Assessment of Abdomen  Abdominal Pain

 Indigestion
Four Quadrants of Abdomen  Nausea and vomiting – can also be
objective
 Appetite
 Any gastrointestinal disorders
 Urinary tract disease
 History of hepatitis
 Abdominal surgery or trauma to abdomen –
can also be objective
 Family history
 Intake of alcohol

Inspection
A. Color of the Skin
 paler than the general skin tone
Abdominal Regions  intact with no lesions or masses
 Grey-Turner sign – bruising of
the flanks (sides of the abdomen),
often a sign of severe internal
bleeding, especially in the pancreas.
 Cullen’s sign – bruising around
the belly button (umbilicus),
often a sign of internal bleeding,
especially in the pancreas.
 Jaundice – yellowing of the skin
and eyes, often a sign of liver
problems.
 Ascites – build up of fluid in the
abdomen, often a sign of liver
disease or other conditions.
 Redness – visible sign of
inflammation or irritation.
 Bruises – discoloration of the
skin caused by bleeding under
the skin.

Equipment
 Examining light
 Tape measure
 Skin-marking pen
 Stethoscope

TECHNIQUES – failure to follow IAPePa will

lead to inaccurate result
 Inspection
 Auscultation -
 Percussion
 Palpation

SUBJECTIVE DATA – felt only by the patient

B. Vascularity of the Abdominal Skin
 New Striae – pink or bluish in E. Abdominal Symmetry
color  Abdomen
 Old Striae – silvery, white, linear,  symmetric
and uneven stretch marks from  does not bulge when client raise head
past pregnancies or weight gain. o Asymmetry
 Caput Medusae – network of o Hernia – occurs when an organ
enlarged veins around the belly or tissue protrudes through a
button. It’s often a sign of portal weak spot in the muscle or
hypertension, which is increased connective tissue that holds it in
pressure in the portal vein, a vein place.
that carries blood from the intestines
to the liver. Auscultation: Abdominal movement
 Cushing’s Syndrome – dark bluish-  On a thin patient, peristalsis and aortic
pink striae pulsations may be visible.
 Women’s respirations are more thoracic,
C. Scars whereas men tend to use their
 Pale, smooth, minimally raised old abdominal muscles more with breathing.
scars may be seen.  Increased peristaltic waves: indicate
 Nonhealing wounds, redness, hyperactive bowel sounds, often
inflammation associated with diarrhea or early bowel
 Deep, irregular scars may result obstruction.
from burns.  Reversed peristaltic waves: This is
 Normal Abdomen is flat, rounded, or abnormal and can be a sign of severe
scaphoid. bowel obstruction or ileus.
 (abN) Distended abdomen –  Abnormal respiratory
obesity, air or fluid accumulation  Shallow respirations in male
 Distention below the umbilicus – patients
full bladder, uterine  Increased/diffuse pulsations
enlargement, or ovarian tumor  AUSCULTATION OF the abdomen.
or cyst
 Distention of the upper DEVIATIONS FROM NORMAL:
abdomen – seen with masses of  Bowel sounds
the pancreas or gastric dilation o hypoactive or hyperactive
D. Lesions and Rashes o Normal: 5-30 BS/min.
 Free of lesions and rashes  Vascular sounds
 Flat or raised brown moles, however, o Loud bruit over aortic area
are normal and may be apparent (possible aneurysm)
o Changes in moles: size, color, o Bruit over renal or iliac arteries
and border symmetry  Bruit - resembling heart murmur
o Bleeding moles or petechiae: o Describes as blowing sound
reddish or purple lesions o Peritoneal Friction Rubs – present

Sites for auscultating the vascular sounds

PERCUSSION OF THE ABDOMEN

Deviations from Normal:
 Tenderness  Measure the distance between the two
 Superficial masses marks: this is the span of the liver.
 Localized areas of increased tension – HEPATOMEGALY – liver span
that exceeds normal limits
A. Tone (enlarged)
 Tympany (inflated sound) – ATROPHY – indicated by a
 Dullness over liver and spleen decreased span.
o Hyperresonance
 gaseous distended abdomen Repeat percussion of the liver at the
 Enlarged area of dullness midsternal line (MSL).
 enlarged liver or spleen.  The normal liver span at the MSL is 4-8
o Abnormal dullness cm.
 distended bladder, large masses  An enlarged liver may be roughly
or ascites estimated when more intense sounds
outline a liver span or borders outside the
B. Span or Height of the Liver normal range.
 Lower border:
– begin in the RLQ at the MCL and C. Spleen
percuss upward.  begin posterior to the left mid-axillary
– To assess the descent of the liver, line (MAL), and percuss downward,
ask the client to take a deep noting the change from lung resonance
breath and hold; then repeat the to splenic dullness
procedure.  The spleen is an oval area of dullness
approximately 7 cm wide near the left
tenth rib and slightly posterior to the
MAL.

Splenomegaly
 an area of dullness greater than 7 cm
wide
 may result from traumatic injury, portal
hypertension, and mononucleosis.
To detect splenic enlargement:
 Percuss the last left intercostal space at
the anterior
axillary line (AAL) while the client takes a
deep breath.
 Normally tympany (or resonance) is
heard at the last left interspace.
 Upper border:
 On inspiration, dullness at the last left
– upper right chest at the MCL and
interspace at the AAL suggests an
percuss downward
enlarged spleen
– The lower level of liver dullness is
located at the costal margin to 1-
Perform blunt percussion on liver and
2cm below.
spleen
– On deep inspiration, the lower
 Percuss the liver by placing your left
border of liver dullness may
hand flat against the lower right anterior
descend from 1 – 4 cm below the
rib cage.
costal margin
 Use the ulnar side of your right fist to
– The upper border of liver
strike your left hand.
dullness may be difficult to
 Perform blunt percussion on the kidneys
estimate if obscured by pleural
at the costovertebral angles (CVA) over
fluid of lung consolidation.
the 12th rib
– The upper border of liver dullness
o No tenderness is elicited.
is located between the left 5th
o Normally no tenderness or pain is
and 7tt intercostal spaces
elicited or reported by the client. The
– The normal liver span at the MCL
examiner senses only a dull thud.
is 6-12 cm (greater in men and
taller clients, less in shorter
clients).
  A prominent, laterally pulsating mass
above the umbilicus with an
Types of Palpation accompanying audible bruit strongly
suggests an aortic aneurysm.
A.Light palpation
 Depress about 1 cm. F. Liver
 Assess skin pulsations.  To palpate bimanually, stand at the
 Always done first- clockwise client's right side and place your left
 It is used to identify areas of tenderness hand under the client's back at the level
and muscular resistance. Always assess of the eleventh to twelfth ribs. Lay your
tender areas last. right hand parallel to the right costal
 Watch patient’s expression during margin (your fingertips should point
palpation toward the client's head). Ask the client
 Abdomen is nontender and soft. There is to inhale then compress upward and
no guarding. inward with your fingers.
o Involuntary reflex guarding is serious  To palpate by hooking, stand to the
and reflects peritoneal irritation. right of the client's chest. Curl (hook) the
o The abdomen is rigid and the rectus fingers of both hands over the edge of
muscle fails to relax the right costal margin. Ask the client to
o Right side guarding may be due to take a deep breath and gently but firmly
cholecystitis pull inward and upward with your
fingers.
B. Deep palpation on all quadrants  The liver is usually not palpable,
 Mild tenderness over the xiphoid, aorta, although it may be felt in some thin
cecum, sigmoid colon and ovaries. clients. If the lower edge is felt, it should
 Severe tenderness or pain related to be firm, smooth, and even.
trauma, peritonitis, infection, tumors, or  Mild tenderness may be normal
enlarged or diseased organs o hard, firm liver
o nodularity may occur
C. Masses o tenderness
 No palpable masses are present. o liver more than I to 3 cm below the
 A mass detected in any quadrant may be costal margin.
due to a tumor, cyst, abscess, enlarged
organ, aneurysm, or adhesions G. Spleen
 Stand at the client's right side, reach
D. umbilicus and surrounding area for over the abdomen with your left arm,
swellings, bulges, or masses and place your hand under the posterior
 Umbilicus and surrounding area are free lower ribs. Pull up gently.
of swellings, bulges, or masses.  Place your right hand below the left
costal margin with the fingers pointing
 A soft center of the umbilicus can be a toward the client's head.
potential for herniation.  Ask the client to inhale and press inward
 Palpation of a hard nodule in or around an upward as you provide support with
the umbilicus may indicate metastatic your other hand
nodes from an occult gastrointestinal  Alternatively asking the client to turn
cancer onto the right side may facilitate splenic
palpation by moving the spleen
E. Aorta downward and forward.
 Use your thumb and first finger or use
two hands and palpate deeply in the H. Kidneys
epigastrium, slightly to the left of  To palpate the right kidney, support the
midline. right posterior flank with your left hand
 Assess the pulsation of the abdominal and place your right hand in the RUQ
aorta just below the costal margin at the MCL
 The normal aorta is approximately  To capture the kidney, ask the client to
2.5 to 3.0 cm wide with a moderately inhale. Then compress your fingers
strong and regular pulse. Possibly deeply during peak inspiration.
mild tenderness may be elicited.  Ask the client to exhale and hold the
 A wide, bounding pulse may be felt breath briefly. Gradually release the
with an abdominal aortic aneurysm. pressure of your right hand. If you have
 captured the kidney, you will feel it slip
beneath your fingers.

I. Urinary Bladder
 Palpate for a distended bladder when the
client's history or other findings warrant
(e.g., dull percussion noted over the
symphysis pubis).
 Begin at the symphysis pubis and move
upward and outward to estimate bladder
borders

INFANTS
 The infant’s liver may be palpable 1 to 2
cm (0.4 to 0.8 in.) below the right
costal margin.

CHILDREN
TEST FOR CHOLECYTITIS
 Toddlers have a characteristic “potbelly”
appearance, which can persist until age
3 to 4 years.

OLDER ADULTS
 The rounded abdomens of older adults
are due to an increase in adipose tissue
and a decrease in muscle tone.
 Decreased absorption of oral
medications often occurs with aging.

TEST FOR APPENDICITIS

 Rebound Tenderness
 No rebound tenderness
o Blumberg’s sign - sharp,
stabbing pain as the examiner
releases pressure from the
abdomen (positive rebound
tenderness)
o McBurney’s sign - severe
right lower quadrant pain with
rebound tenderness.
 No rebound pain is elicited
o ROVSING’S SIGN - pain in the
RLQ during pressure in the
LLQ
o PSOAS sign - pain in the RLQ
is associated with irritation of
Iliopsoas muscle due to
appendicitis

TEST FOR HERNIA

 No abdominal hernias noted.
 Protrusion of abdominal organ is visible
when the client lift or raise his head.