1. Abdomen Inspect Auscultation Percussion Palpation

2. Anatomy

3. Abdominal Contents GI organs GI organs GU organs GU organs

4. Health History  Appetite  Dysphagia  Food intolerance  Abd pain  N/V/D  Bowel & bladder habits  Past history (ulcers, gallbladder dx, hepatitis, appendicitis, colitis, hernia)  Medications

5. Common Symptoms  Indigestion  Anorexia  Nausea, vomiting, hematemesis  Abdominal pain  Dysphagia, odynophagia  Change in bowel function

6.  Constipation  Diarrhea  Jaundice/icterus  Urinary/renal symptoms  Kidney or flank pain  Ureteral colic

7. Equipment  Stethoscope  Measuring tape  Pen or marker  Pillow placed under the knees to relax the abdominal musculature

8. Inspection  Contour – normally flat or rounded Scaphoid (sunken) Protuberant (abd distention)  Symmetry (bulging, visible mass)  Umbilicus (midline & inverted)  Observe for pulsation A soft pulsation above the umbilicus is normal d/t the aorta

9. Inspection  Skin - smooth & even, note pigmentation & turgor Red-inflammation Jaundice-best in natural light Glistening & taut, striae –ascities Purple-blue striae –Cushing’s syndrome, may be normal during pregnancy Petechiae Cutaneous angiomas (spider nevi)- HTN or liver dx

10.  Assess for lesions, draw location, use cm Underlying adhesions and fibrous tissue  Assess for venous patterns, pulsations, hair distribution, demeanor  NOW, go to Ausculation instead of palpation. Palpation can cause motility that may not be there.

11. Auscultation  Bowel Sounds High-pitched use diaphragm, hold lightly Begin in the RLQ at the ileocecal valve area Bowel sounds are high pitched, gurgling, cascading sounds, occurring irregularly between 5 to 30 times per minute

12. Documentation Normoactive Hyperactive – sounds loud, high pitched,rushing, tinkling sounds-increased motility diarrhea Hypoactive – sounds decreased motility Partial obstruction constipation Absent sounds-no sounds for 5 minutes Complete obstruction from some cause

13. Vascular Sounds or Bruits  Assess over aorta, renal arteries, iliac and femoral arteries Usually no sound is present Bruit over the aorta or below naval suggests an aneurysm

14. Percussion  Percuss 4 quadrants Tympany normally hear due to air in intestines Dullness over distended bladder, fat, mass Hyperresonance over gaseous distention  Percuss liver span (left for MD)  Percuss spleen (left for MD)

15. Palpation  Light palpation (1 cm, rotary motions) Assess for muscle guarding, rigidity, large masses, tenderness  Deep palpation (5-8 cm, rotary motions) Use bimanual technique with obesity Tenderness occurs with local inflammation, enlarged organs. Sigmoid colon is usually mildly tender

16. Abdominal Masses  For masses note: Location Size Shape Consistency soft, firm, hard Surface Mobility Pulsality Tenderness

17. Palpable Structures  Liver Usually not palpable, if palpable more than 1-2 cm below ribs it is enlarged  Spleen Enlarged 3 times normal size to be palpable Avoid overpalpation of the spleen it will rupture  Kidneys Use 2 hands (duck-bill)

18. Special Procedures  Rebound tenderness (Blumberg’s sign) Choose a site away from the painful area, push down slowly, lift up quickly Usually tender if Appendicitis If not tender, GI virus  Inspiratory Arrest (Murphy’s Sign) Palpate liver on inspiration, with pain the test is positive

19. Common Laboratory Tests  Esophagogastroduodenoscopy  Barium enema (BE)  Colonoscopy  Computerized tomography scan (CT scan)  Magnetic resonance imaging (MRI)  Urinalysis, stool, emesis

20. Question Mrs. Jones presents at the emergency department complaining of severe pain in her abdomen. She has a history of a liver transplant. What would the nurse know NOT to do? A. Auscultate the abdomen B. Inspect the abdomen C. Palpate the abdomen D. Percuss the abdomen

21. Answer C. Palpate the abdomen Rationale: Do not palpate the abdomen of patients who have had an organ transplant or of a child with suspected Wilms’ tumor. Transplanted organs are often located in the anterior portion of the abdomen and not as well protected as the original placed organ.