created by: nicole anderson mn, np presented by: jennifer burgess rn, gnc(c)

AbdominalAssessment

Created by: Nicole Anderson MN, NP

Presented by: Jennifer Burgess RN, GNC(C)

Objectives

1. Overview of anatomy2. Abdominal assessment technique3. Interpretation of findings4. Constipation, fecal impaction,

and bowel obstruction5. When to report findings

OverviewOf

Anatomy

1. Abdominal quadrants2. Landmarks/surface

anatomy3. Abdominal muscles4. Abdominal vasculature5. Internal organs

Abdominal Quadrants

•Dividing the abdomen into 4 quadrants will aid during assessment and will allow for appropriate documentation of findings.•Understanding which organs are relevant to each quadrant will help you to determine etiology of signs/symptoms found during assessment.

Landmarks and Surface

Anatomy

Understanding landmarks and surface anatomy will

enhance your documentation skills and

will allow for more efficient reporting of symptoms.

Abdominal Muscles

• Function to support abdominal cavity and protect organs•Weakness in these muscles may lead to hernias, inability to cough effectively, increased risk of falls, abdominal distension, postural problems, and back pain.

Abdominal Vasculature

Internal Organs

Liver: bile production, controls levels of fats/amino acids/proteins in the blood, immune function, detoxification, metabolizes drugs, blood clotting, store sugars, etc.Gallbladder: aids in fat digestion and concentrates/stores bile produced by the liver.Pancreas: produces digestive enzymes, secretes insulin/glucagon/somatostatin to control blood sugar levelsSpleen: stores and produces lymphocytes

Small intestine: digestion and absorption of nutrients, approximately 21 feet long.Large intestine: absorption of water, lubrication of contents, neutralization of acids, decomposition by live bacteria, approximately 4.5-5 feet long and 2.5 inches in diameter.

Organs Per Quadrant

RUQ: liver, gallbladder, duodenum, hepatic flexure of colon, head of pancreas, right kidney/ureter, part of ascending and transverse colon

RLQ: cecum, appendix, small intestine, right ureter, right ovary/fallopian tube, right spermatic cord

LUQ: stomach, spleen, splenic flexure of colon, tail of pancreas, left kidney/ureter, part of transverse and descending colon

LLQ: sigmoid colon, small intestine, part of descending colon, left ovary/fallopian tube, left spermatic cord

Abdominal Assessment Technique

Preparation

1. Resident should be calm and supine

2. Bring a stethoscope3. An understanding of health

history or reported symptoms is useful

4. Obtain relevant history from resident

Technique

1. Inspection2. Auscultation3. Percussion4. Palpation

Inspection

1. Observe resident’s abdomen from foot of bed for peristalsis, asymmetry, and abdominal distension

2. Observe umbilicus for deviation3. Assess skin of abdomen4. Measure abdominal girth if

relevant

Auscultation

1. Start in RLQ and listen to each quadrant for 2-5 minutes for bowel sounds

2. Normal sounds are high-pitched and gurgling in small intestine and low-pitched and rumbling in the colon

3. Normally occur at a rate of 5-35/min

Percussion

1. Percuss all quadrants for dullness

2. Percuss for tympany3. Percuss for hyperresonance4. Percuss for bladder volume

Palpation

1. With warm hands lightly palpate all 4 quadrants- palpate any area of pain last

2. Use pads of fingers depressing abdomen 1cm

3. Moderate palpation may be done to assess musculature and deeper structure

Interpretation of

Findings

Inspection

Asymmetry: enlarge spleen or liver

Distension: fat, flatus, stool, fluid, tumor

Bruising at umbilicus: acute necrotizing pancreatitis

Flank bruising: intra-abdominal or retroperitoneal hemorrhage, or injury to pancreas

Periumbilical and flank ecchymosis

Auscultation

Very loud bowel sounds: hyperperistalsis caused by diarrhea or early intestinal obstruction.

High-pitched tinkles and rushes: bowel obstruction

Absence or decreased: paralytic ileus, peritonitis, or acute abdomen

Percussion

Dullness: normal over liver and spleen, but abnormal in mid abdomen and may be due to organ distension or mass

Pain: inflammationTympany: high-pitched tympany

suggests distensionHyperresonance: normal at umbilicus,

but anywhere else suggests distended vasculature or aneurysms

Palpation

Crepitus: subcutaneous emphysema suggests abscess, diverticulitis, or organ perforation.

Pain: many causes such as peritonitis, inflammation, abscess

Mass/Ridge: depending on the area, could mean tumor, aneurysm, abscess.

Constipation, Fecal Impaction,

and Bowel Obstruction

Constipation

Infrequent or difficult passage of stool, hard stool, or a feeling of

incomplete evacuation

Signs and Symptoms

•Difficulty passing stool•Hardened stool•Complaints of rectal fullness•Self disimpaction•hemorrhoids•Symptoms are often un-noticed in the older adult and frequency of stools may not change

Red Flags

•Distended tympanic abdomen•Vomiting•Blood in stool•Weight loss•Severe constipation of recent onset/worsening in older adults

Fecal Impaction

A large lump of hard dry stool that remains stuck in the rectum, often due to chronic constipation

Signs and Symptoms

•Abdominal cramping and bloating• Leakage of liquid from rectum or diarrhea in a resident with chronic constipation•Rectal bleeding•Small, semi-formed stools•Difficulty passing stool and/or straining

Red Flags

•Nausea and vomiting•Tachypnea•Tachycardia•Abdominal distension with tympanic, absent and/or high-pitched bowel sounds

Bowel Obstruction

Significant mechanical impairment for complete blockage of contents through the intestine. Mechanical obstruction can effect either the small or large intestine.

Signs and Symptoms

Small bowel obstruction:•Cramping around umbilicus or epigastrium•Vomiting•Obstipation•Hyperactive, high-pitched bowel sounds with rushes•Diarrhea in partial obstruction

Signs and Symptoms

Large bowel obstruction:•More gradual onset of symptoms• Increasing constipation leading to obstipation and abdominal distension• Lower abdominal cramping unproductive of feces• Loud, hyperactive bowel sounds•Symptoms are mild

Red Flags

•Severe steady pain•Tender with light palpation•Absent bowel sounds•Shock (tachycardia, low BP)•Oliguria• Fever/chills, or abnormal vital signs•Rectal bleeding•Older adults

When to Report

Findings

• Presence of red flags•Any abnormal finding on abdominal exam•Suspected intestinal obstruction•Change in bowel patterns, stool consistency, stool colour•Change in nutritional status•Suspected constipation or fecal impaction•Acute abdominal pain

DiscussionAnd

Questions