BIOE221. Session 6. Abdominal Examination. Bioscience Department. Endeavour College of Natural Health endeavour.edu.au

Transcription

1 BIOE221 Session 6 Abdominal Examination Bioscience Department

2 Examination of the Abdomen Session objectives Understand the organs / structures that are present in the abdominal cavity Understand the importance and rationale for the examination techniques for the abdomen Understand the connection between this section and the previous sections

3 Abdominal Landmarks & Muscles (Jarvis, 2016, p.537)

4 Superficial Abdominal Organs (Jarvis, 2012)

5 Deep Abdominal Structures (Jarvis, 2016, p.539)

6 Abdomen Internal Structures Solid viscera liver/ pancreas/ spleen/ adrenal glands/ kidneys/ ovaries/ uterus (pelvic) Hollow viscera stomach/ gall bladder/ small intestine/ colon urinary bladder (pelvic)

7 Abdominal Quadrants & Regions (Tortora & Derrickson, 2012, p.20)

8 Abdominal Quadrants - Upper RUQ Liver Gall bladder Duodenum Head of pancreas (R) kidney/ adrenal Hepatic flexure colon Part of ascending & transverse colon LUQ Stomach Spleen (L) lobe liver Body of pancreas (L) kidney/ adrenal Splenic flexure colon Part of transverse & descending colon

9 Abdominal Quadrants - Lower RLQ Caecum Appendix (R) ovary & tube (R) ureter (R) spermatic cord LLQ Part of descending colon Sigmoid colon (L) ovary & tube (L) ureter (L) spermatic cord Midline aorta/ uterus/ bladder

10 Spleen Spleen Posterolateral LUQ inferior to diaphragm Lies obliquely, parallel to 10 th rib, extending from the 9 th to the 11 th rib. It should be remembered that the spleen may indicate either local tissue or systemic disease. (Tortora & Derrickson, 2012)

11 Case History Questions Focus of case history questions should include: Appetite Dysphagia Food intolerance Abdominal pain Nausea/ vomiting Bowel habits Past abdominal history Medications Nutritional assessment

12 Preparation for Abdominal Exam Warm room/ free of draughts Practitioner Warm hands & equipment/ short fingernails Work from (R) side of client Client Empty bladder Supine/ head on pillow/ knees bent, on pillow/ arms at sides or across chest (NOT above head) Enhance muscle relaxation soothing voice/ relaxed breathing

13 Order of Abdominal Exam When performing an abdominal examination the usual order of examination is changed so that auscultation is now second in the order. This is done because: Need to assess baseline bowel sounds Percussion and palpation will alter the bowel sounds by increasing peristalsis. Inspection Auscultation Percussion Palpation

14 Inspection - Abdomen Contour and Shape Look down onto and across the abdomen (contour) Observe for bulging flanks (ascites) Symmetry Left should resemble right (L) & (R) costal margin should be equally visible Look for signs of hernia or organ enlargement Umbilicus Typically midline and inverted. If everted check if this is usual or represents a change (ascites or mass) inflammation/ discolouration/ hernia

15 Inspection Contours (Jarvis, 2012)

16 Inspection - Abdomen Skin Colour & appearance (Jaundice, inflammation) Striae (obesity, pregnancy or Cushing s syndrome) Moles/ lesions (Assess wound healing or ABCDE) Scars (Adhesions) Veins (Spider nevi or caput medusa) Turgor (hydration) Pulsation/ movement From aorta in epigastric region (especially if client thin) Respiratory movement Peristalsis in thin persons Marked pulsation (hypertension, aneurysm, intestinal obstruction)

17 Location of Abdominal Aorta (Jarvis, 2012)

18 Inspection - Abdomen Hair Distribution Look and ask about changes in the amount, coarseness and distribution of hair over the abdomen. Normal quality and distribution of body hair is determined by gender, race and genetics. Demeanor The person should be comfortable, still and relaxed Restlessness, knee bending or desire for foetal position suggests colic, gastroenteritis or bowel obstruction Rigidness, knees bent, shallow breathing and reluctance to move suggests peritonitis

19 Auscultation of the Abdomen (Jarvis, 2012)

20 Auscultation - Abdomen Done before palpation and percussion which can increase peristalsis. Bowel sounds relationship to when last eaten Note character & frequency High pitched/ gurgling/ cascading sounds, 5-30 times per minute Normal / hyperactive/ hypoactive Abnormal findings: Loud, fast and non-stop bowel sounds = Hyperactive If fewer than 5/min = Hypoactive If no sounds heard for 5 minutes = Absent bowel sounds

21 Percussion of the Abdomen (Jarvis, 2012)

22 Percussion of the Abdomen Percuss to Assess relative density of abdominal contents Locate organs Screen for abnormal fluid or masses General tympany Percuss lightly in all 4 quadrants for tympany & dullness (mostly tympany air in intestines) Dullness fluid/ mass/ adipose tissue/ distended bladder

23 Percussion of the Liver Span Done right mid-clavicular line The distance between the top and bottom edges of the liver is the liver span Normal adult liver span range 6-12cm Males (av 10.5cm) > females (av. 7cm) Taller people have longer liver spans than shorter people Enlargement of the liver = Hepatomegaly.Investigate for underlying cause. Hepatitis/cirrhosis/Hepatic carcinoma

24 Percussion of the Spleen (Jarvis, 2016 p.538)

25 Percussion of the Spleen If necessary the client may roll slightly towards their right side to allow access to the splenic region. The spleen, being a solid organ will produce a dull note on percussion between the 9 th and 11 th intercostal spaces. If dullness is found above or below this, or at the anterior axillary line, then suspect splenomegaly Enlargement of the spleen = splenomegaly Viral infection mononucleosis, EBV Blood disorders Leukaemia, sickle cell anaemia

26 Palpation of the Abdomen (Jarvis, 2016, p )

27 Light Palpation of the Abdomen Light palpation (1-2cm) form overall impression of the abdomen which should be warm and relaxed and the patient should be comfortable and pain free. Discriminate between Voluntary muscle guarding cold/ tense/ ticklish Involuntary rigidity - acute peritoneal inflammation Large masses Pain or tenderness Fluid like tactile sensation - Ascites

28 Deep Palpation of the Abdomen Deep palpation (5-8cm) is used to determine the size and location of organs and masses. Note Location/ size/ consistency/ mobility of palpable organs Abnormal enlargements/ tenderness/ masses

29 Palpable Masses Distinguish it from normally palpable structures/ enlarged organs Note Location Size Shape Consistency (soft/ firm/ hard) Surface (smooth/ nodular) Mobility (movement with respiration) Pulsatility Tenderness

30 Palpation of the Liver Liver is situated in the RUQ. Palpation is used to determine if the liver has enlarged, and to ascertain the texture of the liver Firm regular ridge or not palpable are the usual findings Enlargement or a nodular border or pain on palpation suggests liver disease or dysfunction. Investigate underlying cause. Hepatitis/cirrhosis/cancer Fatty liver disease Also consider possible cholecystitis or pancreatitis

31 Palpation of the Liver (Jarvis, 2012) Enlarged Nodular

32 Palpation of the Spleen The spleen is not normally palpable and will need to be 2-3 times its normal size before it becomes palpable. Enlargement of the spleen on palpation may be related to: Viral infections EBV and mononucleosis Haemolytic anaemias Blood disorders leukaemia, lymphoma

33 Palpation of the Spleen (Jarvis, 2012)

34 Assessing for Ascites Bulging flanks, dullness on percussion and everted umbilicus are all signs suggesting the presence of ascites. Ascites is an abnormal, intraperitoneal accumulation of fluid (Harris et al 2006) associated with: Heart Failure Portal Hypertension Cirrhosis Hepatitis Pancreatitis Cancer

35 Abdominal Ascites (Jarvis, 2012)

36 Fluid Wave for Ascites (Jarvis, 2008)

37 Resources Jarvis, C. (2016). Physical Examination & Health Assessment (7 th ed.). Sydney: Saunders. Tortora G.J. & Derrickson B. (2014). Principles of Anatomy & Physiology (14 th ed.). Hoboken, NJ: John Wiley & Sons. Harris, P., Nagy, S., & Vardaxis, N. (2006). Mosby s Dictionary of Medicine, Nursing and Health Professions. Australia: Mosby Elsevier.

38 COMMONWEALTH OF AUSTRALIA Copyright Regulations 1969 WARNING This material has been reproduced and communicated to you by or on behalf of the Endeavour College of Natural Health pursuant to Part VB of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice.