomen  Tachypnea, Tachycardia, Low BP  Cramping, Pain, Tenderness  Vomiting  Diarrhea  Bloody Stools  Absent or hyperactive bowel sounds

23. Small Bowel Obstruction

24. Large Bowel Obstruction

25. Ascites  Build up of fluid in the abdomen  High pressure in the blood vessels of the liver  Low levels of albumin  Caused by:  Cancer  Liver failure  Pancreatitis  CHF  Portal Vein Thrombosis

26. Peritonitis  Inflammation of the peritoneum causing severe pain

27. Points to Ponder  Pain = Inflammation  Dullness with percussion = Fullness of normal OR abnormal structure  Crepitus = Diverticulitis or organ perforation  Bruising = Hemorrhage or injury

28. Questions?