The Abdomen: 2 nd Edition - PowerPoint PPT Presentation

The Abdomen:2nd Edition

Presented by

Guy Havice

• Percussion
• Tone in all quadrants
• Liver and spleen borders
• Solid masses

Palpation

• Tenderness /muscle guarding
• Size and shape of organs
• Solid masses

Observation

• General appearance of the abdomen
• Patient's movement (or lack thereof)

Auscultation

• Performed before percussion or palpation
• Bowel sounds – Diaphragm
• Vascular sounds – Bell

Bowel

• Inflammatory Bowel Disease
• Irritable Bowel Syndrome
• Peptic Ulcer Disease
• Gastroesophageal Reflux Disease

• Ulcerative Colitis
• Crohn’s Disease

• Mild – disease is confined to the rectum
• occasional rectal bleeding associated with passage of mucus
• mild diarrhea
• Moderate – inflammation extending to the splenic flexure
• frequent loose, bloody stools (up to 10 per day)
• abdominal discomfort
• low grade fever
• Severe – extensive colon involvement
• frequent loose, bloody stools (greater than 10 per day)
• severe cramps
• rapid weight loss
• fever

• However, it can affect any part of the gastrointestinal tract

• The deeper muscular layers and regional lymph nodes are usually involved
• may result in perforation or obstruction

• Clinical presentation is more variable than ulcerative colitis because of the irregular pattern of lesion, and deeper tissue involvement
• diagnosis is usually established with endoscopic findings
• Typical S/S include:
• fatigue, weight loss, and fever
• prolonged diarrhea with crampy abdominal pain, with or without gross bleeding
• Physical exam may show nonspecific S/S, be sure to review the patients medical history, including family history

• Ulcerative Colitis – large intestine involvement
• Crohn's Disease – small intestine involvement

• Vague S/S – lower abdominal pain, and altered bowel habits in the absence of any factors which might explain the symptoms
• Criteria methods for diagnosis of IBS
• Manning Criteria
• Rome Criteria

Manning Criteria

Rome Criteria

• The ulcers most often develop in the duodenum and stomach

Endoscopy showing duodenal ulcer

• Helicobacter pylori – associated
• NSAID – induced

• Epigastric burning pain
• Abdominal fullness or cramping
• Nocturnal pain – circadian stimulation of acid secretion
• Ulcer location
• Gastric ulcer – food may precipitate ulcer pain
• Duodenal ulcer – pain usually occurs 1-3 hours after meals

• Often due to a prolonged acid clearance, resulting in a increased contact time with the esophageal mucosa.

• Typical
• heartburn
• belching
• regurgitation
• Atypical
• asthma
• chronic cough
• chest pain

Liver

• Hepatitis
• Cirrhosis

• Jaundice – yellow discoloration of the skin
• Icterus – yellow discoloration of the sclera
• Fatigue
• Upper abdominal pain
• Loss of appetite
• Nausea
• Fever

• Hepatitis A, B and C

Transmission

• Hepatitis A – transmitted through human feces ingestion
• Hepatitis B & C – transmitted through body fluids of an infected person (sex, needle sharing, childbirth)

• No chronic infection
• About 15% of people infected will have prolonged symptoms over a 6-9 month period
• One-third of Americans have evidence of a past infection

White <5

Yellow 5-10

Orange 10-20

Red >20

• Highest rate of disease occurs in 20-49-year-olds
• Estimated 30% of infected persons have no signs or symptoms
• Estimated 1.25 million chronically infected Americans
• Death from chronic liver disease occurs in 15-25%

• Estimated 80% of infected persons have no signs or symptoms
• Estimated 3.9 million (1.8%) Americans have been infected with HCV
• Death from chronic liver disease occurs in 1-5%
• Leading indication for liver transplant

www.cnn.com 3/21/02

• Cirrhotic liver:
• Portal Hypertension
• Esophageal Varices
• Ascites

• It becomes difficult for blood to flow through a cirrhotic liver . As a result, esophagus veins not accustomed to carrying large volumes of blood become engorged

• The risk of bleeding from esophageal varices is ~30% in the first year after identification
• Patients who have bled once have a 70% chance of rebleeding, and approximately one third of further bleeding episodes are fatal

Signs / Symtpoms

• Vomiting blood
• Black tarry stools
• Light-headedness

• Ascites is accumulation of fluid in the peritoneal cavity
• ~50% of patients will develop ascites within 10 years of the diagnosis of cirrhosis
• The fluid retention is due to several vascular and biochemical abnormalities relating to a cirrhotic liver

• Place your hands on opposite sides of the umbillicus. Next, firmly tap on the abdomen with your right hand while your left remains against the abdominal wall.
• If there is a lot of ascites present, you may be able to feel a fluid wave

Assessing for a fluid wave

Spleen

• Mononucleosis

• The infection may continue and development into tonsillitis and/or pharyngitis, cervical lymph node enlargement and tenderness, and moderate to high fever

• EBV is associated with a number of infections, complications, and a variety of malignancies
• The majority of primary EBV infections go unnoticed
• Approximately 90 to 95 percent of adults are EBV-seropositive

• In mononucleosis, the macrophages in the spleen become overactive and trap a higher number of cells. In the process, the spleen becomes enlarged.

• estimated 1-2 cases per thousand
• almost all cases have been in males

Material Covered On Last Two Lectures

Kidney

• Kidney Stones
• Pyelonephritis

Gallbladder / Pancreas

• Pancreatitis
• Bile stones

Misc.

• Constipation
• Appendicitis
• Peritonitis

Bowel

• Inflammatory Bowel Disease
• Irritable Bowel Syndrome
• Peptic Ulcer Disease
• Gastroesophageal Reflux Disease
• Bowel Obstruction

Liver

• Hepatitis
• Cirrhosis

Spleen

• Mononucleosis