Assessment of abdomen
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Assessment of Abdomen. Large cavity extending from diaphragm to pelvis Vertebral column & paravertebral muscles along the back Lower rib cage & abdominal muscles in front 4 layers of large flat muscles joined midline by linea alba. Viscera.

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Viscera
Viscera

  • VISCERA – all internal organs inside the abdominal cavity.

    • Solid viscera keep their shape (liver, spleen, kidneys)

    • Hollow viscera shape depends on contents (stomach, bladder, small intestine).


Abdominal organs
Abdominal Organs

  • Liver fills most of RUQ, extends over to left midclavicular line. Lower edge may normally be palpable.

  • Stomach lies below diaphragm between liver & spleen.

  • Gallbladder lies under posterior surface of liver, just lateral to midclavicular line.



  • Aorta lies just left of midline in upper part of abdomen, descending behind the peritoneum. 2cm below umbilicus, it bifurcates into right & left iliac arteries.

  • Can easily palpate aortic pulsations in upper anterior abdominal wall.

  • Right & left iliac arteries become femoral arteries in the groin area. Pulsations easily palpated ½ way between anterior superior iliac spine & symphysis pubis.


Abdominal vascular sounds
Abdominal Vascular Sounds descending behind the peritoneum. 2cm below umbilicus, it bifurcates into right & left iliac arteries.



Costovertebral angle
Costovertebral Angle obliquely across the posterior abdominal wall.

12th rib forms an angle with the vertebral column called the costovertebral angle. Kidneys lie here at 11th & 12th ribs.

Right kidney sometimes palpable b/c it lies 1-2cm lower than the left (liver on the right).


Abdominal quadrants
Abdominal Quadrants obliquely across the posterior abdominal wall.


History
History obliquely across the posterior abdominal wall.

  • Appetite changes

  • Weight changes, over what period of time

  • Dysphagia

  • Food intolerances

  • Abdominal pain

  • N/V

  • Bowel history

  • meds


Assessment of breast

Assessment of Breast obliquely across the posterior abdominal wall.



  • Areola surrounds the nipple for 1-2cm radius. between 2

  • Montgomery’s glands are small elevated sebaceous glands on the areola that secrete a protective lipid material during lactation

  • Areola & nipple have a darker pigmentation than the rest of the breast.


Glandular tissue
Glandular tissue between 2

  • 15-20 lobes radiate from the nipple, made up of lobules.

  • In each lobule are clusters of alveoli that produce milk

  • Lobules drain into lactiferous ducts then drain milk to the lactiferous sinus (storage reservoirs behind the nipple)


Suspensory ligaments
Suspensory ligaments between 2

  • Also called Coopers ligaments

  • Fibrous bands that extend vertically & attach to chest wall muscles

  • Give support to breast tissue


Adipose tissue
Adipose tissue between 2

  • Layers of subcutaneous fat that provides the bulk of the breast

  • Proportion of these 3 varies depending on age, cycle, pregnancy, lactation & nutritional state.



Breast lymphatics
Breast Lymphatics horizontal lines that intersect at the nipple.

  • Central axillary lymph nodes – high up in middle of axilla

  • Pectoral – along the lateral edge of the pectoralis major (just inside the anterior axillary fold)

  • Subscapular – along the lateral edge of the scapula (deep in posterior axillary fold)

  • Lateral – along the humerus (inside the upper arm)


Male breast
Male Breast horizontal lines that intersect at the nipple.

  • Rudimentary structure consisting of a thin disc of undeveloped tissue underlying the nipple

  • Gynecomastia- enlarged male breast tissue, usually temporary & unilateral. Occurs during adolescence & with aging

  • Distinguish between soft fatty enlargement of obesity and firm disc of glandular enlargement (gynecomastia)


Supernumerary nipple
Supernumerary Nipple horizontal lines that intersect at the nipple.

During embryonic life, milk lines curve from the axilla to the groin bilaterally.

The rest of the ridge usually atrophies.

Occasionally a supernumerary nipple persists along the track of the mammary ridge.


Breast self examination
Breast Self Examination horizontal lines that intersect at the nipple.

  • No longer ROUTINELY recommended to Canadian women.

  • Available evidence supports that BSE does not decrease mortality associated with breast cancer & carries the risk of potentially increasing benign biopsy rates.

  • BUT, if after being informed of risks & benefits of BSE, a woman makes an informed decision to perform BSE, then she should be taught to perform this self assessment screening technique proficiently


Routine breast health screening
Routine Breast Health Screening horizontal lines that intersect at the nipple.

  • Women aged 40-69 have CBE by a trained HCP at least once every 2 years

  • Women aged 40-69 discuss their risk of breast cancer & the risks & benefits of routine mammography screening with their HCP

  • Women aged 50-69 have a screening mammogram every 2 years

  • Women aged 70 & older discuss routine breast cancer screening with their HCP

    (Canadian Cancer Society, 2008)


Canadian statistics
Canadian Statistics horizontal lines that intersect at the nipple.

  • 1 in 9 Canadian women will get breast cancer

  • If a first degree relative with breast cancer, risk is 1 in 6

  • Risk of breast cancer in men is 1% or 170 cases per year

  • Only 5 – 10% of cancers have an identifiable breast cancer gene (BRCA1 or BRCA2)

  • Breast cancer is the 2nd major cause of death from cancer in women


History1
History horizontal lines that intersect at the nipple.

  • Pain

  • Lump

  • Discharge

  • Rash

  • Swelling

  • Family hx of breast disease

  • Breast surgery

  • Self-care behaviors

  • Axilla tenderness, lumps, rash


Abdominal shape
Abdominal Shape horizontal lines that intersect at the nipple.


Shifting dullness
Shifting Dullness horizontal lines that intersect at the nipple.


Fluid wave
Fluid Wave horizontal lines that intersect at the nipple.


Breast palpation vertical strip
Breast Palpation – Vertical Strip horizontal lines that intersect at the nipple.


Breast palpation spokes
Breast Palpation - Spokes horizontal lines that intersect at the nipple.


Breast palpation spiral
Breast Palpation - Spiral horizontal lines that intersect at the nipple.


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