Abdomen

Abdomen

1. divided into either four quadrants or nine regions. The four quadrants of the abdomen are the Right upper quadrant (RUQ), Right lower quadrant (RLQ), Left upper quadrant (LUQ), and Left lower quadrant.

   • PALPATION OF THE SPLEEN
     • BIMANUAL TECHNIQUE
       • size
         • tenderness
           • PALPATION OF THE AORTA
             • pulsation
               • PALPATION OF THE KIDNEY
                 • RIGHT KIDNEY

2. nine regions of the abdomen are the Right hypochondriac, Epigastric, Left hypochondriac, Right lumbar, Umbilical, Left Lumbar, Right iliac, Hypogastric or suprapubic, and Left iliac regions.

3. inspect for skin

   • Color
   • venous pattern
   • integrity
     • contour
       • symmetry
         • surface motion
         • umbilicus
           • position
             • color of stools & emesis
             • auscultation
               • bowel motility
                 • vascular sounds
                   • organ enlargement
                     • Start auscultation in the right lower quadrant then proceed in a clockwise manner, covering all quadrants. The diaphragm of the stethoscope must be placed lightly on the abdomen during auscultation.
                   • bowel sound
               • BOWEL MOTILITY may be assessed by auscultation. Bowel sounds are noted for their frequency and character
                 • frequency of bowel sounds has been estimated to be at 5 to 35 per minute. Occasionally, loud prolonged gurgles, signifying peristalsis or hyperactivity of the bowel is noted. This is termed as BORBORYGMI
                 • In assessing the vascular sounds in the abdomen, the bell of the stethoscope is used. Note for bruits which are low-pitched resembling heart murmurs.
                   • The presence of bruit with both diastolic and systolic components may signify turbulent blood flow or obstruction in an artery. If the patient is hypertensive systolic and diastolic bruit is noted over the renal arteries, then the patient may be having renal artery stenosis.
                   • Other areas where bruit may be noted are over the areas of the abdominal aorta, iliac arteries and femoral arteries. If present, arterial insufficiency in the legs may be suspected.

4. Percussion tone

   • Percussion is performed to identify ascitic fluid, solid, fluid-filled masses, as well as gasfilled bowel and abdomen. The liver, and sometimes the spleen, is also measured using the method of percussion.
     • Tympany usually predominates in hollow organs because of the presence of air. Hollow abdominal organs include the stomach, intestines, bladder, aorta, and gallbladder.
       • Dullness is noted over slid organs such as the liver, spleen, pancreas, kidneys, and uterus. Unusual dullness may be a clue to an underlying abdominal mass.
         • LIVER SPAN
           • Percuss in the right midclavicular line (MCL) downward from the chest until a change from lung resonance to dullness is noted. This is marked as the upper border of the liver
             • lower border is identified by percussing in the right midclavicular line at the level of the umbilicus. From this point upward, find the area of liver dullness and mark this as the lower border. The distance from the upper border to the lower border is the liver span.
               • Liver span ranges from 6 to 12 cm in the right MCL in the adult. Generally, it is greater in men than in women, in tall individuals than in short ones.
           • To elicit tenderness over the liver, blunt percussion is performed by placing the left hand flat against the patient’s lower right rib cage. With the use of the ulnar side of the right fist, strike the left hand. Normally, there is no pain nor tenderness when this is performed.
             • in midsternal line
               • SPLEEN
                 • located under the curve of the diaphragm just posterior to the midaxillary line.
                   • Splenic percussion sign: Ask client to take a deep breath and hold it. percuss lowest interspaces at left anterior axillary line.
                     • kidney
                       • BLUNT PERCUSSION of the kidney is performed to elicit tenderness when obstruction and infection is suspected.
                       • patient in a sitting position, the left hand is placed flat against the costovertebral angles over the 12th posterior ribs with the ulnar side of the right fist striking it. Normally, there is no tenderness
                         • Kidney punch test (Goldflam’s sign)
                           • GENERAL PALPATION
                             • LIGHT PALPATION
                               • DEEP PALPATION
                               • tenderness
                                 • consistency
                                   • masses
                                     • Guarding
                 • Percussion for the splenic location is not usually done unless an enlargement is suspected. When a spleen enlarges, it does so anteriorly, medially and downward.
                 • Begin posterior to the left mid-axillary line (this area is normally tympanitic) and percuss downward, noting the change from lung resonance to splenic dullness.
           • Liver span In MCL
       • PALPATION OF THE LIVER
         • bimanual palpation and hooking method
           • tenderness
             • consistency