Abdomen Assessment

D. Tanner, RN, MSN

NUR 211
Fall Semester
 Anatomy of the Abdomen
4 Quadrants RUQ, RLQ, LUQ,
LLQ

Midline

9 Regions- epigastric,
umbilical, suprapubic

The word "abdomen" has a

curious story behind it. It
comes from the Latin
"abdodere", to hide. The idea
was that whatever was eaten
was hidden in the abdomen.
4 Quadrants
9 Regions
 Location! Location!
Location!
RUQ
liver
gallbladder
duodenum (small
intestine)
pancreas head
right kidney and
adrenal
 Location! Location!
Location!
RLQ

cecum
appendix
right ovary and
tube
 Location! Location!
Location!
LLQ

sigmoid colon
left ovary and tube

LUQ

stomach
spleen
pancreas
left kidney and adrenal
 GI Variations Due to Age
Aging- should not affect
GI function unless
associated with a
disease process

Decreased: salivation,
sense of taste, gastric
acid secretion,
esophageal emptying,
liver size, bacterial flora

Increased: constipation!
 GI Variations with
pregnancy
Decrease in gastric
motility
High incidence of N, V
(r/t pregnancy hormones)
and heartburn or acid
reflux
Bowel sounds diminished
r/t enlarged uterus
displacing intestines
Linea nigra- increased
pigmentation of abd
midline
Striae Gravidarum
 Nursing History - Abdomen
Subjective Data:
Ask about:
Appetite
Wt gain or loss
Dysphagia
Intolerance to certain
foods
Any Abdominal Pain of
Nausea and Vomiting
Bowel movements
Any past abdominal
problems
 Nursing History
Infants and Children
Ask: bottle or breast fed, any table
foods, how often & how well & how
much the baby eat, any problems with
constipation, c/o of any abdominal pain
Teenagers-
Ask: nutritional assessment, activity &
exercise patterns, recent wt. loss or gain
 Nursing History
Older Adults
Ask: how do you get your groceries?
prepare your meals?
do you have any trouble swallowing?
how often do your bowels move?
how often do you take anything for
constipation? Rx / OTC/ herbs
what meds do you take?
 Nursing Assessment
Objective Data:
General Observation
Inspect
Auscultate
Percuss
Palpate (always last)
 Focused Health History
Nutrition
Allergies
Medications
Cigarette/tobacco
ETOH intake
Recreational drug use
Stool characteristics
Urine characteristics
Exposure to infectious dz.
Recent stressful life
events
Possibility of Pregnancy
 Techniques for Exam
Provide privacy
Good lighting/appropriate temp in rm
Expose the abdomen
Empty bladder
Position pt supine, arms by side & head on
pillow with knees slightly bent or on a pillow
Warm stethoscope & hands
Painful areas last
Distraction techniques
 Inspection
Overall observation

Abd contour- flat,

scaphoid, round,
protuberant

Abd symmetry and skin

color - note any masses,
striae, scars, veins,
pigmentation

Pulsations
 Auscultation
Always done before
percussion &
palpation

Use diaphragm of
stethoscope

Listen lightly

Start with RLQ

 Auscultation
What makes a bowel sound?
Note character & frequency of bowel
sounds (5-30 times/minute)
Sounds like..
Listen for 5 minutes before documenting
absent bowel sounds
Listen for bruits- aortic, renal, iliac, femoral
Hyper- gastroenteritis, obstruction, hungry
Hypo- pregnancy, peritonitis
 Percussion
Gently tapping on the skin to create a
vibration
Detect fluid, gaseous distention and
masses
Tympany- gas (dominant sound because
of air in sm intestine)
Dullness- solid masses, distended bladder
Percuss liver, spleen ,kidneys
 Palpation of Abdomen
Light palpation- depress about 1 cm. Assess
skin pulsations. Always done first- clockwise

Deep palpation- depress skin about 5-8 cm.

Always assess tender areas last.

Watch pts expression during palpation

 Inspection Abnormal
Findings
Visible or distended veins- ascites

Visible peristalsis- obstruction

Spider nevi (cutaneous angiomas)- cirrhosis

Asymmetry/ Distention- mass or intestinal

obsruction

Color changes- jaundice, bluish/cyanotic

 Abnormal Auscultation
Absence/Hyperactive bowel sounds-
borborygmi

Bruits- swoosh

Peritoneal Friction Rub- rough, grating heard

over liver & spleen- inflammation of
peritoneal surface from tumor, infection, etc.
 Percussion Abnormal
Findings
Enlarged organs, palpable masses,
distention, ascites

Marked tenderness
Palpation Abnormal Findings
Tenderness- rebound- done away from
painful area- done at end of exam

Masses- document location, size, shape,

mobile, pulsating, smooth, nodular, firm

Firmness or muscle guarding/rigidity-

intraabdominal bleeding- DO NOT
CONTINUE TO PALPATE!!!!!!
 Special Procedures
Fluid Wave- need 3 hands- feel for impulse of the
wave of fluid across the abdomen= ascites

Rebound Tenderness- Blumbergs Sign

Iliopsoas Muscle Test- thigh muscle lift R leg and

push down on R thigh= appendicitis
Obturator Test- lift R leg and rotate at 90 degrees=
muscle is irritated by appendicitis

Murphys Sign- inspiratory arrest palpate the liver

should be painless= cholecystitis
 Special Procedures
McBurneys Point- RLQ midclavicular=
appendicitis

Referred pain- location of pain is not

necessarily where the involved organ is! May
be felt where the organ was located in fetal
development ex: spleen= L shoulder pain/
kidney= groin pain

Hooking technique- palpate the liver- feeling

for the liver edge
 Special Procedures

Cullens Sign- bluish discoloration

around the umbilicus EMERGENCY!!!

Kehrs Sign- abd pain radiating to R

shoulder= spleen or pancreatitis
 Sample Documentation
Normal Exam-
Abdomen soft, rounded and symmetric without
distention; no lesions or scars, or visible
peristalsis. Aorta midline without bruit or visible
pulsation; umbilicus inverted and midline
without herniation; bowel sounds present in all
4 quadrants. Liver, kidney and spleen non-
palpable; no tenderness on palpation. Reports
good appetite; no constipation, nausea or
diarrhea. Voiding well and denies laxative use.