STUDY - Technical - New Dacian's Medicine
Abdominal
distention (Classical / Allopathic Medicine)
Abdominal
distention refers to increased abdominal girth - the result of
increased intra-abdominal pressure forcing the abdominal wall
outward. Distention may be mild or severe, depending on the
amount of pressure. It may be localized or diffuse and may
occur gradually or suddenly. Acute abdominal distention may
signal life-threatening peritonitis or acute bowel
obstruction.
Abdominal
distention may result from fat, flatus, an intra-abdominal
mass, or fluid. Fluid and gas are normally present in the GI
tract but not in the peritoneal cavity. However, if fluid and
gas can't pass freely through the GI tract, abdominal
distention occurs. In the peritoneal cavity, distention may
reflect acute bleeding, accumulation of ascitic fluid, or air
from perforation of an abdominal organ.
MEDICAL HISTORY:
Ask the patient
about the onset, duration, and associated signs and symptoms,
such as pressure, fullness, difficulty breathing deeply or
lying flat, and inability to bend at the waist.
Ask the patient about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Review the patient's medical history for recent surgery and GI or biliary disorders that could cause peritonitis or ascites.
Ask the patient about recent accidents, even minor ones such as a fall from a stepladder.
Ask the patient about abdominal pain, fever, nausea, vomiting, anorexia, altered bowel habits, and weight gain or loss.
Review the patient's medical history for recent surgery and GI or biliary disorders that could cause peritonitis or ascites.
Ask the patient about recent accidents, even minor ones such as a fall from a stepladder.
PHYSICAL
ASSESSMENT:
Stand at the foot of the bed, and observe the recumbent patient for abdominal symmetry to determine if the distention is localized or generalized.
Inspect the patient for tense, glistening skin and bulging flanks, which may indicate ascites.
Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas and is also common in obese patients.
Inspect the abdomen for signs of inguinal or femoral hernia and for incisions that may point to adhesions.
Auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm).
Percuss the abdomen to determine if distention results from air, fluid, or both.
Palpate the abdomen for tenderness, noting whether it's localized or generalized.
Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, or rigidity. Note any masses.
Measure abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen; use the markings as a reference for subsequent measurements.
Stand at the foot of the bed, and observe the recumbent patient for abdominal symmetry to determine if the distention is localized or generalized.
Inspect the patient for tense, glistening skin and bulging flanks, which may indicate ascites.
Observe the umbilicus. An everted umbilicus may indicate ascites or umbilical hernia. An inverted umbilicus may indicate distention from gas and is also common in obese patients.
Inspect the abdomen for signs of inguinal or femoral hernia and for incisions that may point to adhesions.
Auscultate for bowel sounds, abdominal friction rubs (indicating peritoneal inflammation), and bruits (indicating an aneurysm).
Percuss the abdomen to determine if distention results from air, fluid, or both.
Palpate the abdomen for tenderness, noting whether it's localized or generalized.
Watch for peritoneal signs and symptoms, such as rebound tenderness, guarding, or rigidity. Note any masses.
Measure abdominal girth for a baseline value. Mark the flanks with a felt-tipped pen; use the markings as a reference for subsequent measurements.
SPECIAL
CONSIDERATIONS:
Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, with generalized rather than localized dullness. Also, overeating and constipation can cause distension.
Obesity causes a large abdomen without shifting dullness, prominent tympany, or palpable bowel or other masses, with generalized rather than localized dullness. Also, overeating and constipation can cause distension.
PEDIATRIC
POINTERS:
Ascites in older children usually result from heart failure, cirrhosis, or nephrosis.
A hernia may cause abdominal distention if it produces an intestinal obstruction.
When percussing a child's abdomen, remember that children normally swallow air when eating and crying, resulting in louder-than-normal tympany. Minimal tympany with abdominal distention may result from fluid accumulation or solid masses.
Ascites in older children usually result from heart failure, cirrhosis, or nephrosis.
A hernia may cause abdominal distention if it produces an intestinal obstruction.
When percussing a child's abdomen, remember that children normally swallow air when eating and crying, resulting in louder-than-normal tympany. Minimal tympany with abdominal distention may result from fluid accumulation or solid masses.
PATIENT
COUNSELING:
If the patient has an obstruction or ascites, explain food and fluid restrictions..
If the patient has an obstruction or ascites, explain food and fluid restrictions..
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)