Download - abdominal examination
![Page 1: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/1.jpg)
Jonathan Downham 2010
Abdominal ExaminationJonathan Downham Advanced Nurse Practitioner 2008
![Page 2: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/2.jpg)
Jonathan Downham 2010
Abdominal Examination
•Gastrointestinal•Weight loss•Nausea, vomiting•Dysphagia• Regurgitation, flatulance, heartburn• Abdominal pain• Stool frequency
![Page 3: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/3.jpg)
Jonathan Downham 2010
Abdominal Examination
![Page 4: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/4.jpg)
Jonathan Downham 2010
Abdominal Examination
![Page 5: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/5.jpg)
Jonathan Downham 2010
Clinical History Taking- Review of systems.
• Gastrointestinal– Weight loss– Nausea, vomiting– Dysphagia– Regurgitation,
flatulance, heartburn– Abdominal pain– Stool frequency– Surgery
– Medications– Last Period– Family History– Alcohol– Diet– Stress
![Page 6: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/6.jpg)
Jonathan Downham 2010
Abdominal ExaminationPatient Position• Good lighting• Undressed nipple to knees• Modesty blanket• Flat on couch with single pillow for head• Arms by their sides• If unable to fully relax abdomen than flex
hips to 45 degrees and knees to 90 degrees.
![Page 7: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/7.jpg)
Jonathan Downham 2010
Abdominal ExaminationGeneral Inspection• Pain, distress, cachexia, pallor or jaundice.• Hands• Metabolic flap- hepatic encephalopathy,
carbon dioxide retention or ureamia• Aneamia
• Eyes• Face• Abnormal pigmentation around lips• Angular stomatitis
• Oral cavity• Lymph glands
![Page 8: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/8.jpg)
Jonathan Downham 2010
Abdominal Examination
![Page 9: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/9.jpg)
Jonathan Downham 2010
Abdominal Examination
Inspection.• Symmetry• Abdominal pulsation• Shape• The five F’s• Scars• Sinuses• Fistulas e.g. crohns• Visible peristalsis due to intestinal
obstruction• Distended veins
![Page 10: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/10.jpg)
Jonathan Downham 2010
Abdominal Examination
Auscultation• May be best to do this before palpating.• Listen specifically for bowel sounds• Place stethoscope to right of umbilicus and do
not move it. • Normal sounds occur every 5-10 seconds• Listen above umbilicus over aorta for bruits• Place stethoscope 2-3cm above and lateral to
umbilicus and listen for renal artery bruits.
![Page 11: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/11.jpg)
Jonathan Downham 2010
Abdominal Examination
Percussion• Percuss over whole abdomen• Pay attention to any masses you may have
detected.• If ascites is suspected test for shifting
dullness• Orientate your hands correctly
![Page 12: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/12.jpg)
Jonathan Downham 2010
Abdominal Examination
PalpationAsk the patient where the pain is.
Warn the patient you are about to put your hand on them.
Light palpationDeep palpation
Specific palpation of the intra-abdominal
organs
![Page 13: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/13.jpg)
Jonathan Downham 2010
Abdominal ExaminationLight Palpation• Commence palpation at a site remote from any
area of discomfort.• All areas must be palpated systematically• Use the nine quadrants as a guide.• Is performed to elicit
any tenderness or guarding• Lie hands and fingers flat• Press very gently.
Deep Palpation
![Page 14: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/14.jpg)
Jonathan Downham 2010
Abdominal Examination
![Page 15: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/15.jpg)
Jonathan Downham 2010
Abdominal ExaminationPalpation of intra abdominal organs.Liver• Start with hand at right iliac fossa, fingers
pointing to head• Palpate deeply whilst patient breathes in and
out deeply• If nothing is felt repeat the process moving
the hand up slightly.• If edge is palpable describe:• Size• Contour• Texture• Tenderness
![Page 16: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/16.jpg)
Jonathan Downham 2010
Abdominal ExaminationPercuss out liver edges
![Page 17: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/17.jpg)
Jonathan Downham 2010
Abdominal ExaminationPalpation of the spleen
![Page 18: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/18.jpg)
Jonathan Downham 2010
Abdominal ExaminationPalpate the Kidney
![Page 19: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/19.jpg)
Jonathan Downham 2010
Abdominal Examination
Abdominal Aorta
![Page 20: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/20.jpg)
Jonathan Downham 2010
Abdominal Examination
Hernias• Examine groin with patient standing upright• Inspect inguinal and femoral canals and scrotum
for any lumps and bumps• Ask patient to cough; look for any impulses• Ask the patient to lie down and establish if the
hernia reduces.• Press two fingers over the internal inguinal ring at
the mid inguinal point and ask patient to cough• If it reappears it is a direct hernia, if not it is
indirect.
![Page 21: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/21.jpg)
Jonathan Downham 2010
Abdominal ExaminationRectal Examination• Explain• Position- left lateral, knees drawn up• Examine peri-anal area• Lubricate• Pulp of finger at 6 0’clock an anal margin• Anal spasm- stop, try again, local suppository
may be required.• Ask patient to squeeze your finger• Identify cervix/prostate• Withdraw finger and examine for colour/blood
![Page 22: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/22.jpg)
Jonathan Downham 2010
Abdominal Examination
Common abdominal conditions•Dysphagia/odynophagia•Questions• Trouble swallowing both solids and liquids?• Where does blockage seem to be?• Intermittent or persistent• Has it been getting worse?• Coughing or choking when starting to swallow• Heartburn or acid indigestion• Weight loss
![Page 23: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/23.jpg)
Jonathan Downham 2010
Abdominal Examination
Common abdominal conditions• Pain• SOCRATES• Site• Onset• Character• Radiation• Associated symptoms• Timing• Exacerbating or relieving factors• Severity
![Page 24: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/24.jpg)
Jonathan Downham 2010
Abdominal ExaminationCommon abdominal conditions• Diarrhoea• Secretory• Osmotic• Abnormal intestinal motility• Exudative• Malabsorption
![Page 25: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/25.jpg)
Jonathan Downham 2010
Abdominal ExaminationCommon abdominal conditions• Diarrhoea- questions• How many stools per day• What do they look like• ?urgency• Woken at night?• Blood mucus or pus?• Pale, greasy, smelly?• Lost weight?• Recent travel?• Antibiotics?• Family history• Recent fevers?
![Page 26: abdominal examination](https://reader030.vdocument.in/reader030/viewer/2022012910/5589d7e8d8b42a5e6f8b469e/html5/thumbnails/26.jpg)
Jonathan Downham 2010
Abdominal Examination
Nausea and vomiting• Questions• Acute or chronic?• Vomiting with or without nausea?• How long after meal?• What does it look
like..blood/bile/faeculent• Abdo pain• Weight loss?• Medications?