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Inspection:
- Abdomen - protuberant under 4 yrs when supine & standing.
- After 4 yrs, potbelly when standing but flat when supine. Abdominal respiratory movement until age 7 yrs.
- Abnormal - absence of resp. movement under age 7 w/ inflammation of peritoneum.
- Scaphoid abdomnen - dehydration or malnutrition.
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Palpation:
- Abdomen - place child in parent's lap, sit knee-to-knee with parent. Flex knees up, elevate head slightly. Have child "pant like dog" to relax muscles. Hold palm flat on abdomen for a moment before palpating to accustom child. If ticklish, hold their hand unders yours as you palpate or apply stethoscope and palpate around it.
- Liver - easily palpable 1-2cm below rib RUQ.
- Spleen - may be palpable w/ soft, sharp, moveable edge.
- Kidney - may feel 1-2cm of R and the tip of L kidneys.
- Note: Use objective findings when assessing (crying change in pitch, facial grimacing, guarding, moving away). Child may answer affirmatively no matter how abdomen feels.
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Percussion:
- Liver span:
- -measures 3.5 cm at 2 yrs
- -measures 5cm at 6 yrs
- -measures 6-7cm during adolescence.
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