copyright 2002, delmar, a division of thomson learning chapter 17 abdomen

Copyright 2002, Delmar, A division of Thomson Learning

Chapter 17

Abdomen


Competencies Identify the physiological function

of the gastrointestinal organs. Assess the health status of a patient

with a gastrointestinal complaint.

(continues)


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.


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


Common Chief Complaints Nausea and vomiting Anorexia Dysphagia Diarrhea or constipation

(continues)


Common Chief Complaints Abdominal distension Abdominal pain Increased eructation or flatulence Dysuria Nocturia


Characteristics of Chief Complaint Quality Associated manifestations Aggravating factors Alleviating factors Timing


Past Health History Medical

Abdomen specific Nonabdomen specific

Surgical GI procedures


Common Medications Histamine: two antagonists Antibiotics Lactulose Antacids Antiemetics

(continues)


Common Medications Antidiarrheals Laxatives or stool softeners Pancreatic enzymes Steroids Chemotherapeutics Antiflatulents


Past Health History Communicable diseases Allergies Injuries/accidents Family health history

Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis


Social History Alcohol use Drug use Travel history Work environment Hobbies/leisure activities Stress Economic status


Health Maintenance Activities Sleep Diet Exercise Stress management Use of safety devices Health checkups


Past Health History Allergies Injuries/accidents Family health history Social history Health maintenance activities


Assessment of the Abdomen Equipment Order

Inspection Auscultation Palpation


Inspection Contour Symmetry Rectus abdominis muscles Pigmentation and color Scars

(continues)


Inspection Striae Respiratory movement Masses or nodules Visible peristalsis Pulsation Umbilicus

(continues)


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


Auscultation Assess all four quadrants Listen for at least 5 minutes before

concluding bowel sounds are absent

(continues)


Auscultation Normal findings

Bowel sounds are heard in all quadrants

Usually sounds are high pitched Occur 5 to 30 times per minute

(continues)


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


Palpation Light vs. Deep Palpate all quadrants Normal findings

No tenderness Abdomen feels soft No muscle guarding


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)


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)


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


Advanced Techniques Rebound tenderness Rovsing’s sign Cutaneous hypersensitivity Iliopsoas muscle test Obturator muscle test Ballotment


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

copyright 2002, delmar, a division of thomson learning chapter 17 abdomen

Documents

abdomen slide

colitis slide

factors timing slide

health status

gastrointestinal complaint

gastrointestinal variations

gastrointestinal organs

common chief complaints