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Unit 06 Abdomen assesment. best PowerPoint
- 1. Health Assessment-I Assessment ofthe Abdomen, Anus & Rectum unit#06
- 2. Objectives By the endof the unit, learners will be able to: 1. Discuss the pertinent health history questions necessary to perform the assessment of Abdomen, Anus and Rectum. 2. Describe the specific assessment to be made during the physical examination of the abdomen. 3. Discuss components of a rectal examination. 4. Document findings. 5. List the changes in abdomen that are characteristics of aging process.
- 3. Abdominal Assessment • SubjectiveAssessment: Ask about: – Appetite – Wt gain or loss – Dysphagia – Intolerance to certain foods – Any Abdominal Pain of Nausea and Vomiting – Bowel movements – Any past abdominal problems – Blood in stool 3
- 4. Subjective Assessment…Cont • Infantsand Children – – Ask: bottle or breast fed, any table foods, how often & how well & how much the baby eat, any problems with constipation, c/o of any abdominal pain • Teenagers- – Ask: nutritional assessment, activity & exercise patterns, recent wt. loss or gain 4
- 5. Subjective Assessment…Cont • OlderAdults – Ask: how do you get your groceries? prepare your meals? – Do you have any trouble swallowing? – How often do your bowels move? – How often do you take anything for constipation? Rx / OTC/ herbs – what meds do you take? 5
- 6. Subjective Assessment…Cont Take Historyof: – Nutrition – Allergies – Medications – Cigarette/tobacco – Alcohol intake – Recreational drug use – Stool characteristics – Urine characteristics – Exposure to infectious dz. – Recent stressful life events – Possibility of Pregnancy 6
- 7. Common Abnormalities…..Cont Abdomen – Distention •Enlarged abdomen – Excessive gas accumulation – Tympany – Ascities • Accumulation of fluid within the abdominal cavity – Bruit • Humming or swishing sound heard through stethoscope over vessels – Narrowing of the vessels 7
- 8. Cont… • Boyborygmi – Wavesof loud, gurgling sound • Hyperactive bowel • Rebound tenderness • Sudden pain when fingers are withdrawn quickly – Appendicitis • Hernia – Bulge or nodule in abdomen • Appearing on straining • Inguinal, femoral, umbilical, or incisional 8
- 9. Common Abnormalities…..Cont Rectum andAnus • Hemorrhoids – Thrombosed veins in rectum and anus • Internal or external • Tenesmus – Painful and ineffective straining at stool • Steatorrhea – Fatty, frothy, foul smelling stool 9
- 10. Manifestations of GIDysfunction • Anorexia – Absence of the desire to eat – Weight, dull,thin brittle hair, tired, apathetic facial expression; dry skin and nails; muscle wasting – Lab work-malnutrition • Albumin < 3.5 g/dL • Lymphocyte count < 1500 mm3 • Changes in electrolytes 10
- 11. Manifestation….Cont. • Intestinal gas –Flatus is gas passed through the rectum – Swallowed air, or gas forming foods – 0.6 L is passed daily • Bleeding – Upper or lower GI tract – Acute- >1000mL or discrete of 100mL – Chronic over a period of weeks or months – Types • Occult • Melena • Hematochezia • Retorrhagia • Hematemesis 11
- 12. Physical Assessment ofthe Abdomen • Review A & P of Structures – Organs – Lymph nodes – Arteries • Function – GI – GU – Vascular supply • Signs/Symptoms of problems – Masses – Size – Pain/ Referred Pain – Other 12
- 13. Review Key Organs •Small intestine • Large Intestine • Liver • Gall bladder • Spleen • Stomach • Pancreas • Ovary • Appendix • Kidney-Ureter-Bladder • Peritoneum 13
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- 15. Before Physical Examinationof Abdomen: • Provide privacy • Good lighting/appropriate temp in 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 15
- 16. Assessment of theAbdomen • IAPP • Inspect, Auscultate, Percuss, Palpate • Special techniques if symptoms present on the history or abnormal physical findings 16
- 17. Assessment of theAbdomen • Anatomical Mapping – 4 quadrants • RUQ, LUQ, RLQ, LLQ – 9 regions • Landmarks – Xiphoid process – Umbilicus – Midline – Costal margins – Anterior superior iliac spine 17
- 18. Division of theAbdomen 18 R Iliac Crest L Iliac Crest Xiphoid Pubic bone RUQ LUQ RLQ LLQ
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- 20. Assessment Skills forthe Abdomen • Inspect – Shape – Lesions – Vascularity – Movements • Auscultate – Bowel sounds – Scratch test for liver position – Vascular sounds 20
- 21. Assessment Skills forthe Abdomen • Percuss – Tympany – Organs • Full bladder- dull • Fist percussion over the costovertebral angle (kidneys) • Ascites • Palpate – Organs • Hooking test for liver – Masses, Lymph nodes – Aorta, Femoral artery 21
- 22. Begin IAPP • Inspection: –Shape- rounded, flat, scaphoid • Distention: unusual stretching of the abdominal wall- 6 F’s- feces, flatus, fat, fluid, fibroid tumor, and fetus • Symmetrical • Note Location of asymmetrical distention – Note position the person is assuming – Is the person Restless or Still – To observe for masses or enlarged liver or spleen have the person take a deep breath • Inspect from the feet – Asymmetry 22
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- 24. Inspection…..Cont. • Skin – Pigmentation,jaundice might be more visible related to lack of sun exposure – Lesions – Striae – Scars – Veins • Dilated veins- portal hypertension- liver • Spider angioma (swollen blood vessels) • Talenjectasis (tiny blood vessels) 24
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- 26. Inspection…..Cont. • Respiratory movement –Males- Abdominal • Lack of abdominal movement may indicate peritonitis – Females- costal • Visible peristalsis – Waves of movement- bowel obstruction • Pulsations – Pulsations throughout the length of the abdominal aorta is normal in thin people 26
- 27. Auscultation • Bowel sounds •Vascular Sounds • Liver Position 27
- 28. Auscultation….Cont. • Bowel Sounds –Diaphragm of the stethoscope – Represent the passage of fluids and gases through the intestinal tract – Best heard at the RLQ- ileocecal valve- bowel sounds more likely to be heard – 5-15 per minute – High pitched- gurgling noises 28
- 29. Auscultation of BowelSounds • Systematic • Listen over 9 areas 29 1 2 3 4 5 6 7 8 9
- 30. Abnormal Findings Relatedto Bowel Sounds • Absent – Listen for 5 minutes – Bowel obstruction – Low Potassium – Surgical manipulation – Lower lobe pneumonia • Tinkling sounds, rushes of tinkling sounds – Early bowel obstruction, low Potassium • Increased Bowel sounds – Increased motility of fluids – Diarrhea 30
- 31. Bowel sounds • Absent –No BS for 5 min • Hypoactive – less than 5/min • Active – 5-30 per min • Hyperactive – > 30 /min 31
- 32. Auscultation of theLiver Position • Scratch test – Place diaphragm of stethoscope over the liver area on the Lower rib cage – Use Index finger – Scratch up the abdomen on the mid-clavicular line – When the sound becomes really loud you have roughly identified the liver border 32
- 33. Auscultation of VascularSounds Bell of stethoscope – Aorta – Renal – Iliac – Femoral 33 Aneurysm
- 34. Auscultation of VascularSounds 34 A R R I I F F
- 35. Cont…. • Common Bruits –Aorta • Aneurysm • Do not palpate if you hear a bruit- rupture the aneurysm – Renal • Stenosis • Radiates laterally 35
- 36. Percussion • Systematic, donebefore palpation to prevent rupturing an aorta or spleen • Tympany – Percussing mostly small or large bowel- hollow structures filled with air – Dull- abnormal, solid structure, fluid filling hollow structures, feces filling hollow structures, urine in bladder, enlarged organ, baby • Ascites – Flank Dullness – Shifting Dullness – Fluid waves 36
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- 39. Fist Percussion ofKidneys • Done in R & L Costovertebral angles to assess kidney tenderness – C/O pain in this area coupled with urinary tract symptoms – Many times pressure from fingertips is painful and then you do not need to percuss – Kidney Infection 39
- 40. CVA – CostovertebralAngle 40
- 41. Palpation • Most organsare not palpable by normal techniques • RUQ- enlarged liver, gallbladder • RLQ- ovarian cyst, cystic appendix • LLQ- sigmoid colon distended with feces • Above the pubis- distended bladder, baby • LUQ- distended Spleen-Dangerous!!!!!!!!!!! 41
- 42. Palpation…..Cont. • Types – Light –Deep – Hooking- liver – Rebound Tenderness – Specific points related to organ pathology • Systematic • Looking for – Organs, Masses, Pulsations, flexibility 42
- 43. Palpation……Cont. • Person needsto relax, flex knees • Palpate painful areas last • Light – One hand – flexibility of abdominal muscles, not rigid • Deep – One hand on top of the other • Hooking: Liver – Place fingers curved under the rib cage – Have patient inhale – Feel the border of the liver descend to your fingers – Note smoothness, or nodules 43
- 44. Light and DeepPalpation 44
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- 46. Palpating Abdominal Reflexes 46 Normal:umbilicus puckers toward the stroke Absent in obese, elderly, multiparous
- 47. Palpate Pulses • Aorta •Femoral 47
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- 49. Palpating Rebound Tenderness •Do this when symptoms present • Place fingers perpendicular to skin • Push in slowly • Let out quickly • Pain on release of pressure is positive for peritoneal irritation 49
- 50. Specific Points Relatedto Organ Pathology • Murphy’s sign – Gallbladder disease – Hooking technique for liver palpation – Inhale – Gallbladder moves down, hits the palpating hand- person stops inhaling • McBurney’s point – Appendicitis – RLQ spot between anterior-superior iliac crest and umbilicus 50
- 51. Peritoneal Irritation • Abdomenis boardlike • Absent Bowel sounds • Knee-chest position • Quiet- little movement, but C/O pain • Severe pain • Rebound tenderness • Positive obturator and iliopsoas test – appendicitis • Nausea and vomiting 51
- 52. Bowel Obstruction • GeneralS/S – Distention – Tingling to absent bowel sounds – Pain, no rebound tenderness • Small bowel S/S – Acute onset, Vomiting, minimal distention, severe bouts of colicky pain, restless • Lower bowel S/S – Slower onset, Distention, less frequent bouts of pain, less to no vomiting, restless, relieved by BM 52
- 53. RUQ Conditions • GallBladder Disease S/S – Stones: • Severe colicky pain in RUQ in increasing intensity, R shoulder, nausea, jaundice, fever, fair, fat, forty, Murphy’s sign – Choleycystitis: • Same as stones, peritoneal signs. 53
- 54. RUQ Conditions……Cont. • Liver:S/S – Anorexia, jaundice, ascites, fatigue, vascular patterns, CHF 54
- 55. LUQ Conditions • SplenicRupture: S/S – LUQ pain referred to L shoulder- Kehr’s sign – Hypotension, syncope • Acute Pancreatitis S/S – LUQ pain- referred to back, scapula, and chest- knifelike – Fever, rigidity, rebound tenderness, nausea, vomiting, distension, decreased to absent bowel sounds – Elevated lipase and amylase 55
- 56. RLQ Conditions • Appendicitis •Ectopic Pregnancy • Perforated Duodenal Ulcer • Right Ureteral Kidney Stone 56
- 57. RLQ…….Cont. • Appendicitis S/S –Anorexia, nausea, Periumbilical colicky to aching pain-12-24 hrs-McBurney’s point, positive peritoneal signs-iliopsoas and obturator, fever, elevated white cell count • Ectopic Pregnancy S/S – Symptoms of pregnancy, RLQ pain- shoulder – Peritoneal signs, shock- low BP and high pulse 57
- 58. RLQ…..Cont. • Perforated DuodenalUlcer S/S – Distension, peritoneal signs, blood in stool, pain in epigastric area and RLQ • R Ureteral Kidney Stone S/S – Nausea, vomiting, fever, colicky severe pain in RLQ and groin area, restless, blood in urine 58
- 59. LLQ Conditions • LUreteral Kidney Stone • L Ectopic Pregnancy • Diverticulitis – Infected diverticulum – S/S • LLQ pain, fever, diarrhea, constipation, pain over descending colon 59
- 60. Examination of Rectum •If your patient is age 40 or older, perform a rectal examination as part of your GI assessment. Be sure to explain the procedure to the patient before you begin. • Inspection • Palpation
- 61. Abnormal Finding • AbdominalDistention • Abdominal Pain • Type of abdominal Pain • Abnormal Abdominal sounds • Skin color Changes • Other Common GI abnormalities
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