Topic;

Assessment of the Abdomen

Prepared by Mr. Roman khan
Nursing instructor at Gulfreen Nursing College,
Lahore.
The spleen

 The spleen is located at about the level of the 10th rib, in

the left midaxillary line. Percussion may produce a small
area of dullness, generally 7 Inches (17.8 cm) or less in
adults. However, the spleen usually can’t be percussed
because tympany from the colon masks the dullness of the
spleen
Percussing the spleen/Procedure

 Percuss the lowest intercostal space in the left anterior

axillary line; percussion notes should be tympanic.
 Ask the patient to take a deep breath, then percuss this
area again. If the spleen is normal in size, the area will
remain tympanic.
 If the tympanic percussion note changes on inspiration to
dullness, the spleen is probably enlarged.
Conti…

 To estimate spleen size, outline the spleen’s edges by

percussing in several directions from areas of tympany to
areas of dullness.
CONTI…

 A change in percussion note from tympany to dullness on

inspiration is a positive splenic percussion sign, but this
sign is only moderately useful for detecting splenomegaly
Palpating the spleen

 Palpate the spleen to detect tenderness and enlargement.

 Splenic tenderness may result from infections, which are
common in a patient with an immunodeficiency disorder.
 ■ With the patient in a supine position and you at his right
side, reach across him to support the posterior lower left
rib cage with your left hand.
Palpating the spleen

 ■ Place your right hand below the left costal margin and press
inward.
 ■ Instruct the patient to take a deep breath. The spleen normally
shouldn’t descend on deep inspiration below the 9th or 10th
intercostal space in the posterior midaxillary line.
 ■ Normally the spleen isn’t palpable. If the spleen is enlarged,
you’ll feel its rigid border. If you do feel the spleen, stop
palpating immediately because an enlarged spleen can easily
rupture.
What should you expect when you
palpate Spleen?
Splenomegaly

 Splenomegaly is eight times more likely when the spleen is palpable.

 Causes include
 portal hypertension,
 hematologic malignancies,
 HIV infection,
 infiltrative diseases like amyloidosis, and splenic infarct or
hematoma. The spleen tip, illustrated in is just palpable deep to the left
costal margin.
The Kidney Palpation.

 The kidneys are retroperitoneal and usually not palpable,

but learning the techniques for examination helps you
distinguish enlarged kidneys from other organs and
abdominal masses.
THE KIDNEYS:
Assessing for Kidney Tenderness

 Find the costo-vertebral angle. CVA

 This is the angle formed by the lower border of 12th rib and the
transverse processes of the upper lumbar vertebrae.

 Place left hand flat in this area on one side, hit the hand sharply
with the fist of the other.

 Patient will admit to tenderness if it is present, that may suggest

pyelonephritis.
 Palpation of the Kidney.

 Return to the patient right side.

 Place your left hand under the patient’s back, try to displace the
kidney anteriorly.

 Place your right hand at the RUQ under the costal angle.

 Now proceed as examining the left kidney.

 Normal right kidney may be palpable, especially in thin, well

relaxed individual.
CONTI…

 At the peak of inspiration, press your left hand firmly and

deeply into the LUQ, just below the costal margin.
 Try to “capture” the kidney between your two hands. Ask
the patient to breathe out and then to stop breathing
briefly. Slowly release the pressure of your left hand,
feeling at the same time for the kidney to slide back into
its expiratory position
PALPATION OF THE RIGHT KIDNEY
The Bladder.

 Normally, the bladder is not palpable unless it is distended

above the symphysis pubis. Percuss for dullness and the
height of the bladder above the symphysis pubis.
 Bladder volume must be 400 to 600 mL before dullness
appears.
 On palpation, the dome of the distended bladder feels
smooth and round. Check for tenderness
CONTI…

 Causes of bladder distention are

 outlet obstruction from a urethral stricture
 prostatic hyperplasia,
 medication side effects,
 neurologic disorders such as stroke or multiple sclerosis.
Supra pubic tenderness is common in bladder infection.
Press deep into the sides of midline
assess for aortic pulsation
HOW TO DETECT AORTIC PULSATIONS
The Aorta

 Press firmly deep in the epigastrium,

 slightly to the left of the midline, and identify the aortic
pulsations.
 In adults over age 50 years, assess the width of the aorta
by pressing deeply in the upper abdomen with one hand
on each side of the aorta a normal aorta is not more than
3 cm wide (average, 2.5 cm)
Shifting Dullness
Percuss inner to outward
Special assessment techniques

 Check for ascites

 A large accumulation of fluid in the peritoneal cavity
caused by
 Advanced liver disease,
 Heart failure,
 Pancreatitis,
 Cancer.
Test for shifting dullness.

 Percuss the border of tympany and dullness with the

patient supine
 Then ask the patient to roll onto one side. Percuss and
mark the borders again.
 In a person without ascites, the border between tympany
and dullness usually stays relatively constant
Test for a fluid wave.
Ask the patient or an assistant to press the
edges of both hands firmly down the
midline of the abdomen. This pressure
helps to stop the transmission wave
through fat. While you tap one flank
sharply with your fingertips, feel on the
opposite flank for an impulse transmitted
through the fluid. Unfortunately, this sign
is often negative until ascites is obvious,
and it is sometimes positive in people
without ascites
An easily palpable impulse suggests ascites.
Assessing Possible Appendicitis

 Appendicitis is a common cause of acute abdominal pain.

 Assess carefully for the peritoneal signs of acute abdomen
and the additional signs of
 McBurney point tenderness,
 Roving sign,
 psoas sign,
 obturator sign
Assessing Possible Appendicitis

 Ask the patient to point to where the pain began and where
it is now.
 Ask the patient to cough to see where pain occurs.
 Palpate carefully for an area of local tenderness.
Classically, “McBurney point” lies 2 inches from the
anterior superior spinous process of ilium on a line drawn
from that process to the umbilicus
McBurney point:
McBurney point
Psoas sign,
Obturator sign