1 Abdominal Assessment
1.
Take the appropriate history
a. Hx of present illness (NOPQRST)
i. Abdo pain, Anorexia, indigestion, dysphagia, nausea, vomiting, hematemesis, fever, chills, jaundice,
pruritus, diarrhea, constipation, flatulence, bleeding, hemorrhoids, melena, change in appetite, weigh gain
or loss, mouth lesions, fecal incontinence, change in abdo girth
Inspection (stand at right side look down; stoop and gaze; go to foot of bed and check symmetry)
Demeanour
Contour
Symmetry
Rectus Abdominis Muscles
Pigmentation and Color
Scars/Striae
Masses/Nodules
Pulsations
Umbilicus
**drains/tubes***
Relaxed, restless (gastroenteritis, bowel obstruction); absolute stillness (peritonitis)
Flat, round, scaphoid, protuberant
Symmetrical Bilat (Asymmetry = cysts, bowel obs. Hernia)
Ø ridges noted
Uniform in colour and pigmentation
Ø none should be noted; possible underlying adhesion; rapid wt loss/gain
Ø none should be noted
Nonexaggerated pulsations of the abdominal aorta may be visible in the epigastric area from aorta,
respirations, peristalsis
Visible peristalsis = pyloric stenosis (contents forcing through GI tract)
Midline and inverted, everted with pregnancy/edema
Cullen Sign = bluish discoloration around umbilicus – sign of intraabdominal bleeding
Tubes  Enteral Tubes, Nasogastric sxn tubes, Gastrostomy
Drains  JP drain, Biliary Drain,
Diversions  Colostomy/Ileostomy, Ileal Conduit, Urethral Stent, Indwelling Catheter
Auscultation
Bowel Sounds (4 quadrants)
start RLQ
Vascular Sounds
Abdo aorta (above umbilicus)
Renal artery (2cm above, midclavicular)
Iliac ( 2cm below, midclavisular)
Femoral (just inside iliac crest)
Venus Hum (all 4Q)
Friction Rub (Rt & Lt costal margin)
RLQ = ileocecal valve; should have BS; Intermittent gurgling (high-pitched),
↑BS = hunger, early obstruction
↓BS = inflammation of peritoneum, paralytic ileus, peritonitis, late bowel obstruction or
post-sx
Absent – very serious, not good! (listen for 5min first)
With bell, Ø audible bruits, may indicate stenosis
Systolic Bruit = occlusion/stenosis (pulsation in epigastric area)
May indicate obstruction to portal circulation
May indicate inflammation of spleen or Liver
Percussion
General Percussion
Liver Span
Spleen
Costovertebral
Angle Tenderness
Resonant = clear, hallow (lung tissues)
Hyperresonant – lower, booming ↑air; (emphysema)
Tympany = air filled (stomach, intestines)
Dullness = Fullness, dense organ (liver, bladder)
Flat = soft, dead sound (bone, thigh muscles)
Along Rt Midclavicular line (up/down)
Start in lung space (5th ICS) and move down until dullness  abdo tympany &
move up to dullness (costal margin)
Normal = 8cm
Start Lt midaxillary line downward (9-10th ICS) <7cm
Normal = tympany (even w/ deep breath)
On pt back, place one hand over 12th rib @ costal angle
Thump your hand w/ other fist; Pain = kidney inflammation
Sylwia Bartosik, RN
Jarvis, C., Browne, A., MacDonald-Jenkins, J. & Luctkar-Flud, M. (2008). Physical examination and health assessment (1st Canadian ed.). Philadelphia, Saunders.
2 Abdominal Assessment
Palpation
Light Palpation
Rebound tenderness
(Blumberg’s Sign)
Iliopsoas Muscle Test
Obturator Test
Only 1cm down with fingertips; Soft, Ø tenderness, Ø masses, rigidity; note voluntary
guarding vs involuntary (constant, boardlike hardness, protective with acute
inflammation)
Press deep, slow @ area away from painful area, lift up quickly; structures indented,
rebound quickly; normal = no pain on release
Pain w/ release = peritoneal inflammation
Raise pt. RIGHT leg & apply pressure ↓
RLQ pain = inflamed appendix (irritation of iliopsoas muscle)
Raise pt RIGHT leg, flex hip & knee, rotate leg inward
RLQ pain = appendicitis (irritation of obturator muscle)
Danger Signs  Do not attempt further assessment if:
 Cullen’s sign, Vascular bruits; silent abdomen; visible peristalsis; pulsations (marked in aortic area)
Sylwia Bartosik, RN
Jarvis, C., Browne, A., MacDonald-Jenkins, J. & Luctkar-Flud, M. (2008). Physical examination and health assessment (1st Canadian ed.). Philadelphia, Saunders.