abdominal assessment

1. ABDOMINAL ASSESSMENT Maria Carmela L. Domocmat, RN,MSN Instructor, Nursing Health Assessment School of Nursing Northern Luzon Adventist College

2. Rectus abdominis muscle Xiphoid process Costal margin Umbilicus Inguinal ligament Pubic tubercle Maria Carmela L. Domocmat, RN, MSN

3. Maria Carmela L. Domocmat, RN, MSN

15. PHYSICAL ASSESSMENT Maria Carmela L. Domocmat, RN, MSN

16. INSPECTION Maria Carmela L. Domocmat, RN, MSN

17. Veins Maria Carmela L. Domocmat, RN, MSN

18. Caput Medusae • Dilated veins around a porto- systemic anastmosis in the umbilical veins • Dilated abdominal veins can be distinguished with Harvey's test: - determines direction of flow – SVC obstruction: direction of flow above umbilicus downwards – IVC obstruction: direction of flow below umbilicus upwards – Caput medusae: direction of flow away from umbilicus Maria Carmela L. Domocmat, RN, MSN

77. SPECIAL MANEUVERS Maria Carmela L. Domocmat, RN, MSN

78. ASCITES Maria Carmela L. Domocmat, RN, MSN

79. Shifting Dullness http://depts.washington.edu/physdx/liver/tech.html Maria Carmela L. Domocmat, RN, MSN

81. http://www.wrongdiagnosis.com/bookimage Maria Carmela L. Domocmat, RN, MSN s/16/5352.1.png

82. Fluid wave test Maria Carmela L. Domocmat, RN, MSN

83. APPENDICITIS Maria Carmela L. Domocmat, RN, MSN

84. McBurney’s Point (Appendicitis) • Pain in the right lower quadrant one third the distance from the anterior iliac crest to the umbilicus. • Caused by the inflamed appendix or bowel coming into contact with the peritoneum. Maria Carmela L. Domocmat, RN, MSN

85. Blumberg's sign • pain on abrupt release of steady pressure (rebound tenderness) over the site of a suspected abdominal lesion, indicative of peritonitis. Maria Carmela L. Domocmat, RN, MSN

87. Rovsing’s sign (Appendicitis) • Pain described in the right lower quadrant (RLQ) when the left lower quadrant (LLQ) is palpated. http://www.impactednurse.com/?p=1835 Maria Carmela L. Domocmat, RN, MSN

88. Psoas sign (Appendicitis) • Pain on passive extension of the right thigh. Patient lies on left side. Examiner extends patient's right thigh while applying counter resistance to the right hip (asterisk). Maria Carmela L. Domocmat, RN, MSN

89. • Anatomic basis for the psoas sign: inflamed appendix is in a retroperitoneal location in contact with the psoas muscle, which is stretched by this maneuver. Maria Carmela L. Domocmat, RN, MSN

90. Psoas sign (Appendicitis) Psoas Psoas major minor Maria Carmela L. Domocmat, RN, MSN

91. Obturator sign • Pain on passive internal rotation of the flexed thigh. • Examiner moves lower leg laterally while applying resistance to the lateral side of the knee (asterisk) resulting in internal rotation of the femur. http://www.aafp.org/afp/991101ap/2027.html Maria Carmela L. Domocmat, RN, MSN

92. Anatomic basis for the obturator sign: • inflamed appendix in the pelvis is in contact with the obturator internus muscle, which is stretched by this maneuver. Maria Carmela L. Domocmat, RN, MSN

93. Hypersensitivity test or Pinch-an-Inch Test (Appendicitis) http://www.ispub.com/ispub/ijs/volume_12_number_2/the_pinch_an_inch_test_is_more_comfort able_than_rebound_tenderness/pinch-fig1.jpg Maria Carmela L. Domocmat, RN, MSN

94. CHOLECYSTITIS Maria Carmela L. Domocmat, RN, MSN

95. Murphy’s sign (Cholecystitis): • Pain on inspiration during gentle palpation below the right subcostal arch. • As the patient breathes in, the liver moves down exposing the gallbladder to pressure from the examiners hand. • Murpy’s sign may also be present with hepatitis. Maria Carmela L. Domocmat, RN, MSN

97. Balance’s Sign (Splenic Injury): • Dullness on percussion of the left upper quadrant of the abdomen due to collection of blood in the subcapsular or extracapsular layers of a ruptured spleen. Maria Carmela L. Domocmat, RN, MSN

98. Kehr’s Sign (Splenic injury / ruptured ectopic) • Severe left shoulder (tip) pain following injury to the spleen. May also arise following other forms of intra- abdominal bleeding such as ruptured ectopic pregnancy. The pain is due to irritation of the left diaphragm and phrenic nerve by intraperitoneal blood, or air when the patient is in the supine position. Maria Carmela L. Domocmat, RN, MSN

99. Grey-Turners Sign ( Pancreatitis) • A bluish discoloration that occurs on the lower back and abdominal flanks. May also occur following bleeding originating from the kidney or with pelvic fractures following traumatic injury. Usually occurs 6-24 hours after onset of any retroperitoneal bleeding. Maria Carmela L. Domocmat, RN, MSN

100. Cullen’s Sign ( Pancreatitis) • Is a bluish or blue-black discoloration around the umbilicus. Over time this discoloration can fade to green-brown or yellow. Often appears 1 to 2 days after the onset of symptoms of pancreatitis. Cullen’s sign may also arise in association with haemoperitoneum due to a ruptured ectopic pregnancy. Maria Carmela L. Domocmat, RN, MSN

abdominal assessment

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