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Assessment of The Abdomen
Assessment of The Abdomen
Abdomen
Anatomical landmarks
◦ Xiphoid process
◦ Umbilicus
◦ Costal margins
◦ Symphysis pubis
◦ Iliac crest
◦ Anterior superior iliac spine
Four Quadrants of Abdomen
◦Sigmoid colon
◦Left ureter
◦Descending colon
◦Left spermatic cord
◦Bladder if distended
◦Uterus if enlarged
◦Ovary
Collecting SUBJECTIVE DATA
Chief complaint / present illness
◦ Abdominal pain
◦ Constipation
◦ Indigestion
◦ Diarrhea
◦ Nausea
◦ Vomiting
Collecting SUBJECTIVE DATA
Chief complaint / present illness
◦ Fecal incontinence
◦ Jaundice
◦ Dysuria
◦ Urinary frequency
◦ Urinary incontinence
◦ Hematuria, blood in stool
◦ Weight loss, weight gain
Collecting SUBJECTIVE DATA
Symptom characteristics
◦ Onset and duration
◦ Prior evaluation or treatment
◦ Getting better or worse
◦ Home or prescribed treatment
◦ Character or quality
◦ Others in family with similar symptoms
◦ Associated symptoms
◦ Alterations in activities of daily living
◦ Location, radiation
◦ Factors that relieve or exacerbate
symptoms
Nursing history to determine
Immunizations
Hepatitis B
Cholera
Hepatitis A
Typhoid
Rota virus
Other
Laboratory test
Stool cultures
Organ biopsy
Abdominal x-ray, sonograms, ultrasounds
Sigmoid or colonoscopy
Urinalysis
Ova and parasites
H. pylori tests
Nursing history to determine
Appendicitis
Trauma to abdomen
Births
Blood transfusions
Falls
Bike
Skateboard
Nursing history to determine
tobacco
Recent stress
Weight gain or loss
Anorexia, bulimia, dieting
Travel outside of country
Collecting OBJECTIVE DATA
Equipment :
Small pillow or rolled blanket
Tape measure
Stethoscope
Marking pin
Collecting OBJECTIVE DATA
Inspection
Skin
Scars
Lesions
Striae – old silver striae or stretch marks
Rashes
Dilated veins, vein pattern (hepatic cirrhosis or inferior vena
cava obstruction)
Umbilicus
Location
Contour , Signs of inflammation or bulging, hernia
Contour
Symmetrical / asymmetrical
Scaphoid (concave or hollowed)
Flat
Protuberant
Rounded
Collecting OBJECTIVE DATA
Neoplasms
Pregnancy
Feces
Tympanitis
Ascites
(Six “F’s”: Fat, Fluid, Flatus, Fetus, Fecus, Fatal
growths)
Location of Distention
Xiphoid - Diastasis recti
Umbilicus - Pregnancy, distended bladder
Pubis - Umbilical hernia
Midline - Diaphragmatic hernia
Collecting OBJECTIVE DATA
◦ Protuberant
Preschool age child
◦ Scaphoid
Adolescent / adult
◦ Varied
Collecting OBJECTIVE DATA
Inspection
◦ Peristalsis
May be seen in thin individuals or with obstructive
conditions (intestinal obstruction)
◦ Pulsation
Pulsations of descending aorta may be seen in thin
individuals in the epigastrium
◦ Respirations
Abdominal breathing normal until school age
Intercostal breathing occurs with
Respiratory distress
Abdominal inflammation
Pneumonia or pleural effusion may cause
Abdominal pain
Altered respirations
Collecting OBJECTIVE DATA
Auscultation
◦ To assess Bowel sounds – (normal sounds
consist of clicks & gurgles)
◦ Vascular sounds (bruits sounds)
◦ Organ size, location
Warm stethoscope before use
Total obstruction
Peritonitis
Paralytic ileus
Severe ascites
Absence of bowel sounds established
Dull
◦ Short high-pitched sound with little
resonance. Found in solid or fluid filled
organs adjacent to air containing organs, i.e.,
liver, spleen, distended bladder.
Flat
Percuss
◦ 4 quadrants for gas or masses (Solid or fluid
filled)
◦ Liver span
◦ Spleen size
◦ Costovertebral angle (CVA) tenderness
Liver percussion
Spleen Percussion
◦ Splenic dullness may be heard near left 10th rib
posterior to the mid-axillary line
Usually not found unless enlarged
Obscured by air in the colon
◦ Percuss at 10th intercostal space to determine
dullness with deep breath
◦ For spleenomegaly
Percuss the lowest interspace in the left anterior
axillary line – usually tympanitic
Percussion for tenderness of liver or kidneys
◦ Place palm of one hand over organ. Strike hand
with ulnar surface of other hand. If organ is
inflamed, this will result in pain.
Collecting OBJECTIVE DATA
Palpation
Light palpation
◦ Liver
Normally palpable near right costal margin,
mid-clavicular line.
Palpate with right hand starting below umbilicus
◦ Spleen
Difficult to palpate unless enlarged
Deep palpation under L costal margin at the
towards midline
Collecting objective data
Kidneys
Difficult to palpate unless enlarged
With hands perpendicular to midline between rib
Special maneuvers
Rebound tenderness
Psoas maneuver
Obturator sign
Murphy’s sign
Murphy’s Sign
Client complains of sharp pain when trying to take a deep breath
Hernias
Protrusions of the peritoneum or intestine
Pyloric Stenosis
Hypertrophy of the pyloric valve prevents feed from
Percussion
Resonant stomach sounds. Contents expelled.
Palpation
An enlarged, firm, “olive shape” mass may be palpable in
Appendicitis
Appendicitis is the most common cause of acute surgical abdomen in
childhood.
◦ Rare in early childhood, becoming more frequent after age 10.
◦ History includes dull aching, steady peri-umbilical pain that localizes to RLQ
after 4-6 hours.
◦ Nausea and vomiting frequently occur but there is no change in bowel habits.
Low grade fever may be present.
Inspection
◦ Note guarding or pain with walking or coughing. Abdominal distention may be
present. Prefer supine position with knees flexed.
Auscultation
◦ Bowel sounds may be decreased or hyperactive. Need to auscultate RLL of
lungs carefully to rule out lobar pneumonia with referred pain.
Percussion
◦ Increased tenderness may make percussion too uncomfortable to perform.
Palpation
◦ Tenderness over area of inflamed appendix, usually RLQ (McBurney point).
◦ Rebound tenderness localized to same area.
Unable to palpate inflamed appendix. Rectal exam usually finds right-sided
tenderness.
Common Abnormal Abdominal Findings
Abdominal pain
Inspection
◦ Limitation of movement or alterations in breathing pattern (shallow or
chest breathing) are important assessment criteria. Watch client climb on
or off the exam table
◦ Periumbilical pain less likely to be serious than other locations
◦ Evaluate for weight loss or gain
Auscultation
◦ Bowel sounds may be increased or decreased
◦ Friction rub may be heard with pleural inflammation or peritoneal
inflammation
Percussion
◦ Percussion over areas of inflammation may result in pain
◦ Watch facial expressions as you attempt to distract individual. Those
who watch you have more pain.
Palpation
◦ Palpation may identify localized or generalized pain.
◦ Watch facial expressions as you attempt to distract during palpation.
◦ Firm but gentle palpation is best.
Common Abnormal Abdominal Findings
Pregnancy
Inspection
◦ Enlargement of lower abdomen, midline
◦ Enlargement of breast
◦ Linea nigra, increase facial pigmentation, striae
Auscultation
◦ Fetal heart sounds
Percussion
◦ Dull mass in lower abdomen
◦ Displaced tympany of bowel and stomach
Palpation
◦ Fetal outline
◦ Fundus of uterus