l / hanaa hammad abdomen assessment 2015 - 2016. learning outcome
TRANSCRIPT
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L / Hanaa Hammad
Abdomen Assessment
2015 - 2016
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Learning outcome
At the end of this Lesson the study will be able to:1. Assess patient with gastrointestinal complaint.3. Demonstrate the techniques of gastrointestinal assessment.
4. Relate abnormal physical gastro-intestinal findings to pathological processes.5. Outline the gastrointestinal variations associated with the aging process.
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Anatomy of the Abdomen
1.Abdominal cavity
2.Peritoneum
3.Abdominal vasculature
4.Abdominal quadrants» Right upper» Right lower» Left upper» Left lower
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•Stomach ,Small
intestine ,Large intestine
Liver ,Gall bladder
Pancreas ,Spleen,
Appendix , kidneys,
ureters, &
bladder ,lymph nodes
Anatomy of the Abdomen
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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
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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
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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
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Health history cont’d
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 ,StressEconomic status
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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
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Implementation
1. Inspection : Inspect abdominal contour- Symmetry , rectus abdominals muscles, Pigmentation and skin color , scars - note any masses, striae, veins, visible pulsations or peristalsis , respiratory movement , masses or nodules ,umbilicus
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
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Inspection
Deviations from Normal : distended veins- ascites, Visible peristalsis- Asymmetry Distention-,Color changes-scar
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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
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Auscultation
Normal findings:Bowel sounds are heard in all quadrants ,usually sounds
are high pitched occur 5 to 30 times per minuteAbnormal 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
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Implementation
Percussion: Percuss all four quadrants ,assess liver span, liver descent, margins of spleen, stomach, kidneys, bladderSounds heard: tympany or dullness
Normal Findings:o Tympany heard over air-filled areas, such as stomach
and intestinesoDullness heard over solid areas, such as liver, spleen, or a distended bladder
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Implementation
4. Palpation: Light palpation:- depress about 1 cm. Assess skinpulsations. 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. DeepPalpate all quadrantsNormal findings : No tenderness ,abdomen feels soft
No muscle guarding
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Abnormal Findings
Dullness over areas where tympany is normally heardThis 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
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Abnormal Findings
Liver is palpable below the costal margin ,may indicate CHF, hepatitis, cirrhosis, encephalopathy, cancerSpleen is palpable , may indicate inflammation, CHF, cirrhosis, mononucleosisKidneys 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
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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
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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.
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Thank you