Large abscesses may be palpable as a mass. Eliminate strong andunpleasant odors from the patients care environment. I think with an abscess you can almost definitely use Impaired Tissue Integrity? However, recent data have not proved the effectiveness of routine irrigation or packing (1 Treatment references A cutaneous abscess is a localized collection of pus in the skin and may occur on any skin surface. Cutaneous abscesses are painful, tender, indurated, and usually erythematous. CT of the abdomen and pelvis with oral contrast is the preferred diagnostic modality for suspected abscess. are more likely when infections are complications of prior intra-abdominal operations or procedures. Provides baseline data for nursing goal formulation during goal setting. What is his fluid status? An echinocandin should be the initial treatment in critically ill patients. Evaluate the patients fluid intake and take note of his/her hydration status by assessing the following: blood pressure, daily weight, skin turgor, and mucous membranes. Blood tests may also be done. Prior to a patients successful activity progression, healthcare providers must address the patients sleep deprivation or difficulties. Nursing Diagnosis: Deficient Knowledge related to abdominal distention, secondary to Hirschsprung disease, as evidenced by constipation, vomiting, poor feeding, malnourished, anemia, stunted growth, and ribbon or pellet-like stools. The patient may complain or present with abdominal tenderness if an object becomes lodged in the stomach. See Also: Care Show details Dietary Intervention. The patient will have a greater sense of control and independence over their own treatment. In patients with severe peritonitis, relaparotomy is not recommended in the absence of intestinal discontinuity, abdominal fascial loss that prevents abdominal wall closure, or intra-abdominal hypertension. Initial empiric anti-enterococcal therapy should be directed against Enterococcus faecalis. For these, please consult a doctor (virtually or in person). An intra-abdominal abscess is a pocket of infected fluid and pus located inside the belly (abdominal cavity). In septic shock, there is critical reduction in tissue perfusion; acute failure read more , extremes of age, comorbidities, extent of abdominal infection, and risk of resistant bacteria. Packing the cavity loosely with a gauze wick reduces the dead space and prevents formation of a seroma. A temporary colostomy has been recommended for patients who are experiencing significant symptoms. for example, if i admit a 55-year-old with diabetes and heart disease, i recall what i know about dm pathophysiology. The presence of oral ulcers may also indicate the presence of Crohns disease. Nursing Diagnosis: Nausea related to abdominal distention, secondary to gastroparesis, as evidenced by gagging, increased swallowing and salivation, refusal to eat, increased heart rate, and sweating. IAA is almost always secondary to a preexisting disease process, or concomitant intra-abdominal process. Use OR to account for alternate terms Talan DA, Mower WR, Krishnadasan A: Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. To relieve muscular tension and guarding. there may be more than one abscess. News & Perspective Drugs & Diseases CME & Education Academy Video . If you know you have an elevated WBC you must be in contact with medical care source. Specializes in NICU, PICU, Transport, L&D, Hospice. Generally, there is tenderness over the location of the abscess. . document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. Routine history, physical examination, and laboratory studies will identify most patients who require further evaluation. Specializes in Med nurse in med-surg., float, HH, and PDN. Associated pathophysiologic effects may become life threatening or lead to . The patient will usually present with sudden onset of abdominal pain with associated nausea or vomiting. Kumar RR, Kim JT, Haukoos JS, et al. Intra-abdominal infection should be considered in patients with unreliable physical examination findings (e.g., those with impaired mental status or spinal cord injury) who present with evidence of infection from an undetermined source. The nursing process itself isa problem solving method that was extrapolated from the scientific methods used by the various science disciplines in proving or disproving theories. Carbuncles are clusters of furuncles connected subcutaneously, read more are types of cutaneous abscesses. By using our website, you consent to our use of cookies. however, your faculty will then ask you how you know. Assessing bowel sounds using auscultation of the abdominal region is also possible, wherein the absence of bowel noises may suggest paralytic ileus. Use for phrases They vary in size, typically 1 to 3 cm in length, but are sometimes much larger. Key points about an intra-abdominal abscess. Abdominal distention is a condition in which the abdomen swells due to the buildup of gas or fluid, resulting in outward expansion and increased abdominal girth. In patients with septic shock, resuscitation should begin immediately after hypotension is identified. Inflammatory sores around the mouth may suggest a deficiency in iron-related to malabsorption. To promote bowel movements. Increased leukocyte count signals infection (e.g., peritonitis) or malignancy, which causes stomach distention. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Progressively increasing the intensity of the activity prevents overexertion and raises the patients tolerance for the exercise. All Rights Reserved. Symptoms and signs are pain and a tender and firm or fluctuant swelling. Additionally, excessive consumption of dietary fiber promotes stomach distention and gas. The doctor will ask about symptoms and health history. Benign cutaneous cysts are read more (often incorrectly referred to as sebaceous cysts) rarely become infected; however, rupture releases keratin into the dermis, causing an exuberant inflammatory reaction sometimes clinically resembling infection. Abdominal Biofeedback Therapy. but i can't put them in any individual's plan for nursing care until *i* assess for the symptoms that indicate them, the defining characteristics of each. The drainage flow is likely blocked, and the tube must be cleaned. If the patient complains of abdominal discomfort, pain, or nausea, or if he or she begins to vomit, immediately notify the physician. Mixed anaerobic infections can include both single anaerobic species or multiple anaerobic species read more ), Postoperative; perforation of hollow viscus, appendicitis Appendicitis Appendicitis is acute inflammation of the vermiform appendix, typically resulting in abdominal pain, anorexia, and abdominal tenderness. Please confirm that you are a health care professional. Intra-abdominal abscess continues to be an important and serious problem in surgical practice. An intra-abdominal abscess may be caused by bacteria. Developing an effective care plan begins with identifying the cause of nausea. Computed tomography (CT) should be performed to determine whether an intra-abdominal infection is present in adults who are not undergoing immediate laparotomy. Are there any alternative treatments for abdominal abscess? Symptoms are malaise, fever, and abdominal pain. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. this is wrong-headed for several reasons. Masks are required inside all of our care facilities. An intra-abdominal abscess is a collection of pus or infected fluid that is surrounded by inflamed tissue inside the belly. For any urgent enquiries please contact our customer services team who are ready to help with any problems. Manage Settings When a patient is able to learn and practice relaxation techniques on their own, they have a greater sense of autonomy and self-care competency. Discuss preventative feeding techniques, including using a pacifier for infants receiving parenteral fluids. one is that nursing diagnoses are made by nurses using the nursing process (which i know you don't have a good handle on yet but we're trying to help), not dependent on a medical diagnostic process. The doctor may feel the abscess during an exam. Copyright 2023 American Academy of Family Physicians. The consent submitted will only be used for data processing originating from this website. However, intervention may be delayed for up to 24 hours in closely monitored patients who have started antimicrobial therapy. Dr Laura Kreiner would like to gratefully acknowledge Dr Ali F. Mallat, Dr Lena M. Napolitano, and Dr Lillian Kao, previous contributors to this topic. Nursing Diagnosis: Deficient Knowledge related to abdominal distention, secondary to Hirschsprung disease, as evidenced by constipation, vomiting, poor feeding, malnourished, anemia, stunted growth, and ribbon or pellet-like stools. Other imaging studies, if done, may show abnormalities; plain abdominal x-rays may reveal extraintestinal gas in the abscess, displacement of adjacent organs, a soft-tissue density representing the abscess, or loss of the psoas muscle shadow. Nurses do that too! Options include: CT scan; Ultrasound; X-rays . A physical exam will be done. Doctors typically provide answers within 24 hours. Diverticulitis can be simple or uncomplicated and complicated. The vast majority of treatments for bloating focus on increasing the movement of stool through the colon. Coverage for obligate anaerobic bacilli should be provided for distal small bowel, appendiceal, and colon-derived infection and for more proximal gastrointestinal perforations in the presence of obstruction or paralytic ileus. Nursing Diagnosis: Deficient Fluid Volume related to fever/hypermetabolic state and fluid shifting into intestines and/or peritoneal space from extracellular secondary to bowel perforation as evidenced by hypotension, tachycardia, decreased urine output, concentrated urine, poor skin turgor, delayed capillary refill, dry mucous membrane, and weak In addition, early mobilization may reduce the discomfort associated with bed rest. If left untreated, the bacteria will multiply and cause inflammation and kill healthy tissue, Early treatment can significantly improve the outcome for people who develop intra-abdominal abscesses. Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Additionally, percussion of the abdominal region can determine the presence of air-filled structures and tenderness. For abscesses on the trunk, extremities, axillae, or head and neck, the most common organisms are Staphylococcus aureus (with methicillin-resistant S. aureus [MRSA] being the most common in the US) and streptococci. Recent intra-abdominal surgery also may pose a diagnostic problem in patients in whom intra-abdominal abscesses are suspected. Copyright 2010 by the American Academy of Family Physicians. Symptoms and signs are pain and a tender and firm or fluctuant swelling. Monitor the blood pressure, resting pulse, breathing rate, quality, and rhythm of the pulse following physical exercise. An intra-abdominal abscess may be caused by bacteria. Pilar cysts are usually on the scalp and may be familial. Initiate patient care by describing procedures and routines related to comfort promotion and anxiety prevention. Other techniques, such as ultrasound or magnetic resonance imaging or MRI, may be used as well. N Engl J Med 374(9):823-832, 2016. doi: 10.1056/NEJMoa1507476. Contiguity to the bladder may result in urinary urgency and frequency and, if caused by diverticulitis, may create a colovesical fistula. Assisting the patient with ADLs permits energy conservation. Routine blood cultures and Gram stains are not recommended in patients with community-acquired intra-abdominal infection. He presented with leg pain and a fever, however those have resolved so I'm not sure if I would still be able to use Acute Pain. See permissionsforcopyrightquestions and/or permission requests. Symptoms include local pain, tenderness, warmth, and swelling (if abscesses are near the skin layer) or constitutional symptoms (if abscesses are deep). Anaerobic cultures are not necessary in these patients if empiric antimicrobial therapy is provided. a drain is left in the abscess cavity, and remains in place until the infection goes away. Symptoms of Abdominal Abscesses. Promote physical exercise within the patients energy levels, and modify activities as needed. Anna Curran. This will be checked by the healthcare team and removed when appropriate. Most frequent isolates are, Aerobic gram-negative bacilli (eg, Escherichia coli Escherichia coli Infections The gram-negative bacterium Escherichia coli is the most numerous aerobic commensal inhabitant of the large intestine. Other symptoms include nausea, loss of appetite, and weight loss. Choosing a specialty can be a daunting task and we made it easier. The trusted provider of medical information since 1899, Acute Perforation of the Gastrointestinal Tract, Last review/revision Sep 2021 | Modified Sep 2022. Chronic pancreatitis is characterized by histologic read more, Spread of renal parenchymal abscess (complication of pyelonephritis or rarely hematogenous from a remote source), Trauma, ascending cholangitis, portal bacteremia, Aerobic gram-negative bacilli if origin is biliary; polymicrobial bowel flora; if portal bacteremia, possibly amebic infection Amebiasis Amebiasis is infection with Entamoeba histolytica. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Your feedback has been submitted successfully. LK declares that she has no competing interests. Please follow your facilities guidelines, policies, and procedures. Drug therapy. Teach the family how to properly hold and rock the infant. Antimicrobial therapy should continue for at least three days in adults, until clinical symptoms and signs of infection resolve or a definitive diagnosis is made. An abscess in the lower abdomen may track down into the thigh or perirectal fossa. Moreover, dehydration may occur due to vomiting, a common symptom of nausea. Drain abscesses accompanied by significant pain, tenderness, and swelling and provide adequate analgesia and, when indicated, sedation. Abnormal vaginal bleeding caused by fibroids or malignancy might be diagnosed by a persistently low RBC count. Broad-spectrum antibiotic therapies that may be useful in such cases include ampicillin, gentamicin, and metronidazole; ampicillin, cefotaxime, and metronidazole; or meropenem. Aminoglycosides are not recommended for routine use in adults with community-acquired intra-abdominal infection because less toxic agents are available that are equally effective. it's got a great body of knowledge waiting out there to help you do well for and by your patients, and you do need to understand its processes. The patient will be able to apply effective techniques to prevent nausea after the health teaching session. Antibiotics should be administered as soon as possible in patients with septic shock. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Consult a physician for a nasogastric (NG) tube if enemas do not ease abdominal distention and placement of a rectal tube fails to provide relief. Nursing Diagnosis: Acute Pain related to abdominal distention secondary to peritonitis, as evidenced by verbal reports of pain, self-focus, guarding of the affected area, distraction behavior, and nausea. St. Louis, MO: Elsevier. He had a biopsy which revealed that the thought abscesses where actually cancerous tumors in his abdomen. Examine the nature of the pain (mild, severe, or persistent), noting its location, duration, and intensity. The patient will be able to maintain a desired degree of comfort. The pus is thin enough to pass through the catheter. Symptoms and signs are pain and a tender and firm or fluctuant swelling. Use of this content is subject to our disclaimer. Treatment is with drainage, either surgical or percutaneous. The low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is by far the most significant treatment for abdominal distention. Cefotetan and clindamycin (Cleocin) are not recommended because of increasing resistance among the Bacteroides fragilis group. If feeding induces increased discomfort due to distention and nausea, emphasize the significance of parenteral nourishment. Double-contrast barium enema. Typically, however, antibiotics are given along with draining the abscess. By mildly percussing the abdomen, the location of pain that suggests peritoneal or intraabdominal inflammation can be identified. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. Symptoms include diarrhea read more ; pelvic inflammatory disease Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease (PID) is a polymicrobial infection of the upper female genital tract: the cervix, uterus, fallopian tubes, and ovaries; abscess may occur. We are vaccinating all eligible patients. The treatment of abdominal abscesses depends on the location, size, and cause. If you've recently had surgery or trauma to an abdominal organ and have other risk factors, such as diabetes or inflammatory bowel disease, and you develop a fever, belly pain, nausea or vomiting, or other symptoms, you should immediately call your healthcare provider. To decrease metabolic rate and intestinal irritation, hence promoting pain alleviation and healing. Antibiotics that modify the microbiome and lower gas-producing bacteria may also aid in reducing excessive fermentation and abdominal distention. Examine for any atypical masses that may indicate an inguinal hernia, umbilical hernia, or a ventral wall hernia. It can involve any abdominal organ, or it can settle in the folds of the bowel. Conditions can be temporary or long-term; they can also be physical or psychological. Gravity localizes inflammatory exudate into lower abdomen or pelvis, relieving abdominal tension, which is accentuated by supine position. Select patients with minimal physiologic derangement and a well-circumscribed focus of infection can be treated with antimicrobial therapy without a source control procedure if close clinical follow-up is possible. Sufficient energy reserves are required while engaging in regular physical activities. When I am trying to find a diagnosis, i look at the presenting signs and symptoms because that will be your evidence. But accurately identifying an abscess requires experience and expertise in abdominal imaging. Medical-surgical nursing: Concepts for interprofessional collaborative care. Malignancies (e.g., stomach cancer, pancreatic carcinoma, renal tumor, colonic carcinoma, hepatoma, liver cancer, ovarian carcinoma), Gynaecological (e.g., ectopic pregnancy, fibroids, endometriosis, twisted ovarian tumors, ovarian follicular cysts rupture), Individuals with gastrointestinal disorders. Intra-abdominal infections are the second most common cause of infectious mortality in intensive care units. The abscess may then spontaneously drain. I am a student nurse working on a care plan for a patient with the primary diagnosis of intra abdominal abscess. They can cause inflammation and kill healthy tissue. Summary background data: Patients with appendiceal abscess or phlegmon are traditionally managed by nonsurgical treatment and . Many cases, however, happen after surgery. Carefully balancing the help provided and encouraging increasing strength and stamina can improve the patients exercise tolerance and self-esteem. An abscess below the diaphragm may form when infected fluid . Subphrenic abscesses may cause chest symptoms such as nonproductive cough, chest pain, dyspnea, hiccups, and shoulder pain. AFM declares that he has no competing interests. in such cases, surgery must be done while the patient is under general anesthesia (unconscious and pain-free). She has worked in Medical-Surgical, Telemetry, ICU and the ER. The abdominal wall will be less strained if the knees are raised. Although manifestations vary, most abscesses cause fever and abdominal discomfort ranging from minimal to severe (usually near the abscess). If you've recently had surgery or trauma to an abdominal organ and . Also write down any new instructions your provider gives you. CT is generally the best diagnostic tool for abdominal abscesses. Specific symptoms of abdominal abscesses depend on the location of the abscess, but most people have constant discomfort or pain, feel generally sick (malaise), and often have a fever. Is there a risk for infection (neutropenic)? Acute Abdomen and Surgical Gastroenterology, 2017 revised guidelines on the management of intra-abdominal infection, Revised Guidelines on the Management of Intra-Abdominal Infection, Flagyl, Flagyl ER, Flagyl RTU, MetroCream, MetroGel, MetroGel Vaginal, MetroLotion, Noritate, NUVESSA, Nydamax, Rosadan, Rozex, Vandazole, Vitazol. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. Symptoms include diarrhea read more , pancreatitis Overview of Pancreatitis Pancreatitis is classified as either acute or chronic. Analgesics may be restricted during the early diagnostic phase since they can obscure signs and symptoms. Maintain bed rest and semi-Fowlers position as indicated. Obtain information about patients with a previous history of nausea and vomiting. Plus clindamycin (Cleocin) or metronidazole. Create well-written care plans that meets your patient's health goals. Is it possible to get a nursing diagnosis for leukocytosis? Bring someone with you to help you ask questions and remember what your provider tells you. Nutritional support is important, with the enteral route preferred. Diagnosis is by examination. Treatment is incision and drainage. If untreated, may lead to clinical deterioration including sepsis or septic shock. To decrease metabolic rate and intestinal irritation, hence promoting pain alleviation and healing. Log in or subscribe to access all of BMJ Best Practice. Routine culture and susceptibility studies should be performed in patients with perforated appendicitis or other community-acquired intra-abdominal infection if a common community isolate (e.g., Escherichia coli) is resistant to antimicrobials in widespread local use. An urgent approach also should be taken in hemodynamically stable patients without evidence of acute organ failure. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. Determine the dietary status and sleep pattern of the patient. I would ask about intake, albumin levels, nausea and vomiting. i'm pretty sure i will probably see a constellation of nursing diagnoses related to these effects, and i will certainly assess for them-- ineffective tissue perfusion, activity intolerance, knowledge deficit, fear, altered role processes, and ineffective health management for starters. Routine use of broad-spectrum antimicrobial agents is not indicated in children with fever and abdominal pain unless complicated appendicitis or other acute intra-abdominal infection is suspected. Patients who suffer from abdominal distention are more likely to skip meals or consume less water due to pain and discomfort caused by nausea and vomiting. Promote a therapeutic relationship through open nurse-patient communication, active listening, and empathic understanding. Symptoms vary with the organ read more , anaerobes Overview of Anaerobic Bacteria Bacteria can be classified by their need and tolerance for oxygen: Facultative: Grow aerobically or anaerobically in the presence or absence of oxygen Microaerophilic: Require a low oxygen concentration read more , aerobic gram-negative bacilli including Salmonella Overview of Salmonella Infections The genus Salmonella is divided into 2 species, S. enterica and S. bongori, which include > 2500 known serotypes. Perineal abscesses may represent cutaneous emergence of a deeper perirectal abscess or drainage resulting from Crohn disease Crohn Disease Crohn disease is a chronic transmural inflammatory bowel disease that usually affects the distal ileum and colon but may occur in any part of the gastrointestinal tract. They can show signs of infection. o [teenager OR adolescent ], , MD, MPH, University of British Columbia, (See also Overview of Bacterial Skin Infections Overview of Bacterial Skin Infections Bacterial skin infections can be classified as skin and soft tissue infections (SSTI) and acute bacterial skin and skin structure infections (ABSSSI). We and our partners use cookies to Store and/or access information on a device. Chinnock B, Hendey GW: Irrigation of cutaneous abscesses does not improve treatment success. Due to their high levels of indigestible carbohydrates and fiber, these vegetables promote gas production. A cutaneous abscess is a localized collection of pus in the skin and may occur on any skin surface. In adults with mild-to-moderate community-acquired infection, the use of ticarcillin/clavulanate (Timentin), cefoxitin, ertapenem (Invanz), moxifloxacin (Avelox), or tigecycline (Tygacil) as a single-agent therapy, or a combination of metronidazole (Flagyl) with cefazolin, cefuroxime, ceftriaxone (Rocephin), cefotaxime (Claforan), levofloxacin (Levaquin), or ciprofloxacin (Cipro) is preferable to regimens with substantial antipseudomonal activity (Table 1). Moreover, stool softeners prevent constipation, a symptom of AD that would otherwise induce straining and pain. these are all things you often see in diabetics who come in with complications. . By providing gentle pressure or rocking the newborn, it is possible to alleviate gas and constipation. An intra-abdominal abscess is a collection of pus or infected fluid that is surrounded by inflamed tissue inside the belly. Surgical procedures may also involve repairing the condition that caused the abscess in the first place, such as a bowel perforation. I also want to say there is a difference between Risk for Impaired Skin Integrity and Impaired Tissue Integrity. Can you tell me the symptoms of abdominal abscess? JAC declares that he has no competing interests. allnurses is a Nursing Career & Support site for Nurses and Students. Patients with perforated appendicitis should undergo urgent intervention for source control. As part of your exam, your healthcare provider will take your temperature and check for tenderness in the belly. These other conditions are usually recognizable by history and rectal examination. This content is owned by the AAFP. They can cause inflammation and kill healthy tissue. Maintain strict aseptic technique in care of abdominal drains, incisions and/or open wounds, dressings, and invasive sites. An intra-abdominal abscess may be caused by bacteria. This will also minimize the patients energy expenditure. If left untreated, the bacteria will multiply and cause inflammation and kill healthy tissue. Used to detect the presence of malignancies, inflammation, blockages, polyps, and diverticula and to evaluate functional abnormalities in the large intestine. The infecting organisms typically reflect normal bowel flora and are a complex mixture of anaerobic and aerobic bacteria. yes, experienced nurses will use a patient's medical diagnosis to give them ideas about what to expect and assess for, but that's part of the nursing assessment, not a consequence of a medical assessment. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. Here are 12 nursing care plans (NCP) and nursing diagnosis for patients with spinal cord injury: Risk for Ineffective Breathing Pattern Risk for Trauma Impaired Physical Mobility Disturbed Sensory Perception Acute Pain Anticipatory Grieving Situational Low Self-Esteem Constipation Impaired Urinary Elimination Risk for Autonomic Dysreflexia Diagnosis is by CT. Use to remove results with certain terms Abscesses can occur anywhere in the abdomen and retroperitoneum. Another way to drain the abscess is with surgery. Risk factors for cutaneous abscesses include the following: Antecedent trauma (particularly when a foreign body is present). To learn more, please visit our, You need to see a dr. To get an evaluation of the. Moreover, resting reduces pain and discomfort. In order to decompress the abdomen, nasogastric tubes (NG) are placed. Diagnoses intestinal obstruction with distal bowel compression. Objective: A systematic review of the nonsurgical treatment of patients with appendiceal abscess or phlegmon, with emphasis on the success rate, need for drainage of abscesses, risk of undetected serious disease, and need for interval appendectomy to prevent recurrence. They mainly occur after surgery, trauma, or conditions involving abdominal infection and inflammation, particularly when peritonitis or perforation occurs. Buy on Amazon, Silvestri, L. A. Almost all intra-abdominal abscesses require drainage, either by percutaneous catheters or surgery; exceptions include small (< 2 cm) pericolic or periappendiceal abscesses, or abscesses that are draining spontaneously to the skin or into the bowel. Some small abscesses resolve without treatment, coming to a point and draining. Any change in the patient's clinical status should be . The best imaging test to check for an abscess is typically a computerized tomography or CT scan to see inside the belly.