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