Abdomen Inspect Auscultation Percussion Palpation.

Abdomen

Inspect

Auscultation

Percussion

Palpation

Anatomy

Abdominal Contents

•GI organsGI organs•GU organsGU organs

Health History

Appetite Dysphagia Food intolerance Abd pain N/V/D Bowel & bladder habits Past history (ulcers, gallbladder dx, hepatitis,

appendicitis, colitis, hernia) Medications

Common Symptoms

Indigestion Anorexia Nausea, vomiting, hematemesis Abdominal pain Dysphagia, odynophagia Change in bowel function

Constipation Diarrhea Jaundice/icterus Urinary/renal symptoms Kidney or flank pain Ureteral colic

Equipment

Stethoscope Measuring tape Pen or marker Pillow placed under the knees to relax the

abdominal musculature

Inspection

Contour – normally flat or rounded Scaphoid (sunken) Protuberant (abd distention)

Symmetry (bulging, visible mass) Umbilicus (midline & inverted) Observe for pulsation

A soft pulsation above the umbilicus is normal d/t the aorta

Inspection

Skin - smooth & even, note pigmentation & turgor Red-inflammation Jaundice-best in natural light Glistening & taut, striae –ascities Purple-blue striae –Cushing’s syndrome, may be

normal during pregnancy Petechiae Cutaneous angiomas (spider nevi)- HTN or liver dx

Assess for lesions, draw location, use cm Underlying adhesions and fibrous tissue

Assess for venous patterns, pulsations, hair distribution, demeanor

NOW, go to Ausculation instead of palpation. Palpation can cause motility that may not be there.

Auscultation

Bowel Sounds High-pitched use diaphragm, hold lightly Begin in the RLQ at the ileocecal valve area Bowel sounds are high pitched, gurgling,

cascading sounds, occurring irregularly between 5 to 30 times per minute

Documentation

Normoactive Hyperactive – sounds loud, high pitched,rushing,

tinkling sounds-increased motilitydiarrhea

Hypoactive – sounds decreased motility Partial obstructionconstipation

Absent sounds-no sounds for 5 minutesComplete obstruction from some cause

Vascular Sounds or Bruits

Assess over aorta, renal arteries, iliac and femoral arteries Usually no sound is present Bruit over the aorta or below naval suggests an

aneurysm

Percussion

Percuss 4 quadrants Tympany normally hear due to air in

intestines Dullness over distended bladder, fat, mass Hyperresonance over gaseous distention

Percuss liver span (left for MD) Percuss spleen (left for MD)

Palpation

Light palpation (1 cm, rotary motions) Assess for muscle guarding, rigidity, large

masses, tenderness Deep palpation (5-8 cm, rotary motions)

Use bimanual technique with obesity Tenderness occurs with local inflammation,

enlarged organs. Sigmoid colon is usually mildly tender

Abdominal Masses

For masses note: Location Size Shape Consistency

soft, firm, hard Surface Mobility Pulsality Tenderness

Palpable Structures

Liver Usually not palpable, if palpable more than 1-2 cm

below ribs it is enlarged

Spleen Enlarged 3 times normal size to be palpable Avoid overpalpation of the spleen it will rupture

Kidneys Use 2 hands (duck-bill)

Special Procedures

Rebound tenderness (Blumberg’s sign) Choose a site away from the painful area, push down

slowly, lift up quickly Usually tender if Appendicitis If not tender, GI virus

Inspiratory Arrest (Murphy’s Sign) Palpate liver on inspiration, with pain the test is

positive

Common Laboratory Tests

Esophagogastroduodenoscopy Barium enema (BE) Colonoscopy Computerized tomography scan (CT scan) Magnetic resonance imaging (MRI) Urinalysis, stool, emesis

Question

•Mrs. Jones presents at the emergency departmentcomplaining of severe pain in her abdomen. She has a history of a liver transplant. What would the nurse know NOT to do?

A. Auscultate the abdomen

B. Inspect the abdomen

C. Palpate the abdomen

D. Percuss the abdomen

Answer

•C. Palpate the abdomen

•Rationale: Do not palpate the abdomen of patients who have had an organ transplant or of a child with suspected Wilms’ tumor. Transplanted organs are often located in the anterior portion of the abdomen and not as well protected as the original placed organ.