2Abdominal AssessmentPatient needs to be exposed from above the xiphoid process to the symphysis pubis.Also, make sure your patient does not have a full bladder.Place patient in a supine position: pillow under the head and knees.Helps to relax abdominal muscles.
3Abdominal AssessmentHave patient point out any areas of pain or tenderness.Examine these last.During exam continue to monitor your patient’s facial expression for pain and discomfort.Use inspection, auscultation, percussion, and palpation to perform the exam.
4Abdominal Assessment Always auscultate before percussing or palpating. These manipulations may alter your patient’s bowel motility and resulting bowel sounds.
5Abdominal Assessment Inspect the skin of the abdomen and flank’s for: ScarsDilated veinsStretch marksRashesLesionsPigmentation changes
6Abdominal Assessment Look for discoloration over the umbilicus: Cullen’s Sign: discoloration over the umbilicusGrey Turner’s Sign: discoloration over the flanksThese are both late signs suggesting intra-abdominal bleeding
7Abdominal AssessmentAssess the size and shape of your patient’s abdomen to determine:Scaphoid (concave)FlatRoundDistendedAsk the patient if it is its usual size and shape
8Abdominal Assessment Check for: BulgesHerniasDistended FlanksAscites appears as bulges in the flanks and across the abdomen and indicates edema caused by CHF, or liver failure.
9Abdominal Assessment Look at your patient’s umbilicus Note location and contour and observe for any signs of herniation or inflammation.Check for:Visible pulsationVisible peristalsis (wavelike motion of organs moving their contents through the digestive tract). May indicate bowel obstruction.Visible masses
10Abdominal AssessmentNext auscultate for bowel sounds and other sounds such as bruits throughout the abdomen.Gently place the diaphragm on your patient’s abdomen and proceed systematically, listening for bowel sounds in each quadrant.Note location, frequency, and characterNormal bowel sounds consist of a variety of high-pitched gurgles and clicks that occur every 5-15 seconds.
11Abdominal AssessmentMore frequent sounds indicate increased bowel motility in conditions such as diarrhea or an early intestinal obstruction.You may hear loud, prolonged, gurgling sounds known as borborygmi.These indicate hyperperistalsis.Decreased or absent sounds suggest a paralytic ileus or peritonitis
12Abdominal AssessmentBruits are swishing sounds that indicate turbulent blood flow.Listen in areas over abdominal blood vessels such as the aorta and renal arteriesPresence indicates abdominal aortic aneurysm or renal artery stenosis
15Abdominal AssessmentPercussing the abdomen produces different sounds based on the underlying tissues.Sounds help you detect excessive gas and solid or fluid-filled massesAlso help you determine the size and position of solid organs such as the liver and spleenPercuss the abdomen in the same sequence you used for auscultation
16Abdominal Assessment Note the distribution of tympany and dullness Expect to hear tympany in most of the abdomenExpect dullness over the solid abdominal organs such as the liver and spleen
17Abdominal Assessment Palpate the abdomen last to detect: TendernessMuscular rigiditySuperficial organs and massesBefore you begin palpation, ask your patient if he has any pain or tendernessPalpate that area last, using gentle pressure with a single finger
18Abdominal AssessmentAsk him to cough and tell you if and where he experiences any painThis is typical for peritoneal inflammation
19Abdominal AssessmentLight palpation by moving your hand slowly and just lifting it off the skin.Use same sequence as for auscultation and percussionWatch for patient’s face for signs of discomfort
20Abdominal Assessment Identify any masses and note: Size Location ContourTendernessPulsationsMobility
21Abdominal AssessmentAbdominal pain upon light palpation suggests peritoneal irritation or inflammationIf rigidity or guarding while palpating, determine whether it is voluntary (patient anticipates the pain) or involuntary (peritoneal inflammation)
22Abdominal AssessmentNext palpate deeply to detect large masses or tendernessUse one hand on top of another and push down slowly.Assess for rebound tenderness by pushing slowly and then releasing your hand quickly off the tender area.
23Abdominal AssessmentIf you note a protruding abdomen with bulging flanks and dull percussion sounds in dependent areas, you might perform two tests for ascites.
24Ascites/Test 1Assess for areas of tympany and dullness while your patient is supineLie him on one sidePercuss again, noting once more any areas of tympany and dullnessIf your patient has ascites, the area of dullness will shift down to the dependent side and the area of tympany will shift up.
25Ascites/Test 2Test for fluid wave, ask an assistant to press the edge of his hand firmly down the midline of your patient’s abdomenWith your fingertips, tap one flank and feel for the impulse’s transmission to the other flank through excess fluidIf you detect the impulse easily, suspect ascites