1. L / Hanaa Hammad Abdomen Assessment 2015 - 2016

2. Learning outcome

3. Anatomy of the Abdomen 1.Abdominal cavity 2.Peritoneum 3.Abdominal vasculature 4.Abdominal quadrants » Right upper » Right lower » Left upper » Left lower

4. Stomach,Small intestine,Large intestine Liver,Gall bladder Pancreas,Spleen, Appendix, kidneys, ureters, & bladder,lymph nodes Anatomy of the Abdomen

5. Health history Patient profile » Age » Child to young adult: appendicitis » Adult: peptic ulcers, cholecystitis, DM, gastrointestinal malignancies » Gender » Female: gallbladder disease » Male: GI cancers, cirrhosis, duodenal ulcers

6. Health history cont’d Common chief complaints : Nausea and vomiting,anorexia, dysphagea,diarrhea or constipation, abdominal distension, abdominal pain, Increased eructation or flatulence, dysuria, nocturia. Characteristics of Chief Complaint : » Quality, associated manifestations,aggravating factors, alleviating factors,timing

7. Past Health History a.Medical » Abdomen specific, Non-abdomen specific » Surgical or GI procedures b.Common Medications: » Histamine: two antagonists,Antibiotics, Lactulose » Antacids, Antiemetic, Antidiarrhea » Laxatives or stool softeners, Pancreatic enzymes » Steroids,Chemotherapeutics, Antiflatulents Health history cont’d

8. Past Health History : – Communicable diseases,Allergies Injuries/accidents – Family health history, Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis. Social History: – Alcohol use, Drug use,Travel history,Work environment,Hobbies/leisure activities,Stress Economic status

9. Health Maintenance Activities: Sleep, Diet, Exercise,Stress management, Use of safety devices,Health checkups. Techniques for Abdominal Assessment: Provide privacy and good lighting,appropriate temperature, expose the abdomen, empty the bladder Position patient supine, arms by side & head on pillow with knees slightly bent or on a pillow Warm stethoscope & hands, Painful areas assess last Health history cont’d

10. Implementation Normal findings : Abdomen is flat or round, symmetrical uniform in color and pigmentation,no scars or striae present No respiratory retractions,no masses or nodules, umbilicus is depressed

11. Deviations from Normal : distended veins- ascites, Visible peristalsis- Asymmetry Distention-,Color changes-scar

12. Implementation 2.Auscultation : Always done before percussion & palpation Use diaphragm of stethoscope Listen lightly Start with RLQ, Auscultate bowel sound? Note character & frequency of bowel sounds (5-30 times/minute) Sounds like…..Listen for 5 minutes before documenting absent bowel sounds Listen for bruits- aortic, renal, iliac, femoral Hyper- gastroenteritis, obstruction, hungry Hypo- pregnancy, peritonitis

13. Auscultation Normal findings: Bowel sounds are heard in all quadrants,usually sounds are high pitched occur 5 to 30 times per minute Abnormal findings: absent, hypoactive or hyperactive bowel sounds Pathophysiological indications,absent and hypoactive bowel sounds may indicate decreased motility and possible obstruction, hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis

14. Implementation Percussion: Percuss all four quadrants,assess liver span, liver descent, margins of spleen, stomach, kidneys, bladder Sounds heard: tympany or dullness Normal Findings: o Tympany heard over air-filled areas, such as stomach and intestines o Dullness heard over solid areas, such as liver, spleen, or a distended bladder

15. Implementation 4.Palpation: Light palpation:- depress about 1 cm. Assess skin pulsations. Always done first- clockwise Deep palpation:- depress skin about 5-8 cm. Always assess tender areas last. Watch pt’s expression during palpation Light vs. Deep Palpate all quadrants Normal findings : No tenderness,abdomen feels soft No muscle guarding

16. Abnormal Findings Dullness over areas where tympany is normally heard This finding may indicate a mass or tumor, ascites, full intestine, pregnancy, Ability to percuss a recently emptied bladder,May indicate urinary retention Tenderness, May indicate inflammation, masses, or enlarged organs Muscle guarding on expiration, may indicate peritonitis, Presence of masses, bulges, or swelling,may indicate enlarged organs, tumors, cholecystitis, hepatitis, cirrhosis

17. Abnormal Findings Liver is palpable below the costal margin,may indicate CHF, hepatitis, cirrhosis, encephalopathy, cancer Spleen is palpable, may indicate inflammation, CHF, cirrhosis, mononucleosis Kidneys are palpable, may indicate hydronephrosis, neoplasms, polycystic kidney disease, Palpable inguinal lymph nodes > 1 cm in diameter or tender nodes,May indicate systemic infections, cancer

18. Gerontological Variations » Abdominal musculature diminishes in mass and tone » Increased fat deposition in abdominal area » Altered GI motility resulting in indigestion and altered absorption » Decreased gastric acid secretion » Increased incidence of malignant disease » Changes in bowel habits

19. Sample Documentation Normal EAssessment: Abdomen soft, rounded and symmetric without distention; no lesions or scars, or visible peristalsis. Aorta midline without bruit or visible pulsation; umbilicus inverted and midline without herniatino; bowel sounds present in all 4 quadrants. Liver, kidney and spleen non-palpable; no tenderness on palpation. Reports good appetite; no constipation, nausea or diarrhea. Voiding well and denies laxative use.