1. NURSING EVALUATION OF THE ABDOMEN MATHENY MEDICAL AND EDUCATIONAL CENTER The Abdominal Evaluation

2. Abdominal Anatomy GLASS  Gallbladder  Liver  Aorta  Stomach  Spleen  Pancreas  Bowel  Appendix  Urinary  Bladder  Reproductive  Ovaries  Uterus

3. Quadrants RUQ Hepatitis Gallstones Cholecystisis Pancreatitis PNA RLQ Appendicitis Diverticulitis SBO Ovaries Hernia LUQ Spleen Ulcers Gastritis PNA LLQ Diverticulitis Constipation SBO Ovarian Hernia

4. Abdominal Exam Sequence Observe Auscultate Palpate Percuss

5. Observation Shape  Flat,  Scaphoid  Distended Appliances  Gtube, Baclofen pump, Ostomies Scars  Adhesions  Obstruction  Surgeries Discolorations/Bruises Distension  Flatus  Obstruction  Gastroparesis  Constipation  Ascites

6. Auscultate Present or Absent  Listen for 2 – 3 minutes  Listen in all 4 quadrants Freqency  Normoactive  1 sound q 2-5 secs  Hyperactive  Intestinal Inflammation  Gastroentritis  Obstruction  Hypoactive  Serosal Inflammation Peritonitis Appendicitis  Ileus  SBO Quality  High Pitched - Obstruction

7. Palpation Use both hands Palpate all four quadrants  Feel for tenderness, masses, organomegaly  Start in quadrant opposite of location of pain and save quadrant with pain till last  First do superficial palpation then do deep Flex hips and knees to relax abdomen if needed Wait for expiration for abdomen to relax in needed Red Flags  Stiff or Rigid abdomen – peritonitis  Pain localized to particular quadrant/area

8. Percussion Differentiates solid mass or ascites vs air filled space  Solid tissue and ascites sounds dull  Air filled space sounds tympanic Used to measure liver

9. Differential Diagnosis Constipation Gastroparesis Pneumonia Ulcers Irritable Bowel Disease Small Bowel Obstruction Volvulus Appendicitis Gallstones/cholecystitis Urinary Retention Ovarian cysts Menstrual pain

10. Notify Physician Bilious, bloody, or intractable vomiting Bloody stool – bright red or melena Rigid abdomen Point tenderness in abdomen Significant/acute abdominal distention

11. What to Report to MD VITAL SIGNS!!! Exam findings  Distention, Quality of bowel sounds, Location of tenderness History should include  Recent GI history  Vomiting – bilious, bloody, content  Diarrhea – bloody, particularly foul smelling  Constipation – know when was last bm  Pertinent GI history if unknown to MD  Recent weight  Any measures already taken  Venting of gtube, residuals, suppositories given, bowel rest, etc…

12. THANK YOU! THE END QUESTIONS ????