PEMERIKSAAN FISIK ABDOMEN (SISTEM PENCERNAAN)

Anamnesa Perawat mulai dengan mengambil riwayat lengkap, memfokuskan pada gejala-gejala umum disfungsi gastrointestinal. Nyeri Indigesti Sendawa dan flatulensi Mual dan muntah Diare dan konstipasi Riwayat kesehatan terdahulu, kesehatan keluarga dan riwayat psikososial.

Pemeriksaan Fisik Posisi supine Inspeksi Auskultasi dilakukan sebelum palpasi dan perkusi untuk mencegah terjadi perubahan motilitasi usus Perkusi Palpasi Adanya temuan abnormal harus dicatat berdasarkan kwadran atau regio-regio untuk menggambarkan abdomen.

Kwadran Abdomen Regio Abdomen

Kwadran kanan atas : § Sebagian besar hati § Kandung empedu § Duodenum § Bagian kepala pancreas § Fleksur hepatikus colon § Sebagian kolon asenden dan tranversum Kwadran kiri atas : § Lobus kiri hati § Lambung § Lien § Badan dan ekor pancreas § Pleksur splenikus colon § Sebagian kolon tranversum dan asenden

Kwadran kanan bawah : § Sekum § Apendiks § Ureter kanan § Ovarium kanan dan tuba fallopi § Korda spermatikus kanan Kwadran kiri bawah : § Sebagian kolon desenden § Kolon sigmoid § Ureter kiri § Ovarium kiri dan tuba fallopi § Korda spermatikus kiri

Hipokondria kanan § Lobus kanan hepar § Bagian duodenum § Fleksur hepatica § Ginjal kanan § Kelenjar suprarenal Epigastrik § Akhir pilorik § Duodenum § Pankreas Hipokondria kiri § Lambung § Limpa § Ginjal kiri

Lumbal kanan § Kolon asenden § Bagian duodenum dan yeynum Umbilikalis § Omentum § Mesentrika § Bag. Bawah duodenum § Yeyenum dan ileum Lumbal kiri § Kolon desenden § Bagian bawah ginjal kiri § Bag. Jejunum dan ileum

Inguinalis kanan § Sekum § Apendik § Ureter/ovarium Hipogastrik § Ileum § Kandung kemih § uterus Inguinalis kiri § kolon sigmoid § ureter § ovarium

Perubahan warna di abdomen Distribusi rambut Inspeksi Perubahan warna di abdomen Distribusi rambut Adanya ras, lesi, striae, petechie, scar atau ikterik Kesimetrisan  Scars : Jaringan parut Striae (stretch marks) : tanda peregangan ibu hamil Colors : Bluish color at the umbilicus is Cullen's sign – a sign of bleeding in the peritoneum. Bruises on the flanks are Grey Turner's sign (retroperitoneal bleeding - e.g. from inflamed pancreas) Jaundice : warna kuning pada kulit Prominent veins : may be due to portal vein obstruction or inferior vena cava obstruction

Diffuse abdominal distension can be caused by any of the 6 Fs: Distension of the lower abdomen only can be caused by pregnancy, full bladder, ovarian tumor, or uterine fibroids (common benign growths) Diffuse abdominal distension can be caused by any of the 6 Fs: Fat (obesity) Fluid (ascites - peritoneal fluid - or obstructed viscera filled with fluid) Flatus (air) - e.g. from air swallowing or intestinal obstruction Feces (constipation Fetus (pregnancy) Fatal cancer.

Auskultasi Bising usus à bunyi klik lembut yang terdengar setiap 5-10 detik di setiap kwdran abdomen, bising usus normal terdengar 5-12 kali/menit Bising usus tidak ada (-) : dijumpai setelah tindakan pembedahan, peritonitis, ileus paralitik Bising usus meningkat disebabkan hipermotilitas usus pada diare atau gastro enteritis, obstruksi usus Bising abdomen (bruit) merupakan bunyi dari pembuluh darah (artery narrowing)

Perkusi Menentukan ukuran dan lokasi organ abdomen Menentukan akumulasi berlebihan dari cairan dan udara dalam abdomen Dilakukan disemua kwadran Bunyi perkusi normal : Timpani pada 4 kwadran , pekak diatas hepar dan limpa

A. Liver Span Percuss downward from the chest in the right midclavicular line until you detect the top edge of liver dullness. Percuss upward from the abdomen in the same line until you detect the bottom edge of liver dullness. Measure the liver span between these two points. This measurement should be 6-12 cm in a normal adult. B. Splenic Dullness Percuss the lowest costal interspace in the left anterior axillary line. This area is normally tympanitic. Ask the patient to take a deep breath and percuss this area again. Dullness in this area is a sign of splenic enlargement.

C. Shifting Dullness This is a test for peritoneal fluid (ascites). ++ Percuss the patient's abdomen to outline areas of dullness and tympany. Have the patient roll away from you. Percuss and again outline areas of dullness and tympany. If the dullness has shifted to areas of prior tympany, the patient may have excess peritoneal fluid. Psoas Sign This is a test for appendicitis. ++ Place your hand above the patient's right knee. Ask the patient to flex the right hip against resistance. Increased abdominal pain indicates a positive psoas sign. Obturator Sign Raise the patient's right leg with the knee flexed. Rotate the leg internally at the hip. Increased abdominal pain indicates a positive obturator sign.

Palpasi Karakter dinding abdomen, ukuran, kondisi dan konsistensi organ, lokasi nyeri Palpasi ringan : tekan ujung-ujung jari sedalam 1-2 cm, palpasi dalam dilakukan penekanan sedalam 4 cm Lakukan palpasi secara sistematis pada ke empat kwadran

Palpation of the Liver Standard Method Place your fingers just below the right costal margin and press firmly. Ask the patient to take a deep breath. You may feel the edge of the liver press against your fingers. Or it may slide under your hand as the patient exhales. A normal liver is not tender.

Alternate Method This method is useful when the patient is obese or when the examiner is small compared to the patient. Stand by the patient's chest. "Hook" your fingers just below the costal margin and press firmly. Ask the patient to take a deep breath. You may feel the edge of the liver press against your fingers.