The bladder normally cannot be examined unless it is distended above the symphysis pubis. On palpation, the dome of the distended bladder feels smooth and round. Check for tenderness. Use percussion to check for dullness and to determine how high the bladder rises above the symphysis pubis.
Press firmly deep in the upper abdomen, slightly to the left of the midline, and identify the aortic pulsations. In persons over age 50, try to assess the width of the aorta by pressing deeply in the upper abdomen with one hand on each side of the aorta, as illustrated. In this age group, a normal aorta is
Bladder distention from outlet obstruction due to urethral stricture, prostatic hyperplasia; also from medications and neurologic disorders such as stroke, multiple sclerosis.
Suprapubic tenderness in bladder infection
In an older person, a periumbilical or upper abdominal mass with expansile pulsations suggests an aortic aneurysm.
not more than 3.0 cm wide (average 2.5 cm). This measurement does not include the thickness of the abdominal wall. The ease of feeling aortic pulsations varies greatly with the thickness of the abdominal wall and with the anteroposterior diameter of the abdomen.
An aortic aneurysm is a pathologic dilatation of the aorta, usually due to arteriosclerosis. A merely tortuous abdominal aorta, however, may be difficult to distinguish from an aneurysm on clinical grounds.
Although an aneurysm is usually painless, pain may herald its most dreaded and frequent complication—rupture of the aorta.
Apparent enlargement of the aorta indicates assessment by ultrasound.
M Special Techniques
Assessment Techniques for:
■ Appendicitis ■ Mass in abdominal wall
■ Acute cholecystitis
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