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Abdominal Assessment
INTERNAL organs; patient position
Exam 2
Abdominal Assessment
Health Assessment
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DEEPER organs
Exam 2
Abdominal Assessment
Health Assessment
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RETORPERIOTENEAL behind other organs
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Left Upper Quadrant
Stomach
Spleen
Left lobe of liver
Body of pancreas
Left kidney & adrenal gland
Splenic fixture of the colon
Part of the transverse & descending colon
Left Lower Quadrant
Part of the descending colon
Left ureter
Left ovary & fallopian tube ♀
Left spermatic cord ♂
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Appetite how often? What do you eat? Any food that bothers you?
Dysphagia difficulty swallowing; trouble ↄ vocal chords
Food intolerance celiac disease
Abdominal pain show where? Does it radiate?
N/V
Bowel habits & use of laxatives
Past abdominal hx
Current medications
o Stool softeners: vitamins, fat
o Morphine slows ↓ peristalsis
Exam 2
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Right Upper Quadrant
Liver
Gallbladder
Duodenum
Head of the pancreas
Right kidney & adrenal gland
Hepatic flexure of the colon
Part of the ascending & transverse colon
Right Lower Quadrant
Cecum
Appendix
Right ureter
Right ovary & fallopian tube ♀
Right spermatic cord ♂
Midline
Aorta
Bladder if distended  below symphysis pubis
Uterus if enlarged ♀
Subjective Data
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Abdominal Assessment
Nutrition
Objective Data
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Make sure pt’s abdominal wall is relaxed
Bladder is empty
Provide privacy
First  inspection
o Note contour and symmetry
o Shape of the umbilicus out or in? centered?
o Condition of the skin taut?
o Look for pulsations or movement aorta movt?
Health Assessment
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Hair growth patterns
Auscultate the abdomen
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Done before percussion & palpation bc it can ↑ peristalsis
& misinterpretation of bowel sounds
Normal sounds can occur 5-30 times per minute
Can listen up to 5 minutes before deciding bowel sounds
are completely absent
Auscultate for vascular sounds or bruits
Most won’t hear sounds unless problematic
Exam 2
Abdominal Assessment
Health Assessment
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Percuss
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Percuss to assess relative density of abdominal contents
Air in intestines  tympany is the predominant sound
Dullness heard over a distended bladder, adipose tissue,
fluid, or mass
o Percuss to determine the borders of the liver and
spleen
o in suspected ascites -> use percussion to test for
fluid wave
Percussion Order for Abdomen
Measure Liver Border
Exam 2
Abdominal Assessment
Health Assessment
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Palpate the Abdomen
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judge size, location, and consistency of organs and to
screen for abdominal mass or tenderness
begin with light palpation, note guarding
next, deep palpation – push ↓ 5-8 cm if mass detected,
note location, size, shape, consistency, surface (close to?),
mobility (usually benign; immobile  malignant), pulsatility (abdominal
aneurysm), tenderness
Exam 2
Abdominal Assessment
Health Assessment
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Exam 2
Palpate liver in RUQ
Palpate spleen in LUQ
Kidneys in both flanks
Aorta just left of the midline
can also check for rebound tenderness
o no pain when push ↓
o pain when move hand quickly
can do iliopsoas muscle test
o inflamed muscle occurs ↄ inflamed/perforated
appendix
Abdominal Assessment
Palpate spleen: reach hand under R-side
Health Assessment
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Kidney under back
Aortic pulsation below ribs joining
Exam 2
Abdominal Assessment
Health Assessment
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Rebound Tenderness
Referred Pain
Exam 2
Abdominal Assessment
Health Assessment
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Charting
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SUBJECTIVE
o States appetite is good with no recent change, no dysphagia, no food intolerance, no pain, no
nausea/vomiting. Has one formed BM/day. Takes vitamins, no other prescribed or over-thecounter medication. No history of abdominal disease, injury, or surgery. Diet recall of last 24
hours listed at end of history.
OBJECTIVE
o Inspection—abdomen flat, symmetric with no apparent masses. Skin smooth with no striae,
scars, or lesions.
o Ausculation—bowel sounds present, no bruits.
o Percussion—tympany predominates in all four quadrants, liver span is 8 cm in right
midclavicular line. Splenic dullness located at 10 th intercostal space in left midaxillary line.
o Palpation—abdomen soft, no organomegaly, no masses, no tenderness
ASSESSMENT
o Healthy abdomen, bowel sounds present.
Abnormal Findings: Abdominal Distention
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Obesity
Air or gas
Ascites fluid
Ovarian cyst
Pregnancy
Feces retained; not having BM
Tumor
Abnormal Findings on Inspection
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Umblilical hernia
Epigastric hernia
Diastasis recti
Abnormal bowel sounds
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Hypoactive bowel sounds
Hyperactive sounds
Abnormal on Palpation
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Enlarged liver
Enlarged nodular liver
Enlarged gallbladder
Enlarged spleen
Enlarged kidney
Aortic aneurysm
Exam 2
Abdominal Assessment
Health Assessment
11
This section discusses key points about the structure and function of the abdomen.
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The abdomen is a large oval cavity extending from the diaphragm down to the brim of the pelvis. It is bordered in back by the vertebral column and
paravertebral muscles and at the sides and front by the lower rib cage and abdominal muscles.
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For convenience in description, the abdominal wall is divided into four quadrants by vertical and horizontal lines that cross at the umbilicus.
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The left upper quadrant contains:
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The right upper quadrant of the abdomen contains:
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The stomach,
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The liver
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The spleen,
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The gallbladder,
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The left lobe of the liver,
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The duodenum,
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The body of the pancreas,
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The head of the pancreas,
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The left kidney and adrenal gland,
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The right kidney and adrenal gland,
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The splenic flexure of the colon,
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The hepatic flexure of the colon,
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And part of the transverse and descending colon.
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And part of the ascending and transverse colon.
The left lower quadrant contains:
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The right lower quadrant of the abdomen contains:
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A part of the descending colon,
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The cecum,
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The sigmoid colon,
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The appendix,
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The left ureter,
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The right ureter,
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And the left ovary and fallopian tube (in women), or the left
spermatic cord (in men).
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And the right ovary and fallopian tube (in women), or the
right spermatic cord (in men).
Additional structures lie in the midline of the abdomen, including:
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The aorta,
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The bladder (if distended),
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And the uterus (if enlarged in women).
This section presents critical points about subjective and objective assessments of the abdomen.
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To obtain subjective data, ask questions that investigate:
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Appetite,
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Dysphagia (or difficulty swallowing),
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Food intolerances,
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Abdominal pain,
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Nausea and vomiting,
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Bowel habits and the use of laxatives,
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Past abdominal history,
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Any current medications,
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And nutrition.
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To obtain objective data, make sure that the patient’s abdominal wall is relaxed and that his or her bladder is empty. Then use the proper sequence to
examine the abdomen.
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First, inspect the abdomen.
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Note its contour and symmetry, the shape of the umbilicus, and the condition of the skin.
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Look for any pulsations or movement.
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Observe the pattern of pubic hair growth and the patient’s demeanor.
Next, auscultate the abdomen. Do this before percussion and palpation because they can increase peristalsis, which may cause misinterpretation of
bowel sounds.
Exam 2
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Note the character and frequency of bowel sounds. Normal bowel sounds can occur 5 to 30 times per minute, but listen for up to 5 minutes
before deciding that bowel sounds are completely absent.
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Also, auscultate to detect any vascular sounds or bruits.
Abdominal Assessment
Health Assessment
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Percuss the abdomen to assess the relative density of its contents. Because of air in the intestines, tympany is the predominant sound. Dullness may be
heard over a distended bladder, adipose tissue, fluid, or a mass.
o
Percuss to determine the borders of the liver and spleen.
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Use indirect first percussion to assess for costovertebral angle tenderness.
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If you suspect ascites, use percussion to test for a fluid wave and for shifting dullness.
Finally, palpate the abdomen to judge the size, location, and consistency of certain organs and to screen for an abnormal mass or tenderness.
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Begin with light palpation to form an overall impression of the skin surface and superficial musculature. Note any guarding.
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Next, perform deep palpation, pushing down about 5 to 8 centimeters. If you detect a mass, note its location, size, shape, consistency, surface,
mobility, pulsatility, and tenderness.
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Then palpate for the liver in the right upper quadrant, the spleen in the left upper quadrant, the kidneys in both flanks, and the aorta just left of
midline.
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If needed, perform special procedures. For example, assess for rebound tenderness or inspiratory arrest, or perform the iliopsoas muscle test.
When assessing the abdomen, incorporate health promotion. Discuss measures that promote a healthy liver and behaviors that increase the risk of
hepatitis. Explain that the three leading causes of hepatitis are hepatitis A, hepatitis B, and hepatitis C infections, and that vaccinations are available
for hepatitis A and hepatitis B.
1. Ascites is defined as:
C.
A.
a bowel obstruction.
A bowel obstruction may result in abdominal distention.
B.
congenital narrowing of the pyloric
sphincter.
Pyloric stenosis is a congenital defect causing a
narrowing of the pyloric sphincter.
a proximal loop of the large intestine.
D.
abnormal opening in the pyloric sphincter.
The proximal loop of the large intestine is the ascending
colon.
3.
C.
Moles on the abdomen:
an abnormal enlargement of the spleen.
A.
Splenomegaly is the term to describe an enlarged
spleen.
D.
are common.
Pigmented nevi (moles) are common on the
abdomen. Nevi are circumscribed brown macular
or popular areas.
an abnormal accumulation of serous fluid
within the peritoneal cavity.
B.
are uncommon.
C.
require a biopsy.
Ascites is free fluid in the peritoneal cavity.
2.
Pyloric stenosis is a(n):
A.
abnormal enlargement of the pyloric
sphincter.
B.
inflammation of the pyloric sphincter.
Incorrect
Nevi should be observed for unusual color or
change in shape; a biopsy or removal is indicated if
nevi changes, which indicates a possible
malignancy.
D.
Exam 2
Abdominal Assessment
are no cause for concern.
Health Assessment
13
The viscera are all the internal organs inside the
abdominal cavity.
4.
The organ in the right upper quadrant of the abdomen is
the:
6.
A.
spleen.
Pyrosis is:
A.
The spleen is in the left upper quadrant.
B.
an inflammation of the peritoneum.
Peritonitis is an inflammation of the peritoneum.
liver.
B.
a burning sensation in the upper abdomen.
Correct
The liver is in the right upper quadrant of the
abdomen.
C.
Pyrosis (heartburn) is a burning sensation in the
esophagus and stomach from reflux of gastric acid.
cecum.
C.
The cecum is in the right lower quadrant.
D.
Pyloric stenosis is a congenital narrowing of the
pyloric sphincter.
sigmoid colon.
The sigmoid colon is in the left lower quadrant.
5.
D.
The four layers of large, flat abdominal muscles form
linea alba.
7.
These muscles are joined at the midline by a
tendinous seam, the linea alba.
B.
rectus abdominus.
The abdomen normally moves when breathing until the
age of ____ years.
A.
4
B.
7
Abdominal breathing in children continues until the
age of 7 years.
One set of abdominal muscles, the rectus
abdominis, forms a strip extending the length of the
midline.
C.
C.
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D.
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ventral abdominal wall.
The four layers of large, flat muscles form the
ventral abdominal wall.
8.
D.
Older adults have:
viscera.
A.
Exam 2
an abnormally sunken abdominal wall.
A scaphoid abdomen abnormally caves in or is
sunken.
the:
A.
a congenital narrowing of the pyloric
sphincter.
Abdominal Assessment
decreased salivation leading to dry mouth.
Health Assessment
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Aging results in decreased salivation leading to dry
mouth.
B.
increased gastric acid secretion.
Aging results in decreased gastric acid secretion.
Anorexia is a loss of appetite and occurs with
gastrointestinal disease, as side effect of some
medications, with pregnancy, or with psychological
disorders.
10.
Methods to enhance abdominal wall relaxation during
examination include:
A.
C.
increased liver size.
Keep the room warm to avoid chilling and tensing
of muscles.
Aging results in decreased liver size.
D.
decreased incidence of gallstones.
B.
The symptoms occurring with lactose intolerance
include:
A.
B.
gray stools.
Gray stools may occur with hepatitis.
C.
hematemesis.
Hematemesis occurs with stomach or duodenal
ulcers and esophageal varices.
D.
Exam 2
Avoid having arms above the head; this increases
abdominal wall tension.
C.
bloating and flatulence.
Lactose intolerance will produce abdominal pain,
bloating, and flatulence when milk products are
consumed.
anorexia.
Abdominal Assessment
having the patient place arms above the
head.
Aging results in increased incidence of gallstone
formation.
9.
a cool environment.
examining painful areas first.
Painful areas should be examined last to avoid
muscle guarding.
D.
positioning the patient with the knees bent.
Position the person supine, with the head on a
pillow, the knees bent or on a pillow, and arms at
the side.
1. The spleen is located in
a. LUQ
2. The appendix is located in the
a. RLQ
3. Auscultation of the bowel sounds starts in which
quadrant?
a. RLQ
4. A bladder filled with urine may be palpated in the
abdomen:
a. Midline above the symphysis pubis
5. Which structure is located in the LLQ of the abdomen?
a. Sigmoid colon
Health Assessment