Abdominal Assessment

1. Inspection Look - Use your Senses - Pt. sitting Skin striae, scars, rashes, lesions Umbilicus midline, bulges = hernias, contour Contour N = flat, rounded or scaphoid and symmetric; Distended/ protruded = abnormal Aortic pulsation = abnormal if vigorous, wide Perstalsis waves = not seen, only w thin people Masses = abnormal observation 2. Auscultation Listen (before percussion & palpation) RUQ 2 RLQ 1 LUQ 3 LLQ 4

Normal = 5 30 per minute sounds = diarrhea, gastroenteritis, early obstruction sounds = paralytic ileius (paralysis of intestines after surg) peritonitis Note: Empty bladder, supine, relaxed, arms at side/across chest, warm hands, short nails, distract pt. w questions Measure Abdo girth at umbilicus, same time, standing is ideal - increase in size = increases in fluid ascities high pitched sounds with cramping indicate obstruction Listen in each quadrant for 1 minute, 5 minutes total Begin in RLQ clockwise. May be pronounced over the ileocecal valve in the RLQ.

3. Percussion Vibration Percuss in all 4 quadrants to determine tympany & dullness tympany predominates, Dullness = liver and spleen Suprapubic dullness over a distended bladder may be felt above the umbilicus Liver a) percuss upwards from RLQ at midclavicular line listening for dullness, b) Then come from upper right chest down at midclavicular line - should be 6 to 12 cm @ midclav. and 4 8 cm at mid sternal line Spleen Just posterior to midaxillary line, 10th rib, percuss over area, should be tympanic and if it changes to dullness, may suggest splenic enlargement

4. Palpation Light identifies muscular resistance, tenderness, superficial organs and masses, DO TENDER AREAS LAST Deep 4 quad., masses, tenderness (rebound), press in/out, Liver breathe in, one hand on top and under, look for tenderness, usually not palpable Spleen reach w left hand over chest under the spleen and press forward, right hand below costal margins toward head should not be able to palpate *be gentle not to rupture Kidneys two hands method, should not be palpable left is not palpable should feel firm, smooth, rounded. Costoverterbral Angle associated w renal disease. Use the heel of your closed fist to strike the pt firmly over the Costoverterbral angle (12th rib and verterbral column) Rebound tenderness Rovsing sign if you press the LLQ and pt has pain in RLQ, rebound pain Cholecystitis Gall Bladder Pain will elicit Murphys Sign a test for gallbladder disease in which the patient is asked to inhale while the examiner's fingers are hooked under the liver border at the bottom of the rib cage. The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed. Deep inspiration can be very much limited. Diverticulitis resembles R sided appendicitis but in LLQ

Created by Torrie Wright 2006 Revised 2011