ASSESSMENT OF THE ABDOMEN Rachel S. Natividad, RN,MSN

ANATOMY RUQ – liver, gallbladder, duodenum, head of the pancreas, hepatic flexure of colon, ascending /transverse colon, right kidney LUQ – stomach, spleen, body of pancreas, left kidney, splenic flexure of colon, transverse/descending colon RLQ – cecum, appendix, right ovary, tube, ureter, and spermatic cord Midline – aorta, uterus, bladder Epigastric, umbilical, suprapubic Abdominal Quadrants

Abdominal Regions

Obtaining a Health History History of GI problems and/or GI symptoms Heartburn Nausea/vomiting Altered bowel habits Investigate… PQRST Abdominal surgery or trauma Current meds Family hx Ulcerative colitis Colon CA Stomach ulcers Alcoholism Chron’s disease

Different Sequence of Assessment Inspect Auscultate Percuss Palpate

ASSESSMENT Inspection: ·Contour flat round Scaphoid Protuberant distended 

Inspection: Distended Abdomen Ascites

Inspection: Skin – lesions, color, texture, scars, venous pattern, striae

Auscultation of Bowel Sounds Absent no BS for 5 min Hypoactive less than 5/min Active 5-30 per min Hyperactive > 30 /min

Auscultation: vascular sounds Aneurysm

Percussion ·    To assess density of abdominal contents, locate organs, and screen for abnormal fluid or masses ·    Tympany – predominantly over the abdomen – gas-filled ·     Dull over organs in the abdominal cavity (liver, spleen) CVA tenderness

CVA – Costovertebral Angle CVA tenderness – positive in pyelonephritis.

Palpate all quadrants Start with rlq or palpate tender areas last – if tender in rlq, then do not begin there.

Palpation Light Palpation Tenderness, Masses, Deep Palpation Rigidity Deep Palpation Tenderness, Masses, Enlarged organs

Normally Palpable Structures

Assessment Guide: Elimination Abdomen Inspection: flat, round, obese, concave, distended Auscultation: BS active on all quadrants, no vascular sounds Palpation: soft, nontender; firm and tender on RLQ

Urine: describe – clear yellow; dark amber with sediments Bowel Sounds: skip Flatus: present, none Stool: large amount, brown formed stool Date LBM: 3/3 Med List: Dulcolax, Lomotil, MOM, etc.