1. D. Tanner, RN, MSN NUR 211 Fall Semester
Abdomen Assessment
D. Tanner, RN, MSN
NUR 211
Fall Semester

2. 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.

3. 4 Quadrants

4. 9 Regions

6. Location! Location! Location!
RUQ
liver
gallbladder
duodenum (small intestine)
pancreas head
right kidney and adrenal

7. Location! Location! Location!
RLQ
cecum
appendix
right ovary and tube

8. Location! Location! Location!
LLQ
sigmoid colon
left ovary and tube
LUQ
stomach
spleen
pancreas
left kidney and adrenal

9. 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!

10. 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

11. 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

12. 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

13. 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?

14. Nursing Assessment Objective Data: General Observation Inspect
Auscultate
Percuss
Palpate (always last)

15. 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

16. 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

17. Inspection Overall observation
Abd contour- flat, scaphoid, round, protuberant
Abd symmetry and skin color - note any masses, striae, scars, veins, pigmentation
Pulsations

18. Auscultation Always done before percussion & palpation
Use diaphragm of stethoscope
Listen lightly
Start with RLQ

19. 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

20. 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

21. 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 pt’s expression during palpation

22. 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

23. 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.

24. Percussion Abnormal Findings
Enlarged organs, palpable masses, distention, ascites
Marked tenderness

25. 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!!!!!!

26. Special Procedures
Fluid Wave- need 3 hands- feel for impulse of the wave of fluid across the abdomen= ascites
Rebound Tenderness- Blumberg’s 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
Murphy’s Sign- “inspiratory arrest” palpate the liver should be painless= cholecystitis

27. Special Procedures McBurney’s 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

28. Special Procedures
Cullen’s Sign- bluish discoloration around the umbilicus EMERGENCY!!!
Kehr’s Sign- abd pain radiating to R shoulder= spleen or pancreatitis

29. 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.