Created by: Nicole Anderson MN, NP
Presented by: Jennifer Burgess RN, GNC(C)
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Overview of anatomy
Abdominal assessment technique
Interpretation of findings
Constipation, fecal impaction, and
bowel obstruction
5. When to report findings
1. Abdominal quadrants
2. Landmarks/surface anatomy
3. Abdominal muscles
4. Abdominal vasculature
5. Internal organs
•Dividing the abdomen into 4
quadrants will aid during assessment
and will allow for appropriate
documentation of findings.
•Understanding which organs are
relevant to each quadrant will help
you to determine etiology of
signs/symptoms found during
assessment.
Understanding landmarks and
surface anatomy will enhance
your documentation skills and
will allow for more efficient
reporting of symptoms.
•Function to support abdominal cavity
and protect organs
•Weakness in these muscles may lead
to hernias, inability to cough
effectively, increased risk of falls,
abdominal distension, postural
problems, and back pain.
Liver: bile production, controls levels of
fats/amino acids/proteins in the blood,
immune function, detoxification,
metabolizes drugs, blood clotting, store
sugars, etc.
Gallbladder: aids in fat digestion and
concentrates/stores bile produced by the
liver.
Pancreas: produces digestive enzymes,
secretes insulin/glucagon/somatostatin to
control blood sugar levels
Spleen: stores and produces lymphocytes
Small intestine: digestion and
absorption of nutrients, approximately
21 feet long.
Large intestine: absorption of water,
lubrication of contents, neutralization
of acids, decomposition by live
bacteria, approximately 4.5-5 feet long
and 2.5 inches in diameter.
RUQ: liver, gallbladder, duodenum,
hepatic flexure of colon, head of
pancreas, right kidney/ureter, part of
ascending and transverse colon
RLQ: cecum, appendix, small intestine,
right ureter, right ovary/fallopian tube,
right spermatic cord
LUQ: stomach, spleen, splenic
flexure of colon, tail of pancreas, left
kidney/ureter, part of transverse and
descending colon
LLQ: sigmoid colon, small intestine,
part of descending colon, left
ovary/fallopian tube, left spermatic
cord
1. Resident should be calm and
supine
2. Bring a stethoscope
3. An understanding of health history
or reported symptoms is useful
4. Obtain relevant history from
resident
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Inspection
Auscultation
Percussion
Palpation
1. Observe resident’s abdomen from
foot of bed for peristalsis,
asymmetry, and abdominal
distension
2. Observe umbilicus for deviation
3. Assess skin of abdomen
4. Measure abdominal girth if relevant
1. Start in RLQ and listen to each
quadrant for 2-5 minutes for bowel
sounds
2. Normal sounds are high-pitched and
gurgling in small intestine and lowpitched and rumbling in the colon
3. Normally occur at a rate of 5-35/min
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Percuss all quadrants for dullness
Percuss for tympany
Percuss for hyperresonance
Percuss for bladder volume
1. With warm hands lightly palpate all
4 quadrants- palpate any area of
pain last
2. Use pads of fingers depressing
abdomen 1cm
3. Moderate palpation may be done to
assess musculature and deeper
structure
Asymmetry: enlarge spleen or liver
Distension: fat, flatus, stool, fluid, tumor
Bruising at umbilicus: acute necrotizing
pancreatitis
Flank bruising: intra-abdominal or
retroperitoneal hemorrhage, or injury
to pancreas
Periumbilical and flank ecchymosis
Very loud bowel sounds:
hyperperistalsis caused by diarrhea
or early intestinal obstruction.
High-pitched tinkles and rushes: bowel
obstruction
Absence or decreased: paralytic ileus,
peritonitis, or acute abdomen
Dullness: normal over liver and spleen, but
abnormal in mid abdomen and may be
due to organ distension or mass
Pain: inflammation
Tympany: high-pitched tympany suggests
distension
Hyperresonance: normal at umbilicus, but
anywhere else suggests distended
vasculature or aneurysms
Crepitus: subcutaneous emphysema
suggests abscess, diverticulitis, or
organ perforation.
Pain: many causes such as peritonitis,
inflammation, abscess
Mass/Ridge: depending on the area,
could mean tumor, aneurysm,
abscess.
Infrequent or difficult passage of
stool, hard stool, or a feeling of
incomplete evacuation
•Difficulty passing stool
•Hardened stool
•Complaints of rectal fullness
•Self disimpaction
•hemorrhoids
•Symptoms are often un-noticed in the
older adult and frequency of stools
may not change
•Distended tympanic abdomen
•Vomiting
•Blood in stool
•Weight loss
•Severe constipation of recent
onset/worsening in older adults
A large lump of hard dry stool that
remains stuck in the rectum, often due
to chronic constipation
•Abdominal cramping and bloating
•Leakage of liquid from rectum or
diarrhea in a resident with chronic
constipation
•Rectal bleeding
•Small, semi-formed stools
•Difficulty passing stool and/or
straining
•Nausea and vomiting
•Tachypnea
•Tachycardia
•Abdominal distension with tympanic,
absent and/or high-pitched bowel
sounds
Significant mechanical impairment for
complete blockage of contents through
the intestine. Mechanical obstruction
can effect either the small or large
intestine.
Small bowel obstruction:
•Cramping around umbilicus or
epigastrium
•Vomiting
•Obstipation
•Hyperactive, high-pitched bowel
sounds with rushes
•Diarrhea in partial obstruction
Large bowel obstruction:
•More gradual onset of symptoms
•Increasing constipation leading to
obstipation and abdominal distension
•Lower abdominal cramping
unproductive of feces
•Loud, hyperactive bowel sounds
•Symptoms are mild
•Severe steady pain
•Tender with light palpation
•Absent bowel sounds
•Shock (tachycardia, low BP)
•Oliguria
•Fever/chills, or abnormal vital signs
•Rectal bleeding
•Older adults
•Presence of red flags
•Any abnormal finding on abdominal
exam
•Suspected intestinal obstruction
•Change in bowel patterns, stool
consistency, stool colour
•Change in nutritional status
•Suspected constipation or fecal
impaction
•Acute abdominal pain