PHARMACOLOGY

1. ASSESSMENT OF THE
ABDOMEN
AKURU E

11. BEFORE EXAMINATION
• Have a good light source
• Short fingernails
• Warm hands and stethoscope
• Instruct the patient to empty the bladder(full bladder can interfere with
accurate examination of nearby organs and can also make the examination
uncomfortable.)
• Approach the patient from the right side
• Position the patient in supine, with arms at the sides
• Place a small pillow under the patients head and another under slightly
flexed knees.
• Ask the patient to point to any painful areas; Examine last

17. INSPECTION
1. SKIN
• Scars
• Striae- old silver striae or stretch marks are normal
Abnormal include pink-purple
• Dilated veins- few small veins normal
• Rashes and lesions
• Stoma
• pigmentation

18. INSPECTION
2. The umbilicus
• Observe contours, inflammation, or bulges and location.
• Inverted, flat or exerted
• Normal is midline, inverted and no discolouration
3. The contour of the abdomen
• Flat, rounded, protuberant(convex), or scaphoid (concave or hollowed)
• Symmetry
• Visible organs or masses
• Enlarged liver or spleen

19. INSPECTION
4. Peristalsis
• Observe visible peristalsis
5. Pulsation
• Observe for pulsation in the epigastrium e.g. of aortic- considered
normal

29. BOWEL SOUNDS
• Listen with the diaphragm of the stethoscope on the four quadrants
• Normal sounds are due to peristaltic activity.
• Normal range: 5 to 35 per minute
• Loud prolonged gurgles of hyperperistalsis are called
borborygmi(stomach growling)
• Increased Bowel Sounds may occur with gastroenteritis, early
intestinal obstruction or hunger.
• Listen for bruits over the aorta, iliac arteries, and femoral arteries

31. BOWEL SOUND
• High pitched tinkling sounds suggest intestinal fluid and air under
pressure
• Decreased bowel sounds occurs with peritonitis and paralytic ileus
• Absent bowel sounds, refers to inability to hear any bowel sounds
after 5 minutes of continuous listening.
• Absent bowel sounds is associated with abdominal pain and rigidity.
Usually a surgical emergency.

34. PERCUSSION
• To assess the amount and distribution of gas in the abdomen
• To identify masses(solid or fluid filled)
• To estimate the size of the liver and spleen
• Percuss the abdomen lightly in all four quadrants
• Tympany predominates(gas in the GIT)
• Take note of large dull areas(may indicate underlying mass or
enlarged organ)
• Percussion of the liver(text book and video)

38. PALPATION
• To assess the organs of the abdominal cavity
• Detect muscle spasm, masses, fluid, and areas of tenderness.
• Assess the abdominal organs for size, shape, mobility, and consistency

43. PALPATION OF THE LIVER
• Place your left hand behind the patient, parallel to and supporting the right
11th and 12th ribs
By pressing your left hand forward, the patient’s liver may be felt more easily
by your other hand.
• Place your right hand on the patient’s right abdomen lateral to the rectus
muscle, with your fingertips well below the lower boarder of the liver
dullness.
• Ask the patient to take a deep breath. Try to feel the liver edge as it comes
down to meet your fingertips
• Note any tenderness, if palpable at all, the normal edge is soft, sharp, and
regular with a smooth surface.

49. SPLEEN PALPATION
• With your left hand, reach over and around the patient to support
and press forward the lower left rib cage and adjacent soft tissues
• With your right hand below the left costal margin, press in toward the
spleen.
• Ask the patient to take a deep breath
• Try to feel the tip or edge of the spleen as it comes down to meet
your fingertips
• Note ant tenderness, contour, and measure the distance between the
spleen’s lowest point and the left costal margin

54. Palpation of the aorta, bladder, kidneys
• Textbook.

56. • For the digital examination of the rectum, the gloved,
lubricated index finger is placed against the anus while
the patient strains.
• Then as the sphincter relaxes, the finger is inserted as
possible as possible and is pointed towards the
umbilicus and all surfaces are palpated.
• A sample of stool can be removed and check for
occult blood

57. ASSIGNMENT
• ASSESSMENT OF INFANTS AND CHILDREN’S ABDOMEN
• DUE 14/10/2021 @ 2.00pm