Fletcher Abdomen1

Umbilical Hernia

Soft, skin covered mass, protrusion of the omentum or the intestine through a weakness or incomplete closure in the umbilical ring. It is common in premature infants and is accentuated by increased intra-abdominal pressure as with crying, coughing, vomiting, or straining.

Obturator muscle test

The patient lies on her/his back with the hip and knee both flexed at ninety degrees. The examiner holds the patient's ankle with one hand and knee with the other hand. The examiner rotates the hip by moving the patient's ankle away from the patient's body while allowing the knee to move only inward. This is flexion and internal rotation of the hip performed when acute appendicitis is suspected. In this condition, the appendix becomes inflamed and enlarged. The appendix may come into physical contact with the obturator internus muscle, which will be stretched when this maneuver is performed on the right leg

Incisional Hernia

The postoperative herniation of tissue into the tissue layers around an abdominal incision. This may occur in the immediate postoperative period or later, after the incision has healed.

Procedure auscultation of bowel sounds

Plash diaphragm lightly against the skin, begin in the RLQ at the ileocecal valve. Using firmer pressure, check over the aorta, renal arteries, iliac, and femoral arteries.

Food intolerance

resulting in bloating or excessive gas after consumption (i.e. lactase deficiency)

Peritoneal friction

rough grating sound heard through the stethoscope over the site of peritoneal inflammation

Silent abdomen

uncommon. You must listen for 5 minutes by your watch before deciding no bowel sounds present

Mean Liver Span

Adult - 6-12cm Liver height correlates with the hight of the person. Males - 10.5cm Females - 7cm

Referred Abdominal Pain

A disorder in another site

Sister Mary Joseph nodule

A hard nodule in umbilicus that occurs with metastatic cancer of stomach, large intestine, ovary, or pancreas

Epigastric Hernia

A small midline protrusion through a defect in the linea alba between the xiphoid and the umbilicus; Protrudes when patient raises head or shoulders

Inspection Abdomen

Determine contour from the rib margin to the pubic bone. Describes nutritional state. Not any localized bulging, visible mass, or asymmetric shape.

Scaphoid

Abnormally sunken abdominal wall, as with malnutrition or underweight Also occurs with dehydration in infants

Barium Swallow

Also called an upper GI series, used to diagnose abnormalities in the esophagus, stomach, and small intestine. The patient swallows a liquid containing barium, and X-rays are taken to record the diagnostic images.

Palpating Enlarged Spleen

An enlarged spleen has a tendency to be friable and can rupture easily with overpalpation. If the nurse suspects an enlarged spleen, he or she should refer it to the health care provider rather than overpalpating it.

Abdomen Vascular Sounds

Aorta, renal arteries, iliac, and femoral arteries. 4-20% of healthy people may have a normal bruit originating from the celiac artery (between xiphoid and umbilicus)

Urgent Abdominal Acute Pain

Appendicitis, cholecystitis, bowel obstruction or a perforated organ

Abdominal Subjective Data

Appetite Dysphagia Food intolerance abdominal pain n&v BM Past abdominal history Medications Nutritional assessment

Blumberg Sign

Assess rebound tenderness. Hands @ 90, push down slowly and deeply, lift up quickly. Pain on release of pressure confirms rebound tenderness, which is a reliable sign of peritoneal inflammation (which accompanies appendicitis)

Eructation

Belching

heamturia

Blood in the urine

Cullen Sign

Bluish periumbilical color occurs with intraperitoneal bleeding

Normal bowel sounds

Bowel sounds are high-ptiched, gurgling, cascading sounds, occurring irregularly anywhere from 5-30 times per minute.

Aging adult abdomen

Contour rounded Proliferation of bacteria in gut lead to diarrhea and infections Decreased peristalysis delayed drug metabolism by the liver

Pyloric stenosis

Congenital narrowing of pyloric sphincter, forming outflow obstruction of stomach

Aneurysm

Defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congenital defict

Ascites

Free fluid in the peritoneal cavity. Skin glistening and taut. Distendended abdomen, bulging flanks, and an umbilicus that is protruding and displaced downward.

Esophagus

GERD is a complex of symptoms of esophagitis, including burning behind lower sternum that radiates upward. Occurs 30-60 minutes after eating; aggravated by lying down or bending over

Red blood in Stool

GI bleeding or localized bleeding around the anus

Chronic Abdominal Pain

Gastric ulcers. Pain of duodenal ulcers occurs 2-3 hours after a meal and is relieved by more food

Hepatomegaly

Enlarged liver span

Enlarged liver

Feels enlarged and smooth but is tender to palpation with early heart failure, acute hepatitis, or hepatic abscess. Enlarged, smooth, nontender liver occurs with fatty infiltration, portal obstruction or cirrhosis, high obstruction of inferior vena cava, and lymphocytic leukemia.

Ascites vs Gasesous distention

Fluid wave A positive wave test occurs with large amounts of ascitic fluid. Also, note edema in the legs.

Pyrosis

Heartburn. Burning sensation in esophagus and stomach, from reflux of gastric acid

Liver referred pain

Hepatitis may have mild-moderate dull pain in RUQ or epigastrium, along with anorexia, nausea, malaise, low-grade fever

borborygmus

Hyperperistalisis that occurs when stomach growls

Ovarian Cyst IAPP

I: Curve in lower half of abdomen, midline, everted umbilicus A: Normal bowel sounds over upper abdomen where intestines pushed superiorly P: Dull over fluid, Intestines pushed superiorly, large cyst produces fluid wave and shifting dullness P: Transmits aortic pulsation, whereas ascites does not.

Tumor IAPP

I: Localized distention A: Normal bowel sounds P: Dull over mass if reaches up to skin surface P: Define borders. Distinguish from enlarged organ or normally palpable structure

Feces IAPP

I: Localized distention A: Normal bowel sounds P: Tympany predominates. Scattered dullness over fecal matter P: Plastic-like or ropelike mass with feces in intestines

Ascites IAPP

I: Single curve. Everted umbilicus. Bulging flanks when supine. Taut, glistening skin; recent weight gain; increase in ab girth A: Normal bowel sounds, diminished over ascitic fluid P: Tympany at top where intestines float, dull over fluid P: Taut skin and increase intra-ab pressure limit palpation

Air or Gas IAPP

I: Single round curve A: Depends on cause of gas; hyperactive with early intestinal obstruction P: Tympany over large area P: may have muscle spasm of abdominal wall

Obesity IAPP

I: Uniformly rounded, umbilicus sunken A: Normal Bowel Sounds P: Tympany. Scattered dullness over adipose P: Normal. May be hard to feel through thick ab. wall

Diverticulitis

Infected or inflamed pouch (diverticulum) in the colon. Common in older persons; Low-fiber diet and constipation are risk factors.

Underlying adhesion

Inflammatory bands that connect opposite sides of serous surfaces after trauma or surgery.

Involuntary rigidity

Involuntary rigidity is a protective mechanism accompanying acute inflammation of the peritoneum. The nurse feels constant, boardlike hardness on palpation of the muscles. Pain increases when the person increases intra-abdominal pressure by attempting to sit-up *If the area is not painful, the patient is experiencing voluntary guarding*

Enlarged nodular liver

Occurs with late portal cirrhosis, metastatic cancer, or tertiary syphilis. edge is firmer than normal, and the edge is easily palpable

RUQ

Liver Gallbladder hepatic flexure of colon ascending and transverse colon duodenum pancreas Right kidney & adrenal gland

abdominal wall masses note

Location size shape consistency surface mobility pulsatility tenderness

Anorexia

Loss of appetite from GI disease, medication, pregnancy, or with mental health disorders

Intestinal obstruction SS

Marked visible peristaisis, together with a distended abdomen. Restlessness and constant turning to find comfort occur with colicky pain of gastroenteritis or bowel obstruction

What to look for when pt raises head to chest

Masses Hernias Diastasis recti

Aortic Aneurysm

Murmur is harsh, systolic, or continuous and accentuated with systole. Note in person with hypertension

Light palpation abnormal finding

Muscle guarding rigidity large masses tenderness

Umbilicus

Norm: midline and inverted, no inflammation Everted with ascites or underlying mass Deeply sunken with obesity Enlarged, everted with umbilical hernia

Cutaneous angiomas

Occur with portal hypertension or liver diseases

Percussion Abdomen Dullness

Occurs over a distended bladder, adipose tissue, fluid, or a mass.

Hair Distribution

Patterns alter with endocrine or hormone abnormalities, and chronic liver disease

Positioning and prep of patient for examination

Position supine, with head on a pillow, knees bent, hands on chest. Examine painful areas last & *Know PO status*

Peritonitis

Potentially fatal inflammation of the abdomen's lining Absolute stillness, resisting any movement, occurs with the pain

Percussion Abdomen Hyperresonance

Present with gaseous distention

Hernia

Protrusion of abdominal visera through abnormal opening in muscle wall. ]\ An incisional hernia is a bulge near an old operative scar. This bulge is usually apparent when the patient increases the intra-abdominal pressure by a sit-up, by standing, or by the Valsalva maneuver. An umbilical hernia is the p

Palpable organs abdomen

SCUBA LARKS Normal liver edge, Right kidney, Pulsatile aorta, Rectus muscles, Sacral promontory, Ascending colon, Cecum, Sigmoid colon, Uterus, Full bladder

Diastasis recti

Separation of the abdominal rectus muscles. A midline longitudinal ridge is revealed when intra-abdominal pressure is increased by raising patient's head while supine.

Diastasis Recti

Separation of the two rectus abdominis muscles, through which abdominal contents form a midline ridge when the patient raises their head and shoulders. Often seen with repeated pregnancies, obesity, and chronic lung disease. No clinical significance

Costovertebral Angle Tenderness

Sharp pain occurs with inflammation of the kidney or paranephric area.

Dullness from 9th-11th intercostal space

Spleen. No wider than 7cm. Dullness forward of the midaxillary line indicated enlargement of the spleen. Occurs with mononucleosis, trauma, and infection.

Cushing syndrome

Striae look purple0blue 0 excess adrenocortical hormone causes the skin to be fragile and easily broken from normal stretching

Finding noted during Abdomen inspection

Symmetry Shape Abdominal girth Skin Characteristics Umbilical characteristics Surface motion Venous pattern Raise head to chest to assess abdominal muscles

Succession splash

Unrelated to peristalsis, loud splash auscultated over the upper abdomen when an infant is rocked side to side, indicates increased air and fluid in the stomach. Seen in pyloric obstruction or large hiatus hernia

Hematemesis

Vomiting blood. Occurs with stomach or duodenal ulcers and esophageal varices (abnormal, enlarged veins in the lower part of the esophagus)

Rovsing's Sign

a sign of appendicitis. If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis.

Murphy sign

a test for gallbladder disease in which the patient is asked to inhale while the examiner's fingers are hooked under the liver border at the bottom of the rib cage. The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed. Deep inspiration can be very much limited.

Amenorrhea

absence of menstruation. Common with anorexia nervosa

Pica

appetite for substances that are largely non-nutritive, such as paper, clay, metal, chalk, soil, glass, or sand

Paralytic ileus

complete absence of peristalic movement that follow abdominal surgery or complete obstruction

Polyposis

condition in which polyps develop in the intestinal tract

Cecum

first of proximal part of large intestine

Hypoactive or absent bowel sounds

follow abdominal surgery or with inflammation of the peritoneum Occurs as a result of inflammation as seen with peritonitis; from paralytic ileus; or from late bowel obstruction. Occurs also pneumonia.

Peptic ulcer disease

frequent use of NSAIDs, alcohol, smoking, and helicobacter pylori infection

Parietal Abdominal Pain

from inflammation of overlying peritoneum. Sharp, precisely localized, aggravated by movement

Visceral abdominal pain

from internal organs. Typically dull, general, poory localized

Gray Stool

hepatitis

Iliopsoas Muscle test

indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal). It is elicited by performing the psoas test by passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip

Cholecystitis

inflammation of the gallbladder

viscera

internal organs

Inguinal ligament

ligament extending from pubic bone to anterior superior iliace spine, forming lower border of abdomen

Assess risk for nutrition deficit

limited access to grocery store income cooking facilities physical disability decreased mobility decreased strength neurologic deficit

Hyperactive bowel sounds

loud, high pitched, rushing, tinkling sounds that signal increased motility Occur with early mechanical bowel obstructions, gastroenteritis, brisk diarrhea, laxative use, and subsiding paralytic ileus.

Costal margin

lower border of rib margin formed by the medial edges of the 8th, 9th, and 10th ribs

linea alba

midline tendinous seam joining the abdominal muscles

Epigastrium

name of abdominal region between costal margins

Suprapubic

name of abdominal region just superior to pubic bone

Prominent, Dilated Abdominal Veins

occur with portal hypertension, cirrhosis, ascites, or ven caval obstruction. Visible with malnutrition as a result of thinned adipose tissue

Venous hum

occurs rarely. heard in pariumbilical region , originates from inferior vena cava, occurs with portal hypertension and cirhotic liver

Voluntary guarding

occurs when cold, tense, or ticklish. It is bilateral, and you will feel the muscles relax slightly during exhalation.

Dysphagia

occurs with disorders of the throat or esophagus

McBurney point

point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus (navel). This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum

Splenomegaly

the anterior axillary line, change from tympany to dull with full inspiration is a positive spleen percussion sign. Detects inflammation before spleen is palpable, as in mononucleosis, malaria, or hepatic cirrhosis.

Ulcerative colitis

this is characterized by mucosal lesions occurring (starting) typically in the rectal area & sigmoid colon & progressing throughout the colon. Symptoms include: fever, anorexia, weight loss, cramping, spasms, ab pain, bloody diarrhea, toxic megacolon & increased risk of colon cancer.