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Lecture

Abdominal Assessment

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Department
Health Sciences
Course
HTHSCI 1J03
Professor
Mc Master University
Semester
Spring

Description
Abdominal Assessment • Large oval cavity extending from the diaphragm down to the top of the pelvis • Bordered by the vertebral column/ paravertebral muscles in the back and by the lower rib cage and abdominal muscles at the side and front • Rectus Abdominis: Forms a strip extending the length of the midline. Palpable. • All internal organs of the abdominal cavity are the viscera • Solid Viscera: Maintain characteristic shape (liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus) • The liver fills most of the right upper quadrant and extends to the left midclavicular line. The lower edge of the liver/right kidney may be palpable (normally) • Hollow Viscera: Shape depends on the contents. Usually not palpabe, though you may feel the colon distended with feces or the bladder distended with urine. Examples of this are the stomach, gallbladder, small intestine, colon, and bladder. • The small intestine is located in all four quadrants • Spleen: Mass of soft lymphatic tissue on the posterolateral wall of the abdominal cavity. Its width extends from the ninth to the eleventh rib • Aorta: Just left of the midline in the upper part of the abdomen. Descends behind the peritoneum. You can palpate aortic palpations easily in the upper anterior abdominal wall • Pancreas: A soft, lobulated gland located behind the stomach in the left upper quadrant • Kidneys: Retroperitoneal, or posterior to the abdominal contents. They are well protected by posterior ribs and muscles. The twelfth rib forms an angle (costovertebral angle) where the left kidney lies. The right kidney lies 1-2 cm lower than the right and is sometimes palpable • Epigastric = Area between the costal margins, Umbilical = The area around the umbilicus, Hypogastric/Suprapubic = The area above the pubic bone • The liver takes up proportionately more space in the abdomen at birth than in later life • An enlarged uterus in a pregnant woman displaces the intestines upward and posteriorly Subjective Data • • Appetite • Bowel Habits • Dysphagia (Difficulty Swallowing) • Past Abdominal History • Food Intolerance • Medications • Abdominal Pain • Nutritional Assessment • Nausea/ Vomiting Additional History for Infants: • How they are being fed • Table Foods • Eating Patterns • Constipation • Abdominal Pain • Overweight Children Additional History for Adolescents: • Eating Schedule and Foods • Exercise • Underweight (Eating Disorders) Additional History for Older Adults: • Food Access • Emotional Characteristics • Recall • Bowel Movements Objective Data 1. Wash your hands, introduce yourself to the patient and clarify their identity.  Explain what you would like to do and obtain consent. A chaperone should be offered for this examination  Wash your hands  Introduce yourself to the patient 1. The patient should initially be laid on the bed and exposed from the waist up. Begin by making a general inspection of the patient from the end of the bed. You should be looking for:  Whether they are comfortable at rest  Do they appear to be tachypnoeic  Are there any obvious medical appliances around the bed (such as patient controlled analgesia)  Are there any medications around (although this is unlikely as all medications should be in a locked cupboard)  Each of these should be reported to the examiner.  Observe the patient from the end of the bed 2. Move on to examine the patient’s hands. You are looking for the presence of:  Koilonychia  Leukonychia  Nail clubbing  Palmar erythema  Nicotine staining  Dupuytren’s contracture Ask the patient to hold their hands out in front of them looking for any signs of a tremor. Them to extend their wrists up towards the ceiling keeping the fingers extended and look for a liver flap. 3. Now is a good time to assess the radial pulse. There is some argument as to whether this should be performed or not in an abdominal exam; however, it can be a good indication of sepsis or thyroid disease.  Take the radial pulse 4. Move on to examine the face.  Initially check the conjunctiva for pallor which could be a sign of anaemia.  Check the sclera for jaundice.  Next move to the mouth asking the patient to open it. Look at the buccal mucosa for any obvious ulcers which could be a sign of Crohn’s disease.  Also look at the tongue. If it is red and fat it could be another sign of anaemia, as could angular stomatitis.  Inspect the eyes  Inspect the mouth and tongue  Angular cheilitis 5. Move down to the neck to palate the left supraclavicular lymph node.  A palpable enlarged supraclavicular (Virchow’s) node is known as Troisier’s Sign. This is the node which drains the thoracic duct. This receives lymph drainage from the entire abdomen as well as the left thorax. Enlargement of this node may therefore suggest metastatic deposit
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