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Posts Tagged ‘Abdomen’

Examination of the abdomen involves the usual four skills, except that the order is significantly changed. Inspection is followed by auscultation, percussion, and then palpation, which may distort the general abdominal sounds. The healing practitioner in charge must have knowledge of the anatomic placement of the abdominal organs in order to differentiate normal, startling findings from abnormal ones. Inspection may occur at any time during the examination.

The abdominal cavity is the measure of the trunk from directly beneath the diaphragm and thoracic cavity to the region of the pelvic cavity. The abdominal cavity contains the major organs of digestion, and the pelvic cavity houses the internal reproductive organs, the lower parts of the digestive tract, and the urinary bladder. However, in infancy, the bladder is an abdominal organ.

Inspection
The contour of the abdomen is inspected while the child is erect and supine. Usually the abdomen of infants and young children is quite cylindrical and in the erect position, fairly leading because of the physiologic lordosis of the spine. In the supine position the abdomen appears flat. during adolescence the Usually male and female contours of the pelvic cavity convert the shape of the abdomen to form characteristic adult curves, especially in the female.

The size and tone of the abdomen also give some indication of general nutritional status and muscular development. A large, prominent, flabby abdomen is often seen in obese children, whereas a concave abdomen is often suggestive of undernutrition. However, true note is made of a protruding abdomen with spindly extremities and flat, wasted buttocks suggests severe malnutrition that may occur from inadequate nutritional intake such as kwashiorkor or from diseases such as cystic fibrosis. Likewise, a scaphiod abdomen may indicate dehydration or disphragmatic hernia in which the abdominal organs rise into the thoracic cavity, or a “scaphoid-like” abdomen that only appears sunken in relationship to pneumothorax or high intestinal obstruction. A midline protrusion form the xiphoid to the umbilicus or pubic sumphysis is Usually diastasis recti, or failure of the rectus abdominis muscles to join in utero. In a salutary child a idline protrusion is Usually a difference of general muscular development. A tense, boardlike abdomen is a serious sign of paralytic ileus and intestinal obstruction.

The healing practitioner also notes the condition of the skin surface the abdomen. It should be uniformly taut, without wrinkles or creases. Sometimes silvery, whitish striae are seen, especially if the skin has been stretched as in obesity or with distention resulting from ascites. Any scars, ecchymotic areas, excessive hair distribution, or distended veins are noted.

Movement of the abdomen is observed. In infants and thin children, peristaltic waves guarantee true assessment They are best observed by standing at eye level over from the abdomen. Descriptive peristaltic waves most often indicate athologic states, particularly intestinal obstruction such as pyloric stenosis.

A doctor may explore pulsation of the descending aorta in the epigastric region (midline and below the xiphoid). Although Descriptive pulsations are Usually seens, especially in thin children, the nurse should auscultate and perceive the aorta for any evidence of an aneurysm, a sacklike enlargement of the vessel.

In children under 7 or 8 years of age, breathing is primarily abdominal. If the abdomen fails to move during respiration, even in older children, this may indicate serious abdominal problems. Conversely, if the thoracic muscles fail to move, caused by breathing confirmed to abdominal movement, pulmonary problems may be at fault. Usually chest and abdominal movements are synchronous.

The umbilicus is inspected for herniation, fistulas, such as patent urachus (an abnormal relationship in the middle of the umbilicus and bladder). Discharge, and hygiene, If a herniation is present the sac is palpated for abdominal contents and the approximate size of the opportunity is estimated. Umbilical hernias are tasteless in infants, especially in black children. Since “home remedies” fro rehabilitation such as taping coins over the umbilicus or using “belly binders” may be harmful to the skin and truly delay natural closure, a doctor should ask parents whether such procedures have been used. Umbilical hernias Usually protrude and advance when the child coughs, cries, or strains.

Hernias are looked for elsewhere on the abdominal wall, such as in the inguinal or femoral region. An inguinal hernia is a protrusion of peritoneum through the abdominal wall in the inguinal canal. It most often occurs in males, is often bilateral, and may be Descriptive as a mass in the scrotum. It is palpated by sliding the exiguous finger into the external inguinal ring at the base of the scrotum and asking the child to cough. If a hernia is present, ti will hit the tip of the finger.

A femoral hernia, which occurs more often in girls, is felt or see as a small mass on the previous surface of the thigh just below the inguinal ligament in the femoral canal (a possible space medial to the femoral artery). Its location can be estimated by placing the index finger of the right hand on the child’s right femoral pulse left hand for left pulse) and the middle ring finger flat against the skin toward the midline. The ring finger lies over the femoral canal, where the herniation occurs. Palpation of hernias in the pelvic region, particularly inguinal ones, is often part of the test of genitals.

Auscultation
Each of the four quadrants should be ausculatated using the diaphragm and bell chestpieces. Unlike listening to the heart or lungs. In which the stethoscope rests slowly on the skin, to hear bowel sounds the stethoscope must be pressed firmly against the abdominal surface. With the bessel chestpiece, especially one with a short cone, the skin may occlude the opportunity and forestall transmission of sound.

The most leading sound to listen for is peristalsis, or bowel sounds, which sound like short metallic clicks and gurgles. Loud grumbling noises, known as borborygmi, are the customary “stomach growls” Usually denoting hunger. A sound may be heard every 10 to 30 seconds and its frequency per exiguous should be recorded (for example, 5 bowel sounds/minutes). However, the healing practitioner may need to listen for several seconds before audible peristalsis can be heard. Bowel sounds may be stimulated by stroking the abdominal surface with a fingernail. Absent bowel sounds or hyperperistalsis is recorded and reported, since whether one Usually denotes abdominal disorder.

Various other sounds may be heard in the abdominal cavity. Usually the pulsation of the aorta is heard in the epigastrium. Sounds that look like murmurs (called bruits), hums, or rubs are all the time referred for added evaluation.

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