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

2. 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

3. 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

4. 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

5. 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.

6. 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.

7. 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)

8. 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

9. 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

10. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 21: Chapter 21: Abdomen Slide 21-10 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

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

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

13. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 21: Chapter 21: Abdomen Slide 21-13 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

14. Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 21: Chapter 21: Abdomen Slide 21-14 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

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

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

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

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

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

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

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

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