Older adults have decreased salivation leading to dry’ mouth. Correct 9. The Symptoms occurring with lactose intolerance include bloating and flatulence. 10. Methods to enhance abdominal wall relaxation during examination include positioning the patient with the knees bent. Review questions: 1 . The sequence of techniques used during an examination of the abdomen is: ; Inspection ; Auscultation ; Percussion ; Palpation 2. Venous pattern, peristaltic waves, and abdominal contour can be noted through inspection of a patients abdomen. . Right, upper quadrant tenderness may indicate pathology in the liver, pancreas, or ascending colon 4. Hyperactive bowel sounds are high-pitches, gushing, and tinkling 5. The absence of bowel sounds is established after listening for 5 full minutes 6. Auscultation of the abdomen may reveal bruits of the Aortic, renal, iliac and femoral arteries 7. The normal range of liver span in the right matriculated line in the adult is 6-12 CM 8. The left upper quandary contains the spleen 9. A female patient has striate on the abdomen.
Which color indicates long- standing striate? Silvery white 10. Auscultation the abdomen is begun in the right lower quadrant because bowel sounds are always normally present here. 11. A dull percussion note forward of the left medically line is indicative The four layers of large, flat abdominal muscles form the ventral abdominal wall and are joined at the midlines by a tendentious seam, the lineal alba. ; The ovaries are normally palpable only on biannual examination during the pelvic examination. ; The small intestine is located in all four quadrants.
It extends from the pyloric valve of the stomach to the locale valve in the right lower quadrant ; The spleen is a soft mass of lymphatic tissue on the posterior wall of the abdominal cavity, immediately under the diaphragm. ; The aorta is just to the left of midlines in the upper part of the abdomen. It ascends behind the peritoneum, and at CM below the umbilicus it bifurcates into the right and left common iliac arteries opposite the 4th lumbar vertebra. ; The pancreas is a soft, elaborated gland located behind the stomach. It stretches obliquely across the posterior abdominal wall to the posterior abdominal quadrant.
The kidneys are retaliations, Or posterior to the abdominal contents. They are well protected by the posterior ribs and musculature. The 12th rib forms an angle with the vertebral column, the esoterically angle. Right Upper Quadrant Left Upper Quadrant ; Liver ; Gallbladder ; Duodenum Stomach ; Spleen ; Head of Pancreas ; Left Lobe of Liver ; Body of Pancreas ; Right Kidney and Adrenal ; Left Kidney & Adrenal ; Hepatic flexure of Colon ; Splenetic flexure Of Colon ; opt. Of ascend/Trans. Colon ; Opt. Of Trans. Desk. Loon Right Lower Quadrant Left Lower Quadrant ; Scum ; Appendix ; part of desk. Colon ; Sigmoid colon ; Right ovary & tube ; Left ovary & tube ; Right router ; Left router ; Right spermaceti’s cord ; Left spermaceti’s cord Midlines Aorta Uterus (if enlarged) Bladder (if distended) ; The enlarging uterus displaces the intestines upward and posterior. Bowel sounds are diminished. The appendix may be displaced upward and to the right, but appendicitis-related pain would still be felt in the RL. Us objective Data: ; Appetite? Any changes in appetite or change in weight? Anorexia is loss of appetite from GIG disease as a side effect to some medications, pregnancy or mental health disorders. ; Dysphasia: occurs with disorders of the throat or esophagi. Difficulty swallowing. ; Food intolerance: Are there any foods you can’t eat? What happens when you eat them? Lactose Into. ; Abdominal Pain: may be visceral from an internal organ (dull); parietal from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement); Acute pain needing urgent diagnosis from appendicitis, collectivists, bowel obstruction or perforated organ.
Chronic pain from gastric ulcers on empty stomach; pain of duodenal ulcers 2-3 hours after a meal. ; Nausea/vomiting is common w/Gal disease, many meds and pregnancy. ; Hemstitches occurs w/ stomach or duodenal ulcers and esophageal avarice. ; GIG upset and diarrhea occur when exposed to new local pathogen in developing countries. ; How often do you have a bowel movement? Assess usual bowel habits. Black stools may be tarry due to occult blood (enamel) from GIG bleed, or non tarry from iron meds. Gray stools occur w/hepatitis.
Red blood in stools occurs with GIG bleeding or localized bleeding around the anus. ; Peptic ulcer disease occurs w/frequent use of nonessential anti- inflammatory drugs, alcohol, smoking, and H. Pylori. ; Nutritional assessment via 24-hour recall Aging adult: Assess for nutritional deficit; limited access to grocery store, income, or cooking facilities; physical disability, social isolation. 24 hour recall may not be sufficient because daily pattern may vary. Attempt a week long diary. Meds: Consider GIG side effects, nausea, anorexia, dry mouth.
Bowel movements, constipation. Objective Data Preparation: ; The lighting should include a strong overhead light and a secondary standard light. ; The person should have emptied their bladder ; Warm room to avoid muscle tensing ; Position the person supine, w/head on pillow, knees bent, or on pillow & arms at sides or over chest. Not overhead because this tenses ABA muscles. ; To avoid ABA tensing, the stethoscope indices must be warm ; Inquire about painful areas ; use distraction. Enhance muscle relaxation through breathing and emotive magma.
Contour: ; Stand on the person’s right side and look down on the abdomen. Then stoop to gaze across the abdomen. Your head should be slightly higher than the abdomen. Et contour describes the nutritional state and normally ranges from flat to rounded. ; Symmetry ; Shine a light across the abdomen toward you lengthwise across the person, should be symmetric bilaterally. Even small bulges are highlighted by shadow. Step to the foot of the bed to recheck symmetry. ; Ask the person to take a deep breath to further highlight any change.
The abdomen should stay smooth and symmetric or ask the person to perform a sit-up without pushing up w/hands. Abnormal findings: ; Sapphic abdomen caves in. ; Protuberant indicates ABA distension ; Bulges, masses ; Hernia-protrusion of abdominal viscera through abnormal opening in muscle wall ; Sister Mary Joseph nodule is a hard nodule in umbilicus that occurs with metastasis cancer of the stomach, large intestine or pancreas ; Note any localized bulging. Hernia or enlarged Liver or Spleen may show. Umbilicus ; Normally it is midlines and inverted with no signs of disconsolation, inflammation or hernia ; Averted with Cities or underlying mass. ; Deeply sunken with obesity ; Enlarged, averted with umbilical hernia ; Bluish pharmaceutical color occurs w/interpersonal bleeding(Cullied sign) ; Skin ; The surface is smooth and even, with homogeneous color. This is a good area to judge pigment because it is protected from the sun. ; One common pigment change is striate (liana lubricants) silvery white, linear jagged marks.
They occur when elastic fibers in the reticular layer of the skin are broken after rapid or prolonged stretching as in pregnancy or excessive eight gain. Recent striate are pink or blue then turn white. ; Redness with localized inflammation ; Jaundice shows best in natural daylight ; Skin glistening and taut with cities ; Striate look purple-blue w/Cushing syndrome (excess directionally hormone that causes the skin to be fragile and easily broken Normal findings ; Pigmented nevi (moles) – circumscribed brown muscular or popular areas common on the abdomen. A surgical scar alerts you to the possible presence of underlying adhesions and excess fibrous tissue. ; Unusual color or change in shape of mole. . Patchier Coetaneous magnolias (spider nevi) occur with portal hypertension or liver disease ; Lesions, rashes ; Underlying adhesions are inflammatory bands that connect opposite sides of serous surfaces after Normal findings trauma or surgery ; Veins are not seen, but a fine venous network may be visible in thin persons. Good skin tutor reflects healthy nutrition. Prominent, dilated veins occur with portal hypertension, cirrhosis, cities, or even cabal obstruction. Veins are more visible in malnutrition as a result of thinned adipose tissue. Poor tutor occurs with dehydration, which often accompanies GIG disease. Pulsation and Movement ; Normally u see the pulsations from the aorta beneath the skin in the epigenetic area, particularly in thin people with good muscle wall relaxation. Respiratory movement also shows in the abdomen, particularly in males. Waves of peristalsis sometimes are visible in very thin people.
They ripple slowly across the abdomen. ; Marked pulsation of aorta occurs with widened pulse pressure (hypertension, aortic insufficiency thrombosis’s and aortic aneurysm) ; Marked visible peristalsis, together with a distended abdomen, indicates intestinal obstruction Calculates Bowel Sounds & Vascular Sounds Depart from the usual examination sequence and calculate the abdomen next. This is done because percussion and palpation can increase peristalsis, which can give a false interpretation Of bowel sounds. Use the diaphragm indices because bowel sounds are often high-pitched.
Hold the stethoscope lightly against the skin, pushing too hard may stimulate bowel sounds. Begin in the RL at the locale valve area because bowel sounds are normally are always present here. Bowel Sounds ; Note character & frequency ; They originate from the movement of air and liquid through the stomach and large/small intestine. Depending on the time elapsed since eating, a wide range of normal sounds can occur. ; Bowel sounds are high-pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5-sax’s per minute. Don’t bother to count them. Because sounds radiate widely over the abdomen, the gurgle you hear in the in the RL may originate in the stomach. Therefore listening in all 4 quandaries is not necessary. Just judge if they are present and hypo/hyper active ; One type of hyperactive bowel sound is common is hyperventilates or stomach growling called boroughs. A silent abdomen is uncommon; you just listen for 5 minutes before deciding if bowel sounds are completely absent. ; Hyperactive bowel sounds are loud, high-pitched, rushing, tinkling sounds signaling increased motility. Hypoactive or absent bowel sounds follow abdominal surgery or w/ inflammation of the peritoneum. Vascular Sounds ; As u listen to the abdomen, note the presence of any vascular sounds or bruits. Using firmer pressure, check over the aorta, renal arteries, iliac, and femoral arteries, especially in people with hypertension. Usually no such sound is present. About 4-20% of healthy people <40 may have a normal bruit riginating from the celiac artery. It is systolic, med to low-pitched and heard between the xiphoid process and the umbilicus. Do not auscelate for correct placement of nasogastric tube. ; A systolic bruit is a pulsatile blowing sound and occurs with stenosis or occlusion of an artery ; Venous hum and peritoneal friction rub are rare General Tympany: ; Percuss to assess the relative density of abdominal contents, to locate organs, and to screen for abnormal fluid or masses ; First percuss lightly in all 4 quadrants to determine the prevailing amount of tympany and dullness. Move clockwise. Tympany should predominate because air in the intestines rises to the surface when the person is supine. Dullness occurs over a distended bladder, adipose tissue, fluid, or mass. Hyperresonance is present with gaseous distention Liver Span: ; Measure the height of the liver in the MCL. For consistent placement of MCL landmark, remember to palpate the acromioclavicular and sternoclavicular joints and judge the line at a point midway between the ;o. ; Begin in the area of lung resonance and percuss down the interspaces until the sound changes to a dull quality. Mark the spot, usu in the 5th intercostal space.
Then find the ABA tympani and apercus up in the MIMIC_. Mark where the sound changes from tympani to a dull sound, normally at the right costal margin. ; Measure the distance bet the two marks; the normal liver span in the adult ranges from 6-12 CM. The height of the liver span correlates with height of the person. Males have a larger span (10. CM) than females (CM). ; One variation occurs in people with chronic Emphysema, in which the liver is displaced downward by the hyperinflation lungs. ; An enlarged liver span indicates liver enlargement or hypnotherapy. Accurate detection of liver borders is confused by dullness above the 5th intersects space, which occurs with lung disease, pleural effusion or consolidation. ; Accurate detection at the lower border is confused when dullness is pushed up with cities or pregnancy or with gas distension in the colon which obscures the lower border. Splenetic Dullness: ; Often the spleen is obscured by stomach contents, but you may locate it by percussion for a dull note from the 9-1 lath intercessor space just behind the left medically line.
The area of splenetic dullness normally is not wider than CM in the adult & shouldn’t encroach on the normal tympani over the gastric bubble. Now apercus in the lowest interstate in the left anterior auxiliary line. Tympani should result. Ask the person to take a deep breath. Normally tympani remains thru full inspiration. ; A dull note forward of the medically line indicates enlargement Of the spleen, as occurs with mono, trauma, and infection. ; In this site, the anterior auxiliary line, a change in percussion from tympani to a dull sound with full inspiration is a positive spleen percussion sign, indicating supplemental.
This method detects mild-to-moderate supplemental before the spleen becomes palpable, as in mono, malaria, or peptic cirrhosis. Esoterically Angle Tenderness: ; Indirect fist percussion causes the tissues to vibrate instead of producing a sound. To assess kidney place one hand over the 12th rib at the esoterically angle on the back. Thump that hand with the lunar edge of your other fist. The person us feels a thud but no pain ; Sharp pain occurs with inflammation of the kidney or parenthetic area.
Palpate Surface and Deep Areas: Perform palpation to judge the size, location, and consistency of certain organs -Bend person’s knees -Keep your palpating hand low and parallel to abdomen Teach person to breathe slowly; in through nose, and out through mouth -Keep your own voice low and soothing; conversation may relax person -Try “emotive imagery,” e. G. , you might say, “Now I want you to imagine you are dozing on beach, with sun warming your muscles and sound of the waves lulling to sleep. -?perform palpation just after auscultation -Keep stethoscope in place and curl your fingers around it, palpating as you pretend to calculate Light and deep palpation ;Begin with light palpation ;With first four fingers close together, depress skin about 1 CM ;Make gentle tarry motion, sliding fingers and skin together ;Then lift fingers (do not drag them) and move clockwise to next location around abdomen ;Objective is not to search for organs but to form an overall impression of skin surface and superficial musculature.