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Abdomen
Orthopedic Assessment III
Head, Spine, and Trunk
with Lab
PET 5609C
Clinical Anatomy
Thoracic Cavity:
Clinical Anatomy
Muscles of
Inspiration:
Diaphragm:
Clinical Anatomy
Clinical Anatomy
Muscles of Inspiration:
Intercostal muscles:
Scalene muscles:
Muscles of Expiration:
Clinical Anatomy
Trachea:
Pleura:
Alveoli:
Heart
Chamber
Function
Right
Atrium
Right
Ventricle
Left Atrium
Left
Ventricle
Clinical Anatomy
Esophagus:
Small intestine:
Large intestine:
Clinical Anatomy
Lymphatic Organ
Anatomy:
Spleen:
Increased risk of
injury
mononucleosis
Clinical Anatomy
Kidneys:
Filter blood
Regulate electrolyte levels:
Location:
Clinical Anatomy
Ureters:
Urinary Bladder:
Urethra:
Clinical Anatomy
Testes:
Epididymis:
Fallopian Tubes:
Ovaries:
Uterus:
Clinical Evaluation
Anatomy:
Abdominal cavity
separated from the
thorax by the
diaphragm
Lined with a
membrane
(Peritoneum)
Lower portion of
abdominal cavity:
(Pelvic region)
Surrounded by
pelvis, vertebrae,
and sacrum
Clinical Evaluation
Upper Right Quadrant
Liver
Kidney
Pancreas
Lung
Clinical Evaluation
History:
Location of Pain:
Onset of Symptoms:
Mechanism of Injury:
Clinical Evaluation
History:
Symptoms:
Medical History:
Medications
Clinical Evaluation
Inspection:
Start observe
patients posture
Throat:
Capillary refill
(cyanosis)
Muscle tone
Discoloration of
skin:
Rate, respiration
rate, depth, quality
Nail beds:
Inspection:
Position of trachea
and larynx
Breathing pattern:
Vomiting:
Contusions,
wounds, abrasion
Presence of blood
Hematuria
Clinical Evaluation
Inspection:
Auscultation:
Lungs:
Inhalation smooth
unobstructed sound
Absence:
pneumothorax,
collapsed lung
Rales:
pneumonia
Abdomen:
Gurgling noises
(peristalsis)
Clinical Evaluation
Palpation:
Sternum:
Manubrium,
body, xiphoid
process
Costal cartilage
and ribs:
Palpate anterior
to posterior
Pain, crepitus,
deformity
Clinical Evaluation
Palpation:
Spleen:
Palpate for
enlarged spleen
under left rib cage
Have patient raise
arms above head
Clinical Evaluation
Palpation:
Kidneys:
Location
under
posterolateral
portion of rib
cage
Right kidney
rests more
inferior than
left
Clinical Evaluation
Palpation: Liver
Method 1:
Place your fingers
just below the costal
margin and press
firmly
Ask the patient to
take a deep breath
May feel the edge of
the liver press
against or slide
under your hand
Clinical Evaluation
Palpation: Liver
Method 2:
Hands "hooked"
around the costal
margin from
above
Instruct patient
to breath deeply
to force the liver
down toward your
fingers
Clinical Evaluation
Palpation:
McBurneys Point
Clinical Evaluation
Palpation:
Abdomen
Rigidity:
Occurs secondary to
muscle guarding or
blood accumulation
Indication of
internal injury
Rebound
Tenderness:
Clinical Evaluation
Palpation: Abdomen
Findings: (positive)
Clinical Evaluation
Palpation:
Percussion
Hollow Organs
Allow materials to
pass through them
(stomach, large
intestine, small
intestine, pancreas)
or act as holding
tanks (gall bladder
and urinary bladder)
Less risk for injury
when empty
Palpation:
Percussion
Solid Organs:
Significant blood
supply
Liver, Spleen,
Pancreas, Kidney,
Ovaries, Testes
Higher risk of
injury
Bruising
Tearing
Clinical Evaluation
Quadrant Pain:
Left
Liver: Pain
Upper
Right
associated with
cholecystitis or
liver laceration
Gall bladder: Pain
without trauma
indicates gall
bladder disease
Lower
Appendix:
Rebound
tenderness
indicates
appendicitis
Colon: Colitis or
diverticulitis may
cause pain
Pelvic
Spleen: Rigidity
under the last
several ribs
Colon: Colitis or
diverticulitis may
cause pain
Pelvic
inflammation:
Diffuse tenderness
Clinical Evaluation
Vital Signs:
Heart Rate:
Pulse:
Regular / Irregular
Strong / Weak
Abnormal:
Clinical Evaluation
Patient position:
Seated or supine
Procedure:
Clinical Evaluation
Affected by:
Decrease in blood volume (severe
bleeding or dehydration) Hypovolemic
shock
Decreased capacity of vessels (shock)
Rapid/weak pulse; BP
Clinical Evaluation
Vital Signs:
Respiratory Rate
Normal: 12 20 bpm
Abnormal:
Internal injury
Shock
Pulmonary instruction
Asthma
Airway obstruction
Clinical Evaluation
Rib Fractures:
History:
MOI:
Clinical Evaluation
Rib Fractures:
Inspection:
Splinting posture:
Discoloration / swelling
Shallow, rapid respirations (minimize chest
movement)
Palpation:
Functional Tests:
Clinical Evaluation
Rib Fractures:
Stress Fractures:
Rowing, swimming, golf
Posterolateral portion of 4th-9th ribs
Causes:
Special Tests:
Clinical Evaluation
Lateral Rib
Compression Test:
Test position:
Action:
Subject supine
Examiner compresses the
lateral aspect of the rib
cage then quickly
releases
Positive finding:
Clinical Evaluation
Anterior/Posterior Rib
Compression Test:
Test position:
Action:
Subject supine
Compress rib cage
anterior to posterior and
quickly release
Positive test:
Clinical Evaluation
Costochondral Injury:
MOI:
Overstretching the
costochondral junction
Hyperflexion
Horizontal abduction
Snap or pop at time
of injury
Symptoms:
Clinical Evaluation
Pneumothorax:
Contributing Factors:
Clinical Evaluation
Pneumothorax:
Tension pneumothorax:
Clinical Evaluation
Pneumothorax:
Clinical Signs:
Palpation:
Apprehension / Agitation
Cyanosis
Diminished breath
sounds
Distended neck veins /
Tracheal deviation
Trauma induced point
tenderness
Vital Signs:
Labored, shallow
respirations
BP drops rapidly
Right tension
pneumothorax
Clinical Evaluation
Hemothorax:
Penetrating injury
Can occur from blunt trauma
Clinical Evaluation
Hemothorax:
Clinical
signs/symptoms:
Produced by
hypovolemia and
respiratory compromise
Anxiety, apprehension
Symptoms of
hypovolemic shock
Decreased breath
sounds or absence at
injury site
Flat neck veins
Clinical Evaluation
Spleen Injury:
History:
Predisposing conditions:
Inspection:
Clinical Evaluation
Spleen Injury:
Palpation:
Cold and clammy skin (shock)
Pont tenderness
Rebound tenderness
Distention in upper left quadrant
Functional Tests:
Kerhs sign
Low blood pressure
Clinical Evaluation
Kidney Pathologies:
Contused/Lacerated Kidney:
History:
Onset: acute
Pain: posterolateral portion of upper lumbar
and lower thoracic region
MOI: blunt trauma or penetrating injury to
kidney
Inspection:
Contusion or laceration
Hematuria:
Severe bleeding noticeable blood
Laboratory analysis needed
Signs/symptoms of shock
Clinical Evaluation
Kidney Pathologies:
Palpation:
Point tenderness
Abdominal rigidity
Functional Testing:
Laboratory Testing:
Hematuria
Clinical Evaluation
Kidney Stones:
Collection of
incomplete kidney
filtration
Causes:
Signs:
Clinical Evaluation
Urethritis:
Inflammation of urethra
Causes: chlamydia, gonorrhea, syphilis
More common in males
Clinical Evaluation
Appendicitis and
Appendix Rupture:
Anatomy
Considered to be a
remnant of a portion of
the digestive tract which
was once more functional
and is now in the process
of evolutionary regression
Clinical Evaluation
Appendicitis:
Cause:
Inflammation caused by
fecal obstruction, lymph
swelling, tumor
High incidence in males
(ages 15 25)
If bursts can bleed into
peritoneal cavity and
cause bacterial infection
McBurneys Point
between ASIS and
umbilicus
Clinical Evaluation
Blow to abdomen
Abdominal pain, possible nausea
Palpation reveals guarding, rigidity, tenderness
(point, rebound)
Bowel sounds are absent (auscultation)
Blood in stool
Clinical Evaluation
Gastritis:
Causes:
Esophageal Reflux:
Intestinal Ulcers:
Causes:
Bacteria
Long-term use of aspirin or anti-inflammatory
medications
Clinical Evaluation
Dyspepsia:
Stomach Ulcers
wounds in lining of
stomach
Common causes:
Stress, virus, diet
Potential for bleeding
if ulcers go untreated
(open wounds)
Clinical Evaluation
Colitis:
Symptoms:
Causes:
Frequent diarrhea
Abdominal pain, increased bowel sounds, fever, painful
defecation, nausea, vomiting
Clinical Evaluation
Testicular Contusion:
Testicular Torsion:
Clinical Evaluation
Menstrual Irregularities:
(associated with physical activity)
Combination:
Disordered eating
Amenorrhea
Osteoporosis
Clinical Evaluation
Disordered Eating:
Amenorrhea:
Primary Amenorrhea:
No spontaneous uterine bleeding:
Clinical Evaluation
Amenorrhea:
Secondary Amenorrhea:
6-month absence of menstrual bleeding in a
woman with primary regular menses
12-month absence with previous
oligomenorrhea
Osteoporosis: