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Adventist University of the Philippines

College of Nursing
MNHA 510 – Advanced Health Assessment

Abdomen
Equipment: stethoscope, centimeter ruler, non-stretch tape measure, and marking pen

Physical Examination Findings

Inspection of the Abdomen (patient supine, pillow under head, arms at sides)
First, use tangential lighting to inspect the abdomen No lesion, discoloration or scars on the
for color, lesions, scars, and venous return. abdomen noted. The skin is smooth and
even, with homogeneous color.
Second, assess the contour and symmetry of the From the rib bone to pubic bone, has a
abdomen. To elicit hidden masses or bulges, have the rounded abdomen. No visible mass,
patient take a deep breath and hold it. Also have the localized bulging or asymmetry noted.
supine patient raise the head from the table as you
inspect the abdomen.

Third, with the patient’s head at rest, observe for the

following three types of abdominal movement:

- Inspect for smooth, even movement with -Smooth and even movement with
respiration. respiration.

- Assess for surface motion for peristalsis. -Can’t see any motion of peristalsis.

- Haven’t observe any aortic pulsation

- Note any aortic pulsation in the midline. in the midline.

Auscultation of All Quadrants

First, bowel sounds and frequently. Bowel sounds heard on all four
quadrants, with 16x per minute.
Second, use the stethoscope diaphragm to detect high- High-pitched friction rubs over the liver
pitched friction rubs over the liver and spleen. and spleen detected.

Third, use the stethoscope bell to check for bruits over No bruit sounds over aorta, renal, iliac,
the aortic, renal, iliac and femoral arteries. or femoral arteries heard.

Fourth, use the stethoscope bell to assess for a low- Gurgling sounds heard on the epigastric
pitched venous hum in the epigastric area and around area. No hum heard on this area.
the umbilicus
Percussion of All Quadrants
First, systematically percuss for tone in all abdominal Tympany heard over the stomach,
quadrants (tympany and dullness). upper mibline, and epigastric area.
Dullness heard over the liver.
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Physical Examination Findings

Second, percuss for the gastric air bubble in the left Gastric air bubble present in these
lower anterior rib cage and left epigastric region. areas.
Gastric bubble tympany is lower in pitch than
intestinal tympany.

Third, percuss to estimate the liver span, using the

following three steps:

- Determine the lower border of the liver by - Did this procedure.

percussing up from an area of tympany along
the right midclavicular line. Mark the point
where tympany changes to dullness, which
usually occurs at slightly below the costal
margin.

- Determine the upper border of the liver by - Did this procedure.

percussing down from an area of resonance
along the right midclavicular line. Mark the
point where resonance changes to dullness,
which usually occurs at the fifth to seventh
intercostal space.

- Measure the distance between the marks.
Fourth, percuss the spleen just posterior to the
midaxillary line on the left side, beginning in areas of
lung resonance and moving in several directions. You
normally may hear a small area of splenic dullness
from the sixth to tenth rib.
-The liver span distance between the
marks was 8cm.
Dullness on the small area of the spleen
was heard from the sixth to the tenth
rib.

Fifth, percuss bladder dullness. Dullness was heard, full bladder.

Sixth, with the patient seated, percuss the kidneys. Have percussed the kidneys.

Light Palpation of all Quadrants

Muscle resistance (tenderness, masses) No masses and tenderness noted. No
muscle guarding observed.
Inguinal region (bulges, tenderness) No bulges noted.

Deep palpation of all Quadrants

Aorta Pulsations felt.

Liver It felt like a firm, regular ridge. Liver

not palpable.
Spleen Spleen was not palpable.
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Physical Examination Findings

Kidneys No mass or enlargement of the kidney
upon palpation
Umbilical ring Umbilical ring is circular and no
irregularities noted.
Perform Special Tests If Indicated (Murphy’s sign, - Negative murphy’s sign.
rebound tenderness, iliopsoas muscle and obturator - No rebound tenderness noted.
muscle tests). - Negative iliopsoas and obturator
muscle tests.