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Abdomen 03

Abdomen 03

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Published by ennxor
all about abdominal parts
all about abdominal parts

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Categories:Topics, Art & Design
Published by: ennxor on Jan 14, 2009
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09/15/2012

 
Abdomen_03Exam of the Abdomen
The major components of the abdominal exam include: observation, auscultation, percussion,and palpation. While these are the same elements which make up the pulmonary and cardiacexams, they are performed here in a slightly different order (i.e. auscultation before percussion)and carry different degrees of importance. Pelvic, genital, and rectal exams, all part of theabdominal evaluation, are discussed elsewhere.
Think Anatomically:
When looking, listening, feeling and percussing imagine what organs livein the area that you are examining. The abdomen is roughly divided into four quadrants: rightupper, right lower, left upper and left lower. By thinking in anatomic terms, you will remindyourself of what resides in a particular quadrant and therefore what might be identifiable during both normal and pathologic states.
Quadrants of the AbdomenTopical Anatomy of the Abdomen
 
By convention, the abdominal exam is performed with the provider standing on the patient's rightside.
Observation:
Much information can be gathered from simply watching the patient and lookingat the abdomen. This requires complete exposure of the region in question, which isaccomplished as follows:1.Ask the patient to lie on a level examination table that is at a comfortable height for bothof you. At this point, the patient should be dressed in a gown and, if they wish,underwear.2.Take a spare bed sheet and drape it over their lower body such that it just covers theupper edge of their underwear (or so that it crosses the top of the pubic region if they arecompletely undressed). This will allow you to fully expose the abdomen while at thesame time permitting the patient to remain somewhat covered. The gown can then bewithdrawn so that the area extending from just below the breasts to the pelvic brim isentirely uncovered, remembering that the superior margin of the abdomen extends beneath the rib cage.
 
Draping the Abdomen
3.The patient's hands should remain at their sides with their heads resting on a pillow. If thehead is flexed, the abdominal musculature becomes tensed and the examination mademore difficult. Allowing the patient to bend their knees so that the soles of their feet reston the table will also relax the abdomen.4.Keep the room as warm as possible and make sure that the lighting is adequate. By paying attention to these seemingly small details, you create an environment that givesyou the best possible chance of performing an accurate examination. This is particularlyimportant early in your careers, when your skills are relatively unrefined. However, itwill also stand you in good stead when examining obese, anxious, distressed or otherwisechallenging patients.While observing the patient, pay particular attention to:1.Appearance of the abdomen. Is it flat? Distended? If enlarged, does this appear symmetric or are there distinct protrusions, perhaps linked to underlying organomegaly?The contours of the abdomen can be best appreciated by standing at the foot of the tableand looking up towards the patient's head. Global abdominal enlargement is usuallycaused by air, fluid, or fat. It is frequently impossible to distinguish between these entitieson the basis of observation alone (see below for helpful maneuvers). Areas which becomemore pronounced when the patient valsalvas are often associated with ventral hernias.These are points of weakening in the abdominal wall, frequently due to previous surgery,through which omentum/intestines/peritoneal fluid can pass when intra-abdominal pressure is increased.

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