Assessment of the Abdomen By Freida Fuller-Jonap fulerjonap_f 678-547-6742

The Abdominal Assessment Includes the lower end of the esophagus stomach kidneys edge of the urinary bladder spleen liver gallbladder uterus large and small intestines peritoneum

Health History Data Should Include possibility of pregnancy family history previous GI or GU trauma specific problems related to GI tract and GU system Diet nutrition level of stress alcohol/cigarette smoking medications stood urinary exposure to infectious disease

Assessment should occur in a particular order Inspection Ausculatation Percussion Palpation

Inspection Skin: color, texture, scars, lesions, striae, rashes, wounds, incisions, ostomies, etc Color: Grey Turner Sign jaundice ascites

Contour: flat, rounded, concave, protuberant Assymetry Masses Movement Vascularity Striae Inspect the Umbilicus Cullen’s sign Contour: flat, rounded, concave, protuberant Assymetry Masses Movement

Pulsations of the aorta Peristalsis of intestines

Auscultation Bowel sounds hyperactive hypoactive Absent

Vascular Sounds Friction Rubs Bruits aorta renal arteries iliac arteries Friction Rubs

Percussion Tympany Liver Span: normal span 6-12 cm. Liver enlargement, hepatomegaly is characterist of liver tumors, cirrhosis, abscess, and vascular engorgement Fist Percussion of CVA

Palpation Light palpation Deep palpation Palpation of the Liver Palpation of the spleen Palpating kidneys Palpating the urinary bladder

Special Abdominal Tests Ascites Fluid Wave Fluid Shift

Special Abdominal Tests (continued) Ballottement Technique Appendicitis Rebound tenderness (Blumberg’s sign Rovsing’s Referred rebound tenderness

Psoas Oburator sign Acute cholecystitis Murphy’s sign

Diagnostic Testing Ultrasound of the Abdomen: visualize abdominal aorta, liver, gallbladder, pancreas, bile ducts, spleen kidneys, ureters, and bladder CT of the Abdomen MRI: less accurate that CT for most abdominal diseases, maybe better for liver and pelvis that CT

Tests for Gallbladder Diseases Bilirubin Direct Indirect

Diagnostic Study for the Pancreas Serum Amylase

Liver Studies Ammonia: hepatitis, cirrhosis, hepatic encephalopathy Prothrombin Time: cirrhosis, hepatitis, bile duct obstruction, ALT (alanine aminotransferase: hepatitis, liver necrosis, cirrhosis, cholestasis, tumor and hepatotoxic drugs

AST (aspartate aminotransferase) Used to be SGOT AST (aspartate aminotransferase) Used to be SGOT. Hepatitis, gallstone, cirrhosis AST/ALT ratio: cirrhosis, liver congestion, tumors ALP (alkaline phosphatase): cirrhosis, biliary obstruction, liver tumor

Diagnostic Tests for Kidney Disorders BUN: metabolic function of the liver and excretory function of the kidney Increased: renal disease/failure, nephrotoxic drugs GI bleeding, excessive protein ingestion Decreased: Liver failure, overhydration, malnutrition, malabsorption, nephrotic syndrome Creatinine Potassium

IVP: intravenous pyelogram KUB: Kidneys, ureters, bladder Urinalysis Protein Leukocyte esterase Nitrates Urine for C & S IVP: intravenous pyelogram KUB: Kidneys, ureters, bladder

Diagnostic Tests for Gastrointestinal System EGD (esophagogastroduodenoscopy): tumors, esophageal diverticula, hiatal hernia, esophagitis, gastritis… Barium enema Barium Swallow Colonoscopy Sigmoidoscopy