1. Health Assessment Across the Lifespan

2.  Structure and Function  Subjective Data—Health History Questions  Objective Data—The Physical Exam  Abnormal Findings Slide 21-2

3.  Surface landmarks  Borders of abdominal cavity  Abdominal muscles  Internal anatomy (viscera)  Solid viscera  Liver  Pancreas  Spleen  Adrenal glands  Kidneys  Ovaries  Uterus Slide 21-3

4.  Internal anatomy (viscera) (cont.)  Hollow viscera  Stomach  Gallbladder  Small intestine  Colon  Bladder Slide 21-4

5. Slide 21-5 © Pat Thomas, 2006.

6. Slide 21-6 © Pat Thomas, 2006.

7.  Abdominal wall divided into four quadrants  Right upper (RUQ)  Left upper (LUQ)  Right lower (RLQ)  Left lower (LLQ) Slide 21-7

8. Slide 21-8

9.  Appetite  Dysphagia  Food intolerance  Abdominal pain  Nausea/vomiting  Bowel habits  Abdominal history  Medications  Nutritional assessment Slide 21-9

10.  Preparation  Lighting and draping  Measures to enhance abdominal wall relaxation  Equipment needed  Stethoscope  Small centimeter ruler  Skin-marking pen  Alcohol swab Slide 21-10

11. Inspect the abdomen  Contour  Symmetry  Umbilicus  Skin  Pulsation or movement  Hair distribution  Demeanor Slide 21-11

12. Slide 21-12

13. 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 Slide 21-13

14. 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 Slide 21-14

15.  Rebound tenderness (Blumberg’s sign)  Inspiratory arrest (Murphy’s sign)  Iliopsoas muscle test  Obturator test Slide 21-15

16. Slide 21-16

17. Slide 21-17

18. Slide 21-18

19.  Obesity  Air or gas  Ascites  Ovarian cyst  Pregnancy  Feces  Tumor Slide 21-19

20.  Umbilical hernia  Epigastric hernia  Incisional hernia  Diastasis recti Slide 21-20

21.  Hypoactive bowel sounds  Hyperactive bowel sounds Slide 21-21

22.  Enlarged liver  Enlarged nodular liver  Enlarged gallbladder  Enlarged spleen  Enlarged kidney  Aortic aneurysm Slide 21-22