ASSESSMENT OF ABDOMEN

ABDOMEN
Theabdomen(also called thebelly),
invertebratessuch asmammals constitutes the
part of the body between thethorax(chest)
andpelvis.
Abdominal Mapping
Four Quadrants ofthe Abdomen
Rightupper quadrant
Rightlower quadrant
Leftupper quadrant
Leftlowerquadrant
Nine Regions ofthe
Abdomen
Right& Left hypochondriac
Right&LeftLumbar
Right &Left Iliac
Epigastric
Umbilical
Hypogastric
 Inspection of the
abdomen
Inspect for skin integrity (Pigmentation, lesions, striae, scars,
veins, and umbilicus).
Contour (flat, rounded, scaphoid)
Distension
Respiratory movement.
Visible peristalsis.
Pulsations
Normal Findings:
Skin color is uniform, no lesions.
Some clients may have striae or scar.
No venous engorgement.
Contour may be flat, rounded or scapoid
Thin clients may have visible peristalsis.
Aortic pulsation maybe visible on thin clients.
 Auscultation of the
Abdomen
This method precedes percussion
because bowel motility, and thus bowel
sounds, may be increased by palpation
or percussion.
The stethoscope and the hands should
be warmed; if they are cold, they may
initiate contraction of the abdominal
muscles.
Light pressure on the stethoscope is
sufficient to detect bowel sounds and
bruits. Intestinal sounds are relatively
high-pitched, the bell may be used in
exploring arterial murmurs and venous
hum.
Listen for bruits over the renal arteries,
 Peristaltic sounds
These sounds are produced by the movements of air and fluids
through the gastrointestinal tract. Peristalsis can provide
diagnostic clues relevant to the motility of bowel.
1.Divide the abdomen in four quadrants.
2.Listen over all auscultation sites, starting at the right lower
quadrants, following the cross pattern of the imaginary lines in
creating the abdominal quadrants. This direction ensures that
we follow the direction of bowel movement.
3.Peristaltic sounds are quite irregular. Thus it is recommended
that the examiner listen for at least 5 minutes, especially at the
periumbilical area, before concluding that no bowel sounds are
present.
4.The normal bowel sounds are high-pitched, gurgling noises that
occur approximately every 5 15 seconds. It is suggested that
the number of bowel sound may be as low as 3 to as high as 20
per minute, or roughly, one bowel sound for each breath sound.
Factors that affect bowel
sound:
Presence of food in the GI tract.
State of digestion.
Pathologic conditions of the bowel
(inflammation, Gangrene, paralytic
ileus, peritonitis).
Bowel surgery
Constipation or Diarrhea.
Electrolyte imbalances.
Bowel obstruction.
 Percussion

Percuss several areas in the four quadrants to

determinepresence of tympany, dullness
orflatness
Use systematic pattern : RLQ, RUQ, LUQ, LLQ
Liver Percussion
Percussdownwardfrom the chest in theright
midclavicular lineuntil you detect the top edge
of liver dullness.
Percussupwardfrom the abdomen in the same
line until you detect the bottom edge of liver
dullness.
Measure the liver span between these two points.
This measurement should be 6-12 cm in a normal
 Splenic Dullness
Percuss the lowest costal interspace in theleft
anterior axillary line. This area is normally
tympanitic.
Ask the patient to take a deep breath and percuss
this area again. Dullness in this area is a sign of
splenic enlargement.
Renal Percussion

Can be done by either indirect or

direct method.
Percussion is done over the
costovertebral junction.
Tenderness elicited by such method
suggests renal inflammation.
 Palpation
Begin withlight palpation. At this point you are
mostly looking for areas of tenderness. The most
sensitive indicator of tenderness is the patient's facial
expression (so watch the patient's face, not your
hands). Voluntary or involuntary guarding may also
be present.
Fingers should beparalleltotheabdomen
Usefinger padsto depress the abdominal wall about1
cm
Movefingerpadsin aslightcircular motion
Proceed todeep palpationafter surveying the
abdomen lightly. Try to identify abdominal masses or
areas of deep tenderness. Depress the abdominal
wall about 4 to 5 cm (1 to 2 in)
If mass is present determine:
Size, Location, Mobility, Contour, Consistency,
 Palpation of the Liver

Place your right hand on the patient's abdomen in

the right lower quadrant. Gently move up to the
right upper quadrant lateral to the rectus muscle.
Gently pressing in and up, ask the patient to take
a deep breath.
If the liver is enlarged, it will come downward to
meet your fingertips and will be recognizable.
Normal:
In normal patients, the edge of the liver may be
palpable just below the costal margin. It is soft
and smooth and may be slightly tender.
 LIVER

SPLEEN
 Palpation of the spleen
Start in the right lower quadrant and proceed
diagonally toward the left upper quadrant.
Attempt to feel spleen with superficial palpation
technique
With each step, ask the patient to take a deep breath.
Feel for the tip of the spleen.
Bimanual Palpation
Stand on the patient's right side and with your left
hand, pull the patient's rib cage anteriorly and palpate
for the tip of the spleen (if enlarged) with your right
hand as the patient takes a deep breath
Normal:
In adults a normal spleen is not palpable.
Palpation of the KIDNEY
The ballottement method is
normally used(A palpatory technique
for detecting or examining a floating
object in the body).
Keep your anterior hand steady in
the deep palpation position in the
right upper quadrant lateral and
parallel to rectus muscle.
Attempt to ballot the kidney with the
other hand in costophrenic angle.
An enlarged kidney should be
palpable by the anterior hand.
Repeat the same maneuver for the
left kidney.