NCM 101

ASSESSMENT OF THE
ABDOMEN

NCM 101 INSTRUCTORS

April 26, 2022
At the end of the discussion, the students should be
able to:
1. Interview a client for an accurate nursing history of the client’s
abdomen and related functions of the organs within the
abdomen.
2. Perform a physical assessment of the abdomen using the
correct techniques.
3. Differentiate between normal and abnormal findings of the
abdomen.
4. Describe the findings frequently seen in assessing the older
client’s abdomen.
5. Analyze the data from the interview and physical assessment
of the abdomen
ASSESSMENT OF THE ABDOMEN
1.Obtain nursing health history
through interview.
• History of Present Health Concern
• Personal Health History
• Family History
2. Conduct physical assessment.
• Inspection
• Auscultation
• Percussion
• Palpation
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview

History of Present Health Concern

“Are you experiencing
abdominal pain?”
1. Abdominal Pain If YES, use COLDSPA to explore
the symptom
ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview
COLDSPA
Character • stabbing, cutting, stinging, burning, boring, splitting,
“What does the pain feels like?” colicky, crushing, gnawing, cramping, gripping,
scalding, shooting, or throbbing
Onset • Acute onset- abrupt and sudden, last for > 6 mos.
“When did the pain start?” • Chronic- insidious and gradual, lasts for < 6 mos.
Location • Localized- pain in 1 specific part of the body
“Where does it hurt” • Radiating- pain literally moves from one part of the
body to another
• Referred- source of pain doesn’t move but pain is felt
in areas other than the source
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview
COLDSPA
Duration • Pain may last within seconds to few months.
“How long does the pain last?” • Constant or intermittent
“Does it recur?”
Severity • Pain scale of 0-10 (0 is the absence of pain, 10 is the
“How painful is it?” worst possible pain
Pattern • Breakthrough pain
“What makes it better or worst?” • Incident pain
• End-of-dose pain
Associated factors/ How it Affects • N/V, diarrhea, constipation, gas, fever, weight loss,
the Client fatigue , jaundice
“Is the pain associated with other
symptoms?”
 MECHANISMS AND SOURCES OF
ABDOMINAL PAIN

1. Visceral Pain
• pain related to the internal organs in
the midline of the body
• poorly defined or localized and occurs
intermittently
• characterized as dully, aching, burning,
cramping or colicky
 MECHANISMS AND SOURCES OF
ABDOMINAL PAIN

2. Parietal Pain
• caused by irritation of fibers that
innervate the parietal peritoneum as in
peritonitis
• localize to the site of pain
• characterize as sharp and severe
 MECHANISMS AND SOURCES OF
ABDOMINAL PAIN

3. Referred Pain
• pain perceived at a location other than
the site of the painful stimulus/ origin
• result of a network of interconnecting
sensory nerves, that supplies many
different tissues
ASSESSING PAIN IN GERIATRICS
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview

History of Present Health Concern

Symptoms: early fullness during a meal,
uncomfortable fullness after a meal,
bloating, burning, discomfort in the upper
2. Indigestion abdomen, nausea
“Do you experience Indication: hyperacidity,
indigestion?” gastroesophageal reflux disease(GERD),
peptic ulcer disease, and stomach cancer.
 INDIGESTION IN GERIATRICS

Indigestion is common in elderly for several reasons:

• Reduced production of digestive juice like saliva, gastric
juice, bile and enzymes can reduce the effectiveness of
digestion.
• Poorly fitted denture, dental decay or loss tooth can lead
to inadequate chewing.
• Lack of physical activity can reduce gut motility.
• Certain drugs like non-steroid anti-inflammatory drugs or
aspirin.
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview

History of Present Health Concern

Triggering Factors: activities, smell, foods,
etc.
3. Nausea and Vomiting Episodes: amount, color,
Vomiting frequency
“Do you experience nausea and Indication: gastric dysfunction, diseases
vomiting?” of the liver and pancreas, drug
intolerance, menstruation
 VOMITING IN GERIATRICS

Considerations when taking care of patients

with vomiting episodes include:
• Elderly clients with impaired consciousness or
neuromuscular diseases are more prone to
aspiration.
• Older clients are more likely to be dehydrated due
to vomiting episodes.
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview

History of Present Health Concern

Assess: weight, onset and duration,
triggering factors, other life events that
4. Appetite may influence appetite
“Have you noticed an increase or
decrease in appetite?” Indication: digestive disorders, chronic
syndromes, cancers, psychological
disorders
 DECREASE APPETITE IN GERIATRICS

Older clients may have a decline in appetite

which make them at risk for nutritional
imbalance. Various factors include:
• Altered metabolism
• Decreased taste sensation
• Decreased mobility
• Possible depression
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview

History of Present Health Concern

Assess: constipation, loose bowel
movement, color of stool, consistency,
5. Bowel Elimination frequency,
“Have you experienced a change
in bowel elimination patterns?” Indication: irritable bowel syndrome,
colon cancer, Crohn’s disease, intestinal
obstruction
 BOWEL ELIMINATION IN GERIATRICS

Older clients are especially at risk for potential

complications with diarrhea-such as fluid volume
deficit, dehydration, and electrolyte and acid-base
imbalance because they have a higher fat to lean
muscle ratio.
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview

Personal Health History

Past Diseases ulcers, gastroesophageal reflux, inflammatory or
obstructive bowel disease, pancreatitis, gallbladder or
liver disease or appendicitis, kidney disease, kidney
stones, nephritis
Exposure to virus Viral hepatitis
Past surgery Abdominal surgery, trauma to the abdomen
Medications Ex: ibuprofen, aspirin, and steroids.
 ASSESSMENT OF THE ABDOMEN: Obtaining Nursing
Health History through Interview

Family Health History

Has anyone in your family had any type of gastrointestinal cancer or other GI
disorders?

Lifestyle and Health Practices

Do you drink alcohol or caffeinated drinks? How much? How often?
What types of foods and how much do you typically consume each day?
How much and how often do you exercise?
What kind of stress do you have in your life right now? How does it affect your
eating or eliminating habits?
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

Abdominal findings can be described using 2 common methods of

subdividing the abdomen into 4 quadrants or 9 regions.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

Prepare needed equipment

Small pillow Rolled blanket Tape measure Stethoscope

Ruler Marking Pen

ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

Prepare the Client

1. Ask the client to empty the bladder

before beginning the examination .

2. Instruct the client to remove clothes and

put on a gown.
3. Help the client to lie supine with the
arms folded across the chest or resting by
the sides
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

Conduct the Examination

1. Inspection
2. Auscultation
3. Percussion

4. Palpation
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

1. Skin Color
Normal Findings
• maybe paler than the
general skin tone
because the abdomen
skin is so seldom
exposed to the natural
elements
• No discoloration
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

1. Skin Color

Abnormal Findings
• Yellow hue indicating
jaundice
• Pale, taut skin commonly
seen with ascites
• Redness indicating
inflammation
• Bruises and other areas of
local discoloration
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

2. Vascularity
Normal Findings
• Scattered fine veins may
be visible.
• Veins above the umbilicus
supplies blood to the
head; veins located below
the umbilicus flows toward
the lower body.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

2. Vascularity

Abnormal Findings
• Dilated veins seen in liver
cirrhosis, obstruction of
the inferior vena cava,
portal hypertension or
ascites.
• Dilated surface, arterioles
and capillaries with a
central star ( spider
angioma)
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

3. Striae

Normal Findings
• pink or bluish in color, old
striae are silvery, white
linear and uneven stretch
marks from past
pregnancies
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

3. Striae

Abnormal Findings
• dark bluish pink
striae are
associated with
Cushing syndrome
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

4. Scars

Normal Findings
• pale smooth minimally
raised old scars may be
seen
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

4. Scars

Abnormal Findings
• Non-healing wounds,
redness, inflammation.
Deep irregular scars may
result from burns.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

5. Lesions and rashes

Normal Findings
• abdomen is free of
lesions or rashes; flat or
raised brown moles
however are normal and
may be apparent.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

5. Lesions and rashes

Abnormal Findings
• changes in moles
including size color, and
border symmetry.
Bleeding moles or
petechiae
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

6. Color of Umbilicus

Normal Findings
• umbilical skin tones are
similar to surrounding
abdominal skin tones or
even pinkish
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

6. Color of Umbilicus
Abnormal Findings
• bluish or purple
discoloration around the
umbilicus(periumbilical
ecchymosis) “Cullen sign”
• sign bluish or purplish
discoloration on the
abdominal flanks “Grey-
turner sign”
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

7. Location of Umbilicus

Normal Findings
• umbilicus is midline at
the lateral line
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

7. Location of Umbilicus

Abnormal Findings
• a deviated umbilicus may
be caused by pressure
from mass, enlarged
organs, hernia, fluid or
scar tissue.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

8. Contour of Umbilicus

Normal Findings
• recessed (inverted) or
protruding no more than
0.5 cm and is round or
conical.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

8. Contour of Umbilicus

Abnormal Findings
• everted umbilicus is seen
with abdominal
distensions
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

9. Abdominal Contour

Normal Findings
• abdomen is flat, rounded
or scaphoid; abdomen
should be evenly
rounded.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

9. Abdominal Contour

Abnormal Findings
• protuberant or distended
abdomen may be due to
obesity, air or fluid
accumulation
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

10. Abdominal symmetry

Normal Findings
• abdomen is symmetric
• does not bulge when
client raises head.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

10. Abdominal symmetry

Abnormal Findings
• a hernia ( protrusion of
the bowel through the
abdominal wall) is seen
as a bulge in the
abdominal wall.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
10. Abdominal movement
Normal Findings
• abdominal respiratory
movement may be seen
especially in male clients
• A slight pulsation of the
abdominal aorta which is
visible in the epigastrium,
extends full length in thin
people.
Abnormal Findings
• diminished abdominal
respiration or change to
thoracic breathing in male
clients may reflect peritoneal
irritation.
• Vigorous wide exaggerated
pulsations maybe seen with
abdominal aortic aneurysm.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

11. Peristaltic Waves

Normal Findings Abnormal Findings
• peristaltic waves are not peristaltic waves are increased
seen although they and progress in a ripple like
maybe visible in very thin fashion from the LUQ to the RLQ
people as slight ripples with intestinal obstruction.
on the abdominal wall.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
1. Bowel Sounds
Normal Findings
• a series of intermittent soft
clicks and gurgles are heard
at a rate of 5-3- per minute.
• Presence of “borborygmus”
which are loud prolonged
gurgles characteristics of
one’s “ stomach growling.
Abnormal Findings
• hyperactive bowel sounds
• Hypoactive bowel sounds
• Decreased or absent bowel
sounds signify the absence of
bowel motility, which
constitutes an emergency
requiring immediate referral.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

• Bowel sounds may be more active over the

ileocecal valve in the RLQ.
• Postoperatively, bowel sounds resume gradually
depending on the type of surgery .
• Bowel sounds normally occur every 5-15
seconds. An easy way to remember is to equate
one bowel sound to one breath sound.
• The increasing pitch of bowel sounds is most
diagnostic of obstruction because it signifies
intestinal obstruction.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

2. Vascular Sounds

Normal Findings Abnormal Findings

• No vascular sounds should Bruits (low-pitched, murmur-like
be heard over abdominal sound) is heard over abdominal
aorta, renal iliac or femoral aorta, renal iliac or femoral
arteries arteries
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

3. Venous hum

Normal Findings Abnormal Findings

• venous hum is not normally • friction rubs heard over the
heard over the epigastric lower right costal areas is
and umbilical areas. associated with hepatic
• No friction rub over liver abscess or metastases.
spleen is present.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

1. Tone

• Normal Findings Abnormal Findings

• generalized tympany • accentuated tympany or
predominates over the hyperresonance is heard over a
abdomen because of air in gaseous distended abdomen.
the stomach and intestines.
Dullness is heard over the
liver and spleen.
• Dullness may also be elicited
over a non evacuated
descending colon
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

Abdominal percussion sequence may proceed

clockwise or up and down over the abdomen
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
PERCUSSING THE LIVER
1. Begin percussing the abdomen
along the mid clavicular line (MCL)
, starting below the level of
umbilicus.
2. Move upward until the percussion
notes change from tympany to
dullness.
3. Percuss downward along the R
MCL, starting below the nipple.
Move downward until percussion
notes from resonance to dullness.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
• Normal Findings
• The normal liver span at the
midsternal line (MSL) is 4-8 cm.
Dull sound should be heard in the
area.
Abnormal Findings
• an enlarged maybe roughly
estimated ( not accurately)
when more intense sounds
outline a liver span or boarders
outside normal ranges
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
PERCUSSING THE SPLEEN
• Located at the 10th rib in the L eft midaxillary
(MAL) percuss downward, noting the change
from lung resonance to splenic dullness
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
• Normal Findings
• The spleen is an oval area of
dullness approximately 7 cm wide
near the left tenth rib and slightly
posterior to the midaxillary line
Abnormal Findings
• Splenomegaly is characterized
by an area of dullness greater
than 7 cm wide.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
PERCUSSING THE KIDNEY
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

Normal Findings
• no tenderness or pain is
elicited or reported by the
client, the examiner senses
only a dull thud.
Abnormal Findings
• tenderness or sharp pain
elicited over the CVA suggests
kidney infection
(pyelonephritis) renal calculi, or
hydronephrosis.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

To perform light palpation:

• Put the fingers of one
hand close together.
• Depress the skin about ½”
with your fingertips, and
make gentle, rotating
movements. Avoid short,
quick jabs.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

• Normal Findings
• Abdomen is non-tender and
soft there is no guarding
behavior indicating pain.
Abnormal Findings
• Tenderness and rigidity is felt,
guarding behavior is present
indicating pain.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

To perform deep palpation:

• Push the abdomen down 2” to
3”; in obese patient, put one
hand on top of the other and
push.
• Palpate the entire abdomen in
a clockwise direction, checking
for tenderness, pulsations,
organ enlargement, and
masses.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
PALPATION OF ABDOMINAL ORGANS
• Palpate for masses, swelling or bulges in the umbilicus and
surrounding area, aorta, liver, spleen, kidneys, urinary bladder
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
PALPATION OF ABDOMINAL ORGANS
• Normal Findings Abnormal Findings
• No palpable masses are • Masses, swelling or bulging are
present detected.
• Umbilicus and surrounding • Severe tenderness (polycystic
area are free of swelling, kidney disease, splenic trauma)
bulges or masses • Presence of pulsating midline
• The aorta is approximately mass (aneurysm)
2.5 – 3.0 cm wide with
moderately strong and
regular pulse. Possibly mild
tenderness may be elicited.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

ABDOMINAL SIGNS
Psoas sign
• can be used to determine the inflammation of
the appendix.
• The right iliopsoas muscle is located right under
the appendix, with the patient maintaining the supine
position.
• The identification of a positive psoas sign might
mean that the patient is suffering from
acute appendicitis, requiring surgical intervention.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

ABDOMINAL SIGNS
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

ABDOMINAL SIGNS
Obturator sign
• another test for appendicitis
• discomfort felt by the subject/patient on the slow internal
movement of the hip joint, while the right knee is flexed.
• It indicates an inflamed pelvic appendix that is in contact
with the obturator internus muscle
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

ABDOMINAL SIGNS
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

ABDOMINAL SIGNS
Rovsing’s sign
• refers to the pain felt in the right
lower abdomen upon palpation of
the left side of the abdomen.
• A positive Rovsing's sign is
indicative of acute appendicitis,
characterized by inflammation,
infection, or swelling of the
appendix.
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

ABDOMINAL SIGNS

Murphy sign
• test for acute cholecystitis
• is a finding for differentiating the
cause, by physical examination
of a patient having pain in the
right upper quadrant of the
abdomen
ASSESSMENT OF THE ABDOMEN: Conducting Physical Examination

ABDOMINAL SIGNS

Blumberg sign
• test for peritonitis
• “rebound tenderness” or the
Shyotkin–Blumberg sign is a
clinical sign in which there is pain
upon removal of pressure rather
than application of pressure to
the abdomen.
Reference: Health Assessment in Nursing/ Janet
Weber, Jane H. Kelley. 4th ed. Pgs. 412- 449