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Assessment

Normal Findings

Deviations Tenderness and hypersensitivity Superficial masses Localized area of increased tension Peritonitis: involuntary guarding and rigidity Generalized or localized areas of tenderness Mobile or fixed masses Masses: Tumor, enlarged uterus, feces-filled colon Enlarge liver: liver cirrhosis, hepatitis Enlarge spleen: malignancy, infection or trauma Lateral diffuse pulsation: abdominal aortic aneurysm Aortic width >3cm: abdominal aortic aneurysm Liver palpable below costal margin: Congestive Heart Failure, hepatitis, encephalopathy, cirrhosis, cysts, cancer. Liver is enlarged, tender, firm, and nodular and has irregular border: Liver cancer Splenic Enlargement & tenderness: CHF, cancer, infection, cirrhosis, trauma. Enlarged kidneys: hydronephrosis, neoplasm, polycystic disease. Nodular & assymetrical bladder: possible malignancy + rebound tenderness, iliopsoas & obturator sign: peritoneal inflammation, peritonitis, appendicitis. + fluid wave, shifting, puddle sign: ascites

Palpation Light palpation No tenderness ; relaxed To detect areas of tenderness abdomen with smooth, and/ or muscle guarding. consistent tension; soft; no Ensure that the clients masses; no umbilical bulges position is appropriate for relaxation of the abdominal muscles and warm hands. Deep palpation Tenderness may be present Used with bimanual near the xiphoid process, technique to palpate organs over cecum and over sigmoid (liver, spleen, kidneys) and colon. masses. Note tenderness, Liver: non palpable or may be consistency, pulsations, palpable at costal margin, enlarged organs firm, smooth and nontender. Spleen nontender, nonplapable. Kidneys nonpalpable. + slight aortic pulsation, no diffusion, aorta 2.5cm

Assess for rebound Negative rebound tenderness at McBurneys point, iliopsoas test and obturator test. Test for fluid wave test

Use ballottement to assess fetal position or masses

Test for abdominal reflexes

+ abdominal reflexes

Use light palpation to Inguinal nodes nonpalpable, nontender. palpate horizontal and vertical inguinal lymph nodes. Note size, shape, consistency, tenderness, mobility.

+ Kehrs sign: splenic injury, renal calculi, ectopic pregnancy + Balances sign: peritoneal irritation, splenic injury +Murphys sign: Cholecystitis Absent abdominal reflexes: Pyramidal tract lesion Absent upper abdominal reflexes: problems at spinal levels T8-T10 Absent lower abdominal reflexes: problems at spinal levels T10-T12 Tender, unmovable nodes >1cm: infection, cancer, lymphoma.