Chapter 23

Assessing Abdomen
Abdomen
 Bordered superiorly by the costal margins
 Bordered inferiorly by the symphysis pubis and inguinal
canals
 Bordered laterally by the flanks

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Abdominal Quadrants

 Four quadrants: right upper quadrant (RUQ), right lower

quadrant (RLQ), left lower quadrant (LLQ), left upper
quadrant (LUQ)
 Two imaginary lines (vertical/midline; horizontal/lateral)
 Regions commonly used: epigastric, umbilical,
hypogastric, or suprapubic

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Right Upper Quadrant
 Ascending and transverse colon
 Duodenum, gallbladder, hepatic flexure of colon, liver
 Pancreatic head, pylorus, right adrenal gland
 Right kidney, right ureter

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Right Lower Quadrant

 Appendix
 Ascending colon, cecum
 Right kidney
 Right ovary and tube
 Right ureter
 Right spermatic cord

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Left Upper Quadrant
 Left adrenal gland
 Left kidney
 Left ureter
 Pancreas, spleen, stomach
 Transverse descending colon

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Left Lower Quadrant
 Left kidney
 Left ovary and tube
 Left ureter
 Left spermatic cord
 Descending and sigmoid colon

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Abdominal Wall Muscles

 Three muscle layers from back, around flanks, to front:

external and internal abdominus oblique, transverse
abdominus
 Abdominal wall muscles protect internal organs; allow
normal compression of internal organs during functional
activities

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Question #1
Is the following question true or false?
The abdominal wall allows normal compression during
functional activities such as childbirth.

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Answer to Question #1
True.
The abdominal wall allows normal compression during
functional activities such as childbirth.

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Internal Anatomy #1
 Parietal peritoneum; visceral peritoneum
 Different body systems:
o Gastrointestinal
o Reproductive (female)
o Lymphatic and urinary

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Internal Anatomy #2

 Solid viscera: liver, pancreas, spleen, adrenal glands,

kidneys, ovaries, uterus
 Hollow viscera: stomach, gallbladder, small intestine,
colon, bladder
 Palpation of abdominal viscera depends on location,
structural consistency, size

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Internal Anatomy #3
 Viscera normally not palpable:
o Pancreas, spleen, stomach, gallbladder, small
intestine
 Vascular structures: abdominal aorta; right and left iliac
arteries

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Question #2
Is the following question true or false?
The small intestine is normally palpated during a physical
assessment.

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Answer to Question #2
False.
The small intestine is not normally palpated during a
physical assessment.

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Risk Assessment for Peptic Ulcer Disease

 Presence of Helicobacter pylori in gastrointestinal tract

 Excessive alcohol intake 
 Regular use of nonsteroidal anti-inflammatory
medications (NSAIDs), as well as bisphosphonates
  Smoking cigarettes or chewing tobacco
  Serious illness (especially if on respirator)
  Radiation treatments
  Zollinger–Ellison syndrome  
  Uncontrolled stress

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Client Education #1
 Wash hands frequently with soap and water.
 Eat foods that have been cooked completely.
 Use all recommended cautions when taking pain
relievers, such as taking as low a dose over as short a
length of time as possible; take pain medications with
food; avoid drinking alcohol while on the pain
medications.
  Avoid excessive alcohol intake (more than one drink per
day for women and two drinks per day for males).
 
 

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Client Education #2
 Avoid or stop smoking and chewing tobacco.
  If medications are ordered by your primary health care
provider, follow the directions carefully and report if
there are continuing symptoms, symptoms worsen, or
more serious symptoms occur (such as severe pain,
vomiting with bleeding, tarry stools).
 

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Risk Assessment for Gastroesophageal
Reflux Disease
 Obesity
 Hiatal hernia
 Pregnancy
 Smoking (weakens esophageal sphincter)
 Dry mouth
 Asthma
 Diabetes
 Delayed stomach emptying
 Connective tissue disorders, such as scleroderma
 Alcohol consumption (weakens esophageal sphincter)

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Current Symptoms
 Abdominal pain
 Factors that precipitate pain or make it worse
 Description and location of pain
 Other symptoms
 Recent weight gain or loss

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History

 Past:
o Abdominal surgery, trauma, injury, medications
o Abdominal pain and treatment
o Lab work or gastrointestinal studies
 Family:
o Stomach, colon, liver cancer
o Abdominal pain, appendicitis, colitis, bleeding,
hemorrhoids
o Nutritional habits in family

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Lifestyle and Health Problems

 Smoking
 Alcohol use
 Diet
 Antacid
 Medications
 Fluid intake
 Exercise
 Stress

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Preparing the Client
 Empty the bladder.
 Remove clothes and put on a gown.
 Lie supine with the arms folded across the chest or
resting by the sides.
 Drape the client.
 Breathe through the mouth; take slow, deep breaths.

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Equipment
 Small pillow or rolled blanket
 Centimeter ruler
 Stethoscope (warm the diaphragm and bell)
 Marking pen

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Inspection #1
 Observe the coloration of the skin.
 Note the vascularity of abdominal skin.
 Note any striae.
 Inspect for scars.
 Assess for lesions and rashes.

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Inspection #2

 Inspect:
o Umbilicus, abdominal contour, abdominal movements
when client breathes
 Assess abdominal symmetry.
 Observe aortic pulsations.
 Observe for peristaltic waves.

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Auscultation
 Auscultate for:
o Bowel sounds
o Vascular sounds
o Friction rub over the liver and spleen

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Percussion
 Percuss for tone.
 Percuss the span or height of the liver by determining its
lower and upper borders.
 Percuss the spleen.
 Perform blunt percussion on the liver.

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Palpation #1
 Perform light palpation.

 Deeply palpate all quadrants to delineate abdominal

organs and detect subtle masses.

 Palpate for masses.

 Palpate the umbilicus and surrounding area for swellings,

bulges, or masses.

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Palpation #2
 Palpate:
o Aorta
o Liver
o Spleen
o Kidneys
o Urinary bladder

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Question #3
Is the following statement true or false?
The nurse should begin the collection of objective data by
palpating the client.

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Answer to Question #3
False.
The nurse should begin the collection of objective data by
auscultating the client.

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Special Abdominal Tests #1
 Tests for ascites:
o Test for shifting dullness.
o Perform the fluid wave test.

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Special Abdominal Tests #2

 Tests for appendicitis:

o Rebound tenderness
o Psoas sign
o Obturator sign
o Perform hypersensitivity test

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Special Abdominal Tests #3
 Test for cholecystitis:
o RUQ pain or tenderness
o Murphy sign

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Question #4
Which test should a nurse perform on a client with ascites?
A. Fluid wave test
B. Murphy sign
C. Psoas sign
D. Obturator sign

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Answer to Question #4
A. Fluid wave test.
The nurse should perform the fluid wave test on a client
with ascites. Murphy sign is used to test for cholecystitis
and the psoas sign and obturator signs are performed to
test for appendicitis.

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Mechanism and Sources of Abdominal
Pain
 Types of pain:
o Visceral
o Parietal
o Referred

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Abdominal Distention

o Pregnancy (normal)
o Fat
o Feces
o Fibroids and other masses
o Flatus
o Ascitic fluid

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Abdominal Bulges
o Umbilical hernia
o Epigastric hernia
o Diastasis recti
o Incisional hernia

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Enlarged Abdominal Organs
o Enlarged liver
o Enlarged nodular liver
o Liver higher than normal
o Enlarged spleen
o Aortic aneurysm
o Enlarged kidney
o Enlarged gallbladder

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Older Client
 Dilated superficial capillaries without a pattern may be
seen in older clients. They are more visible in sunlight.
 Assess older adult clients carefully for acute abdominal
conditions as sensitivity to pain may diminish with aging.

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Analysis of Data
 Wellness diagnosis
 Risk diagnosis
 Actual diagnosis
 Collaborative problems

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