Dividing the abdomen into 4 quadrants will aid during assessment and will allow for appropriate documentation of findings. Understanding which organs are relevant to each quadrant will help you to determine etiology of signs/symptoms found during assessment.
Function to support abdominal cavity and protect organs Weakness in these muscles may lead to hernias, inability to cough effectively, increased risk of falls, abdominal distension, postural problems, and back pain.
Liver: bile production, controls levels of fats/amino acids/proteins in the blood, immune function, detoxification, metabolizes drugs, blood clotting, store sugars, etc. Gallbladder: aids in fat digestion and concentrates/stores bile produced by the liver. Pancreas: produces digestive enzymes, secretes insulin/glucagon/somatostatin to control blood sugar levels Spleen: stores and produces lymphocytes
Small intestine: digestion and absorption of nutrients, approximately 21 feet long. Large intestine: absorption of water, lubrication of contents, neutralization of acids, decomposition by live bacteria, approximately 4.5-5 feet long and 2.5 inches in diameter.
RUQ: liver, gallbladder, duodenum, hepatic flexure of colon, head of pancreas, right kidney/ureter, part of ascending and transverse colon RLQ: cecum, appendix, small intestine, right ureter, right ovary/fallopian tube, right spermatic cord
LUQ: stomach, spleen, splenic flexure of colon, tail of pancreas, left kidney/ureter, part of transverse and descending colon LLQ: sigmoid colon, small intestine, part of descending colon, left ovary/fallopian tube, left spermatic cord
1.Observe resident’s abdomen from foot of bed for peristalsis, asymmetry, and abdominal distension 2.Observe umbilicus for deviation 3.Assess skin of abdomen 4.Measure abdominal girth if relevant
1.Start in RLQ and listen to each quadrant for 2-5 minutes for bowel sounds 2.Normal sounds are high-pitched and gurgling in small intestine and low- pitched and rumbling in the colon 3.Normally occur at a rate of 5-35/min
1.Percuss all quadrants for dullness 2.Percuss for tympany 3.Percuss for hyperresonance 4.Percuss for bladder volume
1.With warm hands lightly palpate all 4 quadrants- palpate any area of pain last 2.Use pads of fingers depressing abdomen 1cm 3.Moderate palpation may be done to assess musculature and deeper structure
Very loud bowel sounds: hyperperistalsis caused by diarrhea or early intestinal obstruction. High-pitched tinkles and rushes: bowel obstruction Absence or decreased: paralytic ileus, peritonitis, or acute abdomen
Dullness: normal over liver and spleen, but abnormal in mid abdomen and may be due to organ distension or mass Pain: inflammation Tympany: high-pitched tympany suggests distension Hyperresonance: normal at umbilicus, but anywhere else suggests distended vasculature or aneurysms
Crepitus: subcutaneous emphysema suggests abscess, diverticulitis, or organ perforation. Pain: many causes such as peritonitis, inflammation, abscess Mass/Ridge: depending on the area, could mean tumor, aneurysm, abscess.
Large bowel obstruction: More gradual onset of symptoms Increasing constipation leading to obstipation and abdominal distension Lower abdominal cramping unproductive of feces Loud, hyperactive bowel sounds Symptoms are mild
Presence of red flags Any abnormal finding on abdominal exam Suspected intestinal obstruction Change in bowel patterns, stool consistency, stool colour Change in nutritional status Suspected constipation or fecal impaction Acute abdominal pain