1. Copyright 2002, Delmar, A division of Thomson Learning Chapter 17 Abdomen

2. Copyright 2002, Delmar, A division of Thomson Learning Competencies Identify the physiological function of the gastrointestinal organs. Assess the health status of a patient with a gastrointestinal complaint. (continues)

3. Copyright 2002, Delmar, A division of Thomson Learning Competencies Demonstrate the techniques of gastrointestinal assessment. Relate abnormal physical gastro- intestinal findings to pathological processes. Outline the gastrointestinal variations associated with the aging process.

4. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Abdominal cavity Peritoneum Abdominal vasculature Abdominal quadrants  Right upper  Right lower  Left upper  Left lower (continues)

5. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Stomach Small intestine Large intestine Liver Gall bladder (continues)

6. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Pancreas Spleen Veriform appendix Kidneys, ureters, and bladder Lymph nodes

7. Copyright 2002, Delmar, A division of Thomson Learning Health History Patient profile  Age  Child to young adult: appendicitis  Adult: peptic ulcers, cholecystitis, DM, gastrointestinal malignancies  Gender  Female: gallbladder disease  Male: GI cancers, cirrhosis, duodenal ulcers

8. Copyright 2002, Delmar, A division of Thomson Learning Common Chief Complaints Nausea and vomiting Anorexia Dysphagia Diarrhea or constipation (continues)

9. Copyright 2002, Delmar, A division of Thomson Learning Common Chief Complaints Abdominal distension Abdominal pain Increased eructation or flatulence Dysuria Nocturia

10. Copyright 2002, Delmar, A division of Thomson Learning Characteristics of Chief Complaint Quality Associated manifestations Aggravating factors Alleviating factors Timing

11. Copyright 2002, Delmar, A division of Thomson Learning Past Health History Medical  Abdomen specific  Nonabdomen specific Surgical  GI procedures

12. Copyright 2002, Delmar, A division of Thomson Learning Common Medications Histamine: two antagonists Antibiotics Lactulose Antacids Antiemetics (continues)

13. Copyright 2002, Delmar, A division of Thomson Learning Common Medications Antidiarrheals Laxatives or stool softeners Pancreatic enzymes Steroids Chemotherapeutics Antiflatulents

14. Copyright 2002, Delmar, A division of Thomson Learning Past Health History Communicable diseases Allergies Injuries/accidents Family health history  Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis

15. Copyright 2002, Delmar, A division of Thomson Learning Social History Alcohol use Drug use Travel history Work environment Hobbies/leisure activities Stress Economic status

16. Copyright 2002, Delmar, A division of Thomson Learning Health Maintenance Activities Sleep Diet Exercise Stress management Use of safety devices Health checkups

17. Copyright 2002, Delmar, A division of Thomson Learning Past Health History Allergies Injuries/accidents Family health history Social history Health maintenance activities

18. Copyright 2002, Delmar, A division of Thomson Learning Assessment of the Abdomen Equipment Order  Inspection  Auscultation  Percussion  Palpation

19. Copyright 2002, Delmar, A division of Thomson Learning Inspection Contour Symmetry Rectus abdominis muscles Pigmentation and color Scars (continues)

20. Copyright 2002, Delmar, A division of Thomson Learning Inspection Striae Respiratory movement Masses or nodules Visible peristalsis Pulsation Umbilicus (continues)

21. Copyright 2002, Delmar, A division of Thomson Learning Inspection Normal findings  Abdomen is flat or round, symmetrical  Uniform in color and pigmentation  No scars or striae present  No respiratory retractions  No masses or nodules  Ripples of peristalsis may be visible  Nonexaggerated pulsation of the abdominal aorta may be present  Umbilicus is depressed

22. Copyright 2002, Delmar, A division of Thomson Learning Auscultation Assess all four quadrants Listen for at least 5 minutes before concluding bowel sounds are absent (continues)

23. Copyright 2002, Delmar, A division of Thomson Learning Auscultation Normal findings  Bowel sounds are heard in all quadrants  Usually sounds are high pitched  Occur 5 to 30 times per minute (continues)

24. Copyright 2002, Delmar, A division of Thomson Learning Auscultation Abnormal findings: absent, hypoactive or hyperactive bowel sounds Pathophysiological indications  Absent and hypoactive bowel sounds may indicate decreased motility and possible obstruction  Hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis

25. Copyright 2002, Delmar, A division of Thomson Learning Percussion Percuss all four quadrants Assess liver span, liver descent, margins of spleen, stomach, kidneys, bladder Sounds heard: tympany or dullness

26. Copyright 2002, Delmar, A division of Thomson Learning Normal Findings Tympany heard over air-filled areas, such as stomach and intestines Dullness heard over solid areas, such as liver, spleen, or a distended bladder No tenderness elicited over kidneys and liver Empty bladder is not percussable above the symphysis pubis

27. Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Dullness over areas where tympany is normally heard  This finding may indicate a mass or tumor, ascites, full intestine, pregnancy Liver span > 12 cm or < 6 cm  This finding may indicate hepatomegaly or cirrhosis (continues)

28. Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Liver descent > 2 to 3 cm  May indicate hepatomegaly or cirrhosis Dullness > 8 cm line  May indicate splenic enlargement Costovertebral angle tenderness  May indicate pyelonephritis Ability to percuss a recently emptied bladder  May indicate urinary retention

29. Copyright 2002, Delmar, A division of Thomson Learning Palpation Light vs. Deep Palpate all quadrants Normal findings  No tenderness  Abdomen feels soft  No muscle guarding

30. Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Tenderness on palpation  May indicate inflammation, masses, or enlarged organs Muscle guarding on expiration  May indicate peritonitis Presence of masses, bulges, or swelling  May indicate enlarged organs, tumors, cholecystitis, hepatitis, cirrhosis (continues)

31. Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Liver is palpable below the costal margin  May indicate CHF, hepatitis, cirrhosis, encephalopathy, cancer Spleen is palpable  May indicate inflammation, CHF, cirrhosis, mononucleosis Kidneys are palpable  May indicate hydronephrosis, neoplasms, polycystic kidney disease (continues)

32. Copyright 2002, Delmar, A division of Thomson Learning Abnormal Findings Aorta width > 4 cm  May indicate abdominal aortic aneurysm Able to palpate recently emptied bladder  May indicate urinary retention Palpable inguinal lymph nodes > 1 cm in diameter or tender nodes  May indicate systemic infections, cancer

33. Copyright 2002, Delmar, A division of Thomson Learning Advanced Techniques Rebound tenderness Rovsing’s sign Cutaneous hypersensitivity Iliopsoas muscle test Obturator muscle test Ballotment

34. Copyright 2002, Delmar, A division of Thomson Learning Gerontological Variations Abdominal musculature diminishes in mass and tone Increased fat deposition in abdominal area Altered GI motility resulting in indigestion and altered absorption Decreased gastric acid secretion Increased incidence of malignant disease Changes in bowel habits