Health Assessment Across the Lifespan

Structure and Function Subjective DataHealth History Questions Objective DataThe Physical Exam Abnormal Findings

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Surface landmarks
Borders of abdominal cavity Abdominal muscles

Internal anatomy (viscera)

Solid viscera

Liver Pancreas Spleen Adrenal glands Kidneys Ovaries Uterus

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Internal anatomy (viscera) (cont.)

Hollow viscera
Stomach Gallbladder Small intestine Colon Bladder

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 Pat Thomas, 2006.

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 Pat Thomas, 2006.

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Abdominal wall divided into four quadrants

Right upper (RUQ) Left upper (LUQ) Right lower (RLQ) Left lower (LLQ)

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Appetite Dysphagia Food intolerance Abdominal pain Nausea/vomiting Bowel habits Abdominal history Medications Nutritional assessment

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Preparation

Lighting and draping Measures to enhance abdominal wall relaxation

Equipment needed
Stethoscope Small centimeter ruler Skin-marking pen Alcohol swab

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Inspect the abdomen Contour Symmetry Umbilicus Skin Pulsation or movement Hair distribution Demeanor

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Auscultate the abdomen

Bowel sounds
Vascular sounds (bruits)

Percuss the abdomen General tympany Liver span

Usual technique Scratch test

Splenic dullness Costovertebral angle tenderness Special procedures

Fluid wave Shifting dullness

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Palpate the liver Measures to enhance muscle relaxation Light palpation Deep palpation Bimanual palpation Normally palpable structures Liver

Spleen
Kidneys Aorta

Usual technique Hooking technique

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Rebound tenderness (Blumbergs sign) Inspiratory arrest (Murphys sign)

Iliopsoas muscle test

Obturator test

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Obesity Air or gas Ascites Ovarian cyst Pregnancy Feces Tumor

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Umbilical hernia Epigastric hernia Incisional hernia Diastasis recti

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Hypoactive bowel sounds Hyperactive bowel sounds

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Enlarged liver Enlarged nodular liver Enlarged gallbladder Enlarged spleen Enlarged kidney Aortic aneurysm

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