Assessing the Abdomen

Prepared by : Mary Ann F. Rubio , RN, MN

 The Abdomen
 (commonly called the belly) is
the body space between the
thorax (chest) and pelvis.
The diaphragm forms the upper
surface of the abdomen.
At the level of the pelvic bones,
the abdomen ends and
the pelvis begins.
 The diaphragm
 is a thin skeletal muscle that sits
at the base of the chest and
separates the abdomen
from the chest.
It contracts and flattens
when a person inhale.
 This creates a vacuum effect that
pulls air into the lungs.
When a person exhale,
the diaphragm relaxes and
the air is pushed out of lungs.
Organs inside the abdomen
 Abdomen

2 Methods of subdividing the Abdomen:

1. Quadrants
2. Regions
 are used to locate and describes
abdominal findings.
 1. Dividing by quadrants

Make 2 imaginary lines:

a. Vertical line from the
xiphoid process to the
pubic symphysis
b. Horizontal line across
the umbilicus .
 4 quadrants are labeled as :

1. Right upper quadrant

2. Left upper quadrant
3. Right lower quadrant
4. Left lower quadrant
Organs located in the four quadrants
of the abdomen
4 quadrants of the abdomen
 2. Division into 9 regions
Make 2 vertical lines that
extend from the midpoints
of the inguinal ligaments
and two horizontal lines ,
one at the level of the
edge of the lower ribs
and the other at
the level of the iliac crests .
Nine regions and organs
Quadrants and regions of the abdomen
4 quadrants and 9 regions of the
abdomen
 Assessment involves all four methods of
examination
In the following sequence:
1. Inspection
2. Auscultation
3. Percussion
4. Palpation
Auscultation is done before palpation and
percussion because palpation and percussion
cause movement or stimulation of the bowel, which
can increase bowel motility , and heighten bowel
sounds , creating false results.
 Procedure : Assessing the abdomen
Planning
1. ask client to empty bladder ; makes
assessment more comfortable.
2. Ensure room is warm , since client will be
exposed.
3. Position patient in a supine position , arms
on the side , bend knees slightly. Bending knee
will help to relax the abdomen and make
palpation easier.
Planning

Expose abdomen fully. Nurse’s hands and

diaphragm of the stethoscope must be
warm to prevent discomfort from cold
hands and stethoscope.
Sequence of examination of the
quadrants RLQ, RUQ, LUQ, LLQ.
Equipment

Examining light
Tape measure
Water- soluble skin-marking pencil
Stethoscope
 Implementation
1. Inspect the abdomen for skin integrity ;
normal findings : unblemished skin , uniform
color. Silver white striae ( stretch marks),
surgical scars.
deviations from normal:
- Presence of rash, lesions
- Tense , glistening skin ( edema)
 Inspection
2. Inspect for ;
a. contour
- Stand on patient’s rigth side and look down on
the abdomen. Then, stoop and gaze across the
abdomen. The contour describes the nutritional
state.

Normal : flat, rounded

Deviations : Distended
 inspection
b. Inspect the symmetry of the abdomen .
- Shine a light across the abdomen lengthwise across the patient
Then ask patient to take deep breath and to hold it ( makes an
enlarged liver or spleen more obvious).
Normal findings :
 no evidence
of enlargement of
liver/ spleen when
patient takes a deep breath.
Deviations :
- Evidence of enlargement.
 inspection
c. Assess the symmetry of contour
while standing at the foot
of the bed.
Normal findings : symmetric contour.
Deviations : asymmetric contour;
protrusions around
the umbilicus , inguinal hernia , scars .
 inspection

d. If distention is present,
measure the abdominal
girth by placing a tape
around the abdomen
at the level of the umbilicus.
 inspection
e. Check the umbilicus for contour or hernia.
Normal findings :
- Umbilicus is midline and
- inverted, no sign of
- discoloration, inflammation,
- or hernia.
- Becomes everted and
- pushed upward with
- pregnancy.
 inspection
Abnormal findings :
- Everted umbilicus :
- ascites or abdominal
mass
- Deeply sunken with obesity
- Enlarged and everted with umbilical hernia
- Bluish periumbilical color with intraabdominal
bleeding ( Cullen’s sign )
Inspection
F. Observe abdominal movements
associated with respiration , peristalsis or
aortic pulsations.
Normal findings : symmetric movements
caused by respiration .
- Visible peristalsis in very lean people.
- Aortic pulsations : thin persons at
epigastric area.
inspection

Deviations from normal

- limited movement due to pain or disease
process.
- Visible peristalsis in clients with bowel
obstructions
- Marked aortic pulsations
 Inspection
g.Observe vascular pattern
Normal findings
- No visible vascular
- pattern

Deviations :
- Visible venous pattern
- ( dilated veins )
associated with liver disease , ascites and
venocaval obstruction.
 Auscultation of the abdomen
g. Auscultation of the abdomen for bowel
sounds, vascular sounds, and peritoneal friction
rubs( Friction rub is a rare finding that indicates inflammation of
the peritoneal surface of the organ from infection, tumor, or infarct.)

- Use diaphragm end piece of the

stethoscope because bowel sounds are
relatively high pitched.
- Hold stethoscope lightly against the skin , to
prevent stimulation of bowel sounds.
 Auscultation
1.Auscultate for bowel sounds in the four
quadrants
Begin on the RLQ at the
ileocecal valve area
because bowel sounds
are normally always
present here,
( Sequence: RLQ, RUQ, LUQ, LLQ).
a. Auscultate bowel sounds
- note character and
frequency of bowel sounds.
Auscultation

Normal findings :
- Bowel sounds are high pitched , gurgling ,
cascading sounds, occurring , irregularity
anywhere from 5 to 30 times per minute.
- Do not bother to count them .
- Judge if they are normal , hypoactive or
hyperactive.
auscultation
One type of hyperactive bowel sounds is
borborygmus . This is the hyperperistalsis
when a patient feels the” stomach
growling.”
Auscultate the abdomen for 5 minutes
before concluding absence of bowel
sounds.
Auscultation
2. Auscultate for vascular sounds
- Note for presence of vascular sounds or
bruits.
- Using firm pressure, check over the aorta,
renal, iliac and femoral arteries, especially
in people with hypertension .
Abnormal findings :
- A systolic bruit is a pulsative blowing
sound and occurs with stenosis or
occlusion of an artery.
 percussion
Percuss lightly in the four
quadrants to determine
for tympany and dullness.
a. In the RUQ in the
midclavicular line,
percuss the liver to
determine its size
a. Tympany of the gastric air bubble can be in the
LUQ over the anterior lower border of the rib
cage.
Percussion

Abnormal findings :
- Dullness over a distended bladder,
adipose tissues , fluid or mass.
- Hyperresonance is present with gaseous
distention.
- An enlarged liver span indicates liver
enlargement or hepatomegaly.
Percussing the liver
Percussion to determine liver size begins
in the right midclavicular line below the
level of the umbilicus and proceeds as
follows :
1. Percuss upward over tympanic areas
until a dull percussion sound indicates the
lower liver border.
- Mark the site with a skin- marking pencil.
 Percussing the liver
2. Then percuss downward
at the RMCL,beginning
from the area of lung
resonance and
progressing downward
until a dull percussion
sound indicates the
upper liver border
( usually at the 5th – 7th
interspace ).

. Mark this site.

Percussing the liver

3. Measure the distance between the two

marks ( upper and lower liver border ) in
centimeters to establish the liver span or
size.
4. Repeat steps 1 to 3 at the midsternal line.
 Palpation of the abdomen
 Perform light palpation first to detect areas of
tenderness and / or muscle guarding . Systematically
explore all four quadrants .
Light palpation
1. Hold palm of your
hand slightly above the
client’s abdomen,
with fingers parallel to the
abdomen.
2. Depress the abdominal wall lightly , about1 cm or
to the depth of the subcutaneous tissue with the
pads of your fingers .
3. Move finger pads in a slight circular motion.
4. Note areas of tenderness or superficial pain,
masses, muscle guarding.
5. If patient is excessively ticklish , begin by
pressing your hand on top of the client’s
while pressing lightly. Then slide your hand off the
client’s and onto the abdomen to continue
examination.
 Deep palpation
Palpate sensitive areas last.
Press the distal half of the
palmar surface of the
fingers of one hand into
the abdominal wall.
- Use the bimanual method of palpation .
Depress the abdominal wall about 4 to 5 cm ( 11/2
to 2 inches )
 note masses and the underlying content.
Check for rebound tenderness in areas where
the client complains of pain .
- With one hand , press slowly and deeply
over the area indicated and then lift the
hand quickly. If patient does not complain
pain during deep pressure but indicates
pain at the release of the pressure ,
rebound tenderness is present ( indicate
peritoneal inflammation and should be reported
immediately .
 Palpation of the liver
Palpate the live to detect enlargement and
tenderness.
Procedure in palpating the liver
1. Stand on client’s right side.
2. Place your left hand on
the posterior thorax at about
the 11th or 12th rib. This hand
is used to push upward and provide support of
underlying structures for the subsequent anterior
palpation.
3. Place hand along e your right hand along
the rib cage at 45 degree angle to the
right of the rectus abdominis muscle or
parallel to the rectus muscle with the
fingers pointing toward the rib cage.
4. While patient exhales exert a gradual
and gentle downward and forward pressure
beneath costal margin until you reach a depth of
4-5 cm ( 1 ½ to 2 in ). During expiration , the
abdominal wall relaxes, facilitating deep
palpation..
Palpating the liver
5. Maintain your hand position, and ask the
patient to inhale deeply. This makes the liver
border descend and moves the liver into a
palpable position.
6. While the client inhales , feel the liver border
against your hand . It should feel firm and
have regular contour.
7. If liver is enlarged ( palpable below the costal
margin measure the number of centimeters it
extends below the costal region.
Palpation of the bladder

palpation of the bladder. A

full bladder presents as a pelvis mass
which is typically, regular, smooth,
firm, and oval-shaped. It arises in the
midline. The lower border cannot be
felt.
 Palpation of the bladder
Palpation of the bladder
- Palpate the area above
the pubic symphysis .
 normally not palpable.
 deviations : distended and
palpable as a smooth round
tense mass ( indicates
urinary retention ).
 Thank you !!!
