06/11/1431 Examination of the Abdomen Chapter 10 Ra'eda Almashaqba 1 Review Anatomy Xiphoid Process Rectus Abdominis Costal Margin Linea Alba Anterior Superior Iliac Spine Symphysis Pubis Ra'eda Almashaqba 2 Inguinal Ligament 1 06/11/1431 Ra'eda Almashaqba 3 9 Regions Ra'eda Almashaqba 4 2 06/11/1431 Ra'eda Almashaqba 5 Ra'eda Almashaqba 6 3 06/11/1431 Location! Location! Location! RUQ  liver gallbladder duodenum (small intestine) pancreas head right kidney and adrenal Ra'eda Almashaqba 7 Location! Location! Location! RLQ  cecum appendix right ovary and tube Ra'eda Almashaqba 8 4 06/11/1431 Location! Location! Location! LLQ sigmoid colon left ovary and tube LUQ stomach spleen pancreas left kidney and adrenal Ra'eda Almashaqba 9 GI Variations Due to Age Aging- should not affect GI  function unless associated with a disease process Decreased: salivation,  sense of taste, gastric acid secretion, esophageal emptying, liver size, bacterial flora Increased: constipation!  Ra'eda Almashaqba 10 5 06/11/1431 Health History Gastrointestinal Disorder  Indigestion, N&V, Anorexia, Hematemesis - Ask the pt how is your appetite Indigestion ----- distress associated with eating Heartburn ---- sense of burning or warmth that is retrosternal and may radiate to the neck Excessive gas: frequent belching, distention or flatulence ,Abd fullness.  Dysphagia & odynophagia  Change in bowel function  Constipation or diarrhea  Jaundice Ra'eda Almashaqba 11 Abdominal pain:  Visceral : Occur in all the abd, burning, aching, difficult to localize, varies in quality e.g. pain in RUQ from liver distention Parietal pain: In parietal peritoneum, caused by inflammation, steady, more sever, localized, increase by movement or coughing Referred pain: felt at more distant site, well localized, Ra'eda Almashaqba 12 6 06/11/1431 Urinary Tract Disorder: Ask about difficulty in passing urine? --- dysuria  How often do you go to bathroom?---- frequency  Do you have to get up at night ?----- nocturia  How often?  How much urine do you pass at a time? --- polyuria  Do you ever get problem getting to the toilet on time?  Do you have any problem in holding urine?- incontinence  Do you have any problem in initiating urination? -hesitancy  Do you have notice any change in urine color? -- hematuria  Assess for kidney or flank pain, uretral pain  Ra'eda Almashaqba 13 Bowel Habits  Past Abdominal History  Medications  Aspirin  smoking  Nutritional Assessment  24 hour recall  Nutritional patterns  Weight change  Exercise patterns  Ra'eda Almashaqba 14 7 06/11/1431 Ra'eda Almashaqba 15 Techniques for Exam Provide privacy.  Good lighting/appropriate temp room  Expose the abdomen.  Empty bladder.  Position pt supine, arms by side & head on  pillow with knees slightly bent or on a pillow. Warm stethoscope & hands.  Painful areas last.  Distraction techniques.  Ra'eda Almashaqba 16 8 06/11/1431 Technique of examination Inspection  Start from Rt side, note:  Skin( scars, striae, dilated vein, rashes, lesions) -Scars ( describe them, or diagram location) -striae ( pink-purple with Cushing's syndrome) -Coetaneous angiomas (spider nevi) occur with portal hypertension or liver disease -Prominent dilated veins with portal hypertension, liver cirrhosis, or inferior vena cava obstruction Ra'eda Almashaqba 17 Umbilicus:  Contour  location  any inflammation, or bulge)  Abnormalities: Everted  Sunken  Enlarged  Bluish color  Ra'eda Almashaqba 18 9 06/11/1431 Contour   Normally range from flat to rounded  Abnormalities include protuberant or scaphoid, bulge in flank area Symmetry   Abnormalities: bulges, masses, Hernia (protrusion of abd viscera through abnormal opening in muscle wall) Pulsation or movements( peristalsis)   Normally: aortic pulsation and peristalsis movements may be seen in thin persons  Abnormalities: Increased pulsation ----- aortic aneurysm Increased peristalsis ----- intestinal obstruction Ra'eda Almashaqba 19 Auscultation Always done before  percussion & palpation Use diaphragm of  stethoscope Listen lightly  Start with RLQ  Ra'eda Almashaqba 20 10