Abdominal Assessment

 Infants and Children  Newborns . In newborn, umbilical cord shows prominently on abdomen  Contains two arteries and one vein  Liver takes up proportionately more space in abdomen at birth than in later life  Urinary bladder located higher in abdomen than in adult  During early childhood abdominal wall less muscular, so organs may be easier to palpate

 Pregnancy  Nausea and vomiting/“morning sickness” . first and second missed periods . Cause unknown; may be due to hormone changes  Acid indigestion/heartburn (pyrosis) /reflux . Gastrointestinal motility decreases, which prolongs gastric emptying time  Constipation . increased venous pressure in lower pelvis may lead to ______ Skin changes on abdomen include striae and linea nigra

 Aging Adult  More adipose tissue in abdomen and hips . suprapubic area in females as a result of decreased estrogen levels . Males prone to “spare tire”  Salivation decreases, causing a dry mouth and a decreased sense of taste  Gastric acid secretion decreases with aging; may cause pernicious ______(because it interferes with vitamin B12 absorption), iron deficiency anemia, and malabsorption of calcium  Incidence of gallstones increases with age,  10% to 20% of middle-aged and older adults; more common in females  Drug metabolism decreases (age 60 to 80) years blood flow through liver is decreased  Constipation frequently reported

 Abdominal Signs and Symptoms  Nausea and vomiting  Anorexia  Dysphagia  Diarrhea or constipation  Abdominal Distension  Abdominal pain  Increased flatulence  Dysuria  Nocturia 1 Page 2 of 5

 Dysguesia

 Lactose Intolerance  Lactase is digestive enzyme necessary for absorption of carbohydrate lactose (milk sugar) . abdominal pain, bloating, and flatulence when milk products are consumed  Incidence of lactose intolerance is . 70% to 90% in African Americans, American Indians, Asians, and Mediterranean groups . 15% in Europeans and Americans

 Referred Pain  Upper GI . Patient may complain of “ heart pain” or “chest pain” . May point to or describe substernal area  Lower GI . Intestinal blockage – constipation . Appendicitis – radiating pain from RLQ to umbilicus  Liver . Upper right quadrant and right shoulder

 Subjective Questioning and ROS  GI . nausea, vomiting, diarrhea, hepatitis, peptic ulcers, gallstones, gastroesphageal reflux, or loss of appetite  GU . changes in color, dysuria, hesitancy, urgency, frequency, nocturia, incontinence, polyuria, dribbling, loose of force of stream, kidney stones, flank pain, testicular and penile pain, penile discharge, enlarged prostate, emissions, and hernias.  GYN . pain during intercourse, vaginal drainage, odor

 Medical History  Abdomen specific . acute or chronic disease processes of the stomach, intestines, kidneys, liver, spleen, uterus, prostate, etc.  Nonabdomen specific . CHF (ascites), cancer (possible metastases), fibromyalgia (possible IBS), pituitary disorders (adrenal, polycystic ovaries), alcoholism (hepatitis), spinal cord damage (constipation, dysphagia), diabetes (kidney dysfunction).  Surgical . GI, reproductive, urinary procedures . N/V,D/C due to medication sensitivities  GI procedures  Injuries/accidents . Trauma, PID, peritonitis, ruptured appendix  Family health history . Cancers (stomach, pancreas, liver, kidney, colon), PUD, DM, polyps, IBS, colitis, malabsorption (celiac)  Social history . alcohol (malabsorption), cirrhosis, upper/lower GI bleeding 2 Page 3 of 5

 Allergies  Health maintenance activities  Medications: . Histamine: two antagonists . Antibiotics . Lactulose . Antacids . Antiemetics, Antidiarrheals . Laxatives or stool softeners . Pancreatic enzymes . Steroids . Chemotherapeutics . Antiflatulents  Alcohol use  Drug use  Travel history  Work environment  Stress

 Physical Assessment  Sequence of Steps . Inspection . ______. Percussion . ______ Empty Bladder  Supine  Arms at side

 Characteristics Determined by Inspection  Contour . Flat . Round . Scaphoid . Protuberant  Symmetry  Rectus abdominis muscles  Pigmentation and color  Scars  ______ Respiratory movement  Masses or nodules  Visible peristalsis  Pulsation  Umbilicus

 Inspection: 7 F’s of Abdominal Distension  1. Fat  2. Fluid (______) 3 Page 4 of 5

 3. Flatus  4. Feces  5. Fetus  6. Fatal growth (malignancy)  7. Fibroid tumor

 Auscultation  Assess all four quadrants  Listen for at least ______before concluding bowel sounds are absent  Hypoactive  Hyperactive  Normal findings . Bowel sounds are heard in all quadrants . Usually sounds are high pitched . Occur 5 to 30 times per minute  Bell . Low pitch . Vascular Sounds  Diaphragm . Hi pitch . Gastric Sounds

 Palpation- Normal Findings  Light vs. Deep . Light: ½ inch . Deep: 1-3 inches  Palpate all quadrants . One-handed method . Bimanual method  Do not palpate a rigid abdomen  Normal findings . No tenderness . Abdomen feels soft . No muscle guarding . No masses or organomegaly . No bladder distension . Aorta <3 cm, if palpated

 Palpation – Abnormal Findings  Rigidity  Tenderness on palpation  Muscle guarding on expiration  Presence of masses, bulges, or swelling  ______. At a site away from tenderness, press down perpendicular to abdomen. Push down slow, lift up fast. Causes structures to rebound. Negative = no pain . Peritoneal inflammation, appendicitis

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 Documentation Example  Abdomen symmetrical and rounded. Color pink with even distribution of pigmentation. No, masses, pulsations, peristalsis, retractions, or rectus abdominis muscles visible. Positive bowel sounds heard in all quadrants. No masses, muscle guarding, tenderness upon light palpation. No complaints of pain. ------Sam Smith ADNS Chippewa Valley Technical College