Location
RUQ anatomy
Where is Liver, gallbladder, head of pancreas, R kidney/adrenal, hepatic flexure of colon, part of ascending and transverse colon?
Health history cues in adult
What are Appetite changes, dysphagia, N/V/D, pain, medication use, ETOH, stressors, C/O of burning, gas, upset stomach, blood in urine or stool
Inspection of umbilicus
What is midline and inverted, no discoloration/inflammation/or hernia
Signs of Pain
Restlessness = colicky pain of gastroenteritis and obstruction
Absolute stillness = pain of peritonitis
Knees flexed + facial grimacing + rapid, uneven respirations = pain
high pitched, gurgling, cascading sound, occur irregularly q 5-30 seconds
What are normal bowel sounds?
LUQ anatomy
Where is the Stomach, spleen, L lobe of liver, body of pancreas, L kidney/adrenal, splenic flexure of colon, part of transverse and descending colon
Health history cues in infant
What are Colic, distention, poor feeding, vomiting, rigidity, change in elimination
Atypical inspection of the umbilicus
What is everted with ascites, mass, pregnancy/ sunken with obesity/ enlarged and everted/protruding with hernia
Assess density of abdominal contents, locate organs, screen for abnormal fluid or masses
What is the purpose of percussing the abdomen?
Hypoactive bowel sounds
What is:
Longer than 5-30 seconds; follow abdominal surgery
Seen with inflammation of peritoneum, paralytic ileus
Silent abdomen uncommon and must listen for 5 minutes
RLQ anatomy
Where is the Cecum, appendix, R ovary, R ureter, R spermatic cord
Typical abdominal inspection
What is Flat/rounded, symmetrical bilaterally
Bluish periumbilical color occurs with intraperitoneal bleeding
What is Cullen Sign?
Percussing liver span technique
What is:
Start at MCL over lung to percuss resonance
Percuss down until resonance changes to dullness = mark spot
Start at RLQ with tympany at MCL, percuss up until tympany changes to dullness = mark the spot
Measure distance
Loud, high-pitched, rushing tinkling
Seen with early obstruction
What are hyperactive bowel sounds?
LLQ anatomy
Where is Part of descending colon, sigmoid colon, L ovary and tube, L ureter, L spermatic cord
Atypical abdominal assessment
What is Scaphoid (sunken in); protuberant (pregnant/obese)
Asymmetry--tumors, cysts, obstruction
Abnormal findings upon inspection of Striae
What is prolonged stretching
purple = Cushing's,
pregnancy = white, obesity, tumors, ascites?
Normal distance for liver span
6-12 cm MCL (although up to 15cm may be considered normal-look at other indicators also), 4-8 cm midsternal line
>span = consider hepatomegaly
Vascular sounds
Important in patient with HTN, listen with bell for bruit
Normal = no sound
Abn = aorta - midline, renal arteries, iliac arteries, femoral arteries
Note location, pitch, timing
Systolic bruit pulsating blowing sound heard with occlusion of an artery
Friction rub = inflammation of peritoneum
Midline anatomy
Where is the Aorta, uterus, bladder
Expected abdominal inspection in infants
What is Rounded, protuberant, Diastasis recti (ridge that runs down middle of belly)may be noted (normal), Blood vessels and peristalsis
Abnormal findings upon Inspection of Pulsations
What is marked pulsation of aorta = AAA, HTN visible peristalsis + distended abdomen = obstruction
To assess ascites seen with CHF, portal HTN, cirrhosis, hepatitis, pancreatitis, and cancer
Why is the fluid wave performed?
Method and findings for percussing on abdomen
What is:
Percuss lightly in all 4 quadrants to determine tympany versus dullness
Normal is tympany
Abn: dullness over the distended bladder, fat, fluid or mass; hyperresonance with gas distention