Assessing Abdomen
STRUCTURE AND FUNCTION
• ABDOMINAL QUADRANTS
o Right Upper Quadrant (RUQ)
o Left Upper Quadrant (LUQ)
o Right Lower Quadrant (RLQ)
o Left Lower Quadrant (LLQ)
• ABDOMINAL WALL MUSCLES
o External Abdominal Oblique
- Outermost layer
o Internal Abdominal Oblique
- Middle layer
o Transverse Abdominis
- Innermost layer
o Rectus Abdominis
- Connective tissue from these muscles
extends forward to encase a vertical
muscle of the anterior abdominal wall.
o Linea Alba
- a tendinous, fibrous raphe that runs
vertically down the midline of the
abdomen. It extends between the
inferior limit of the sternum and the
pubis, separating the rectus abdominis
muscles.
o Abdominal Wall Muscles
- Muscles protect the internal organs
- Allow normal compression during
functional activities such as coughing,
sneezing, urination, defecation, and
childbirth.
• INTERNAL ANATOMY
o Peritoneum Lines
- Thin, shiny, serous membrane
- Provides a protective covering for most
internal abdominal organs.
Within the abdominal cavity are structures of
several body systems: gastrointestinal,
reproductive (female), lymphatic, and urinary.
These structures are typically referred to as the
abdominal viscera and can be divided into two
types: Solid Viscera and Hollow Viscera.
SOLID VISCERA
• Liver
- Largest solid organ in the body.
- Located below the diaphragm in the
right upper quadrant of the abdomen.
- It is composed of four lobes that fill
most of the right upper quadrant and
extend to the left midclavicular line.
• Pancreas
- Located mostly behind the stomach
deep in the upper abdomen.
- Normally not palpable.
- The pancreas has two functions: it is an
endocrine gland and an accessory organ
of digestion.
- Approximately 7 cm wide
- In some healthy clients, the lower tip
can be felt below the left costal margin.
• Spleen
- Functions primarily to filter the blood of
cellular debris, to digest
microorganisms, and to return the
breakdown products to the liver.
• Kidneys
- Glandular, bean-shaped organs
- Approximately 10 x 5 x 2.5 cm
- The tops of both kidneys are protected
by the posterior rib cage.
- Primary function: filtration and
elimination of metabolic waste
products.
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 - Also plays a role in blood pressure • Urinary Bladder
control and maintenance of water, salt, - A distensible muscular sac located
and electrolyte balances. behind the pubic bone in the midline of
- They also function as endocrine glands
the abdomen.
by secreting hormones.
- Function: acts a temporary receptable
• Right Kidney for urine.
- Positioned slightly lower because of the NURSING PROCESS
position of the liver.
• Pregnant Uterus ASSESSMENT
- May be palpated above the level of the • Abdominal Pain
symphysis pubis in the midline.
- COLDSPA (Character, Onset, Location,
• Ovaries
- Located in the right lower quadrant and Duration, Severity, Pattern, Associated
left lower quadrant Factors)
- Normally palpated only during by a - Indigestion
bimanual examination of the internal - Nausea and Vomiting
genitalia. - Appetite
- Bowel Elimination
HOLLOW VISCERA
- Personal Health History
• Stomach
- Family History
- Not usually palpable.
- Lifestyle and Health Practices
- Main function: store, churn, and digest
food. TYPES OF PAIN
• Gallbladder
TYPES OF PAIN
- Muscular sac approx. 10 cm long
• Visceral Pain
- Functions: to concentrate and store the
- Occurs when hollow abdominal organs
bile needed to digest fat.
─ such as the intestines ─ become
- Not normally palpated.
distended or contract forcefully, or
• Small Intestine
when the capsules of the organs such as
- The longest portion of the digestive
the liver and spleen are stretched.
tract
- Poorly defined or localized and
- Two major functions: digestion and
intermittently timed, this type of pain is
absorption of nutrients.
often characterized as dull, aching,
• Colon/Large Intestine
burning, cramping, or colicky.
- Composed of three major sections:
• Parietal Pain
ascending transverse, and descending.
- Occurs when parietal peritoneum
- Functions: secrete large amounts of
becomes inflamed, as in appendicitis or
alkaline mucus to lubricate the intestine
peritonitis.
and neutralize acids formed by the
- This type of pain tends to localize more
intestinal bacteria.
to the source and is characterized as
- Water is also absorbed in the large
more severe and steady pain.
intestine, leaving waste products to be
eliminated in a stool.

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• Referred Pain
- Occurs at distant sites that are
innervated at approximately the same
levels as the disrupted abdominal
organ.
- This type of pain travels, or refers, from
the primary site and becomes highly
localized at the distant site.
Equipment:
o Small pillow or rolled blanket
o Centimeter Ruler
o Stethoscope (Warm the diaphragm and
the bell)
o Marking Pen
PHYSICAL ASSESSMENT
PHYSICAL ASSESSMENT
Common Abnormal findings include:
o Abdominal Edema, or swelling, signifying
ascites
o Abdominal masses, signifying abnormal
growths or constipation
o Unusual pulsations such as those seen
with an aneurysm of the abdominal
aorta
o Pain associated with appendicitis
ABNORMAL FINDINGS
ABDOMINAL DISTENTION
• Pregnancy
- it causes a generalized protuberant
abdomen, protuberant umbilicus, a
fetal heartbeat that can be heard on
auscultation, percussible tympany over
the intestines, and dullness over the
uterus.
• Fat
- Obesity accounts for most uniformly
protuberant abdomens. The abdominal
wall is thick, and tympany is the
percussion tone is elicited. The
umbilicus usually appears sunken.
• Feces
- Hard stools in the colon appear as
localized distention. Percussion over the
area discloses dullness.
• Fibroids and other Masses
- A large ovarian cyst or fibroid tumor
appears as generalized distention in the
lower abdomen. The mass displaces
bowel, thus the percussion tone over
the distended area is dullness with
tympany at the periphery. The
umbilicus may be everted.
• Flatus
- The abdomen distended with gas may
appear as a generalized protuberance
or it may appear more localized.
- Tympany is the percussion tone over the
area.
• Ascitic Fluid
- Fluid in the abdomen causes
generalized protuberance, bulging
flanks.
- Percussion reveals dullness over fluid
and tympany over the intestines.
• Umbilical Hernia
- Results from bowel protruding through
a weakness in the umbilical ring.
- This condition occurs more frequently in
infants but occurs in adults.
• Epigastric Hernia
- Occurs when the bowel protrudes
through a weakness in the linea alba.
The small bulge appears midline
between the xiphoid process and the
umbilicus. It may be discovered only on
palpation.
• Incisional Hernia
- Occurs when the bowel protrudes
through a defect or weakness resulting
from a surgical incision. It appears as a
bulge near a surgical scar on the
abdomen.
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