Abdomen Assessment
D. Tanner, RN, MSN
NUR 211
Fall Semester
Anatomy of the Abdomen
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4 Quadrants RUQ, RLQ, LUQ,
LLQ
Midline
9 Regions- epigastric,
umbilical, suprapubic
The word "abdomen" has a
curious story behind it. It
comes from the Latin
"abdodere", to hide. The idea
was that whatever was eaten
was hidden in the abdomen.
4 Quadrants
9 Regions
Location! Location! Location!
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RUQ
liver
gallbladder
duodenum (small
intestine)
pancreas head
right kidney and adrenal
Location! Location! Location!
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RLQ
cecum
appendix
right ovary and tube
Location! Location! Location!
LLQ
sigmoid colon
left ovary and tube
LUQ
stomach
spleen
pancreas
left kidney and adrenal
GI Variations Due to Age
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Aging- should not affect
GI function unless
associated with a disease
process
Decreased: salivation,
sense of taste, gastric
acid secretion,
esophageal emptying,
liver size, bacterial flora
Increased: constipation!
GI Variations with pregnancy
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Decrease in gastric
motility
High incidence of N, V
(r/t pregnancy hormones)
and “heartburn” or acid
reflux
Bowel sounds diminished
r/t enlarged uterus
displacing intestines
Linea nigra- increased
pigmentation of abd
midline
Striae Gravidarum
Nursing History - Abdomen
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Subjective Data:
Ask about:
Appetite
Wt gain or loss
Dysphagia
Intolerance to certain
foods
Any Abdominal Pain of
Nausea and Vomiting
Bowel movements
Any past abdominal
problems
Nursing History
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Infants and Children –
Ask: bottle or breast fed, any table foods,
how often & how well & how much the
baby eat, any problems with constipation,
c/o of any abdominal pain
TeenagersAsk: nutritional assessment, activity &
exercise patterns, recent wt. loss or gain
Nursing History
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Older Adults
Ask: how do you get your groceries?
prepare your meals?
do you have any trouble swallowing?
how often do your bowels move?
how often do you take anything for
constipation? Rx / OTC/ herbs
what meds do you take?
Nursing Assessment
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Objective Data:
General Observation
Inspect
Auscultate
Percuss
Palpate (always last)
Focused Health History
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Nutrition
Allergies
Medications
Cigarette/tobacco
ETOH intake
Recreational drug use
Stool characteristics
Urine characteristics
Exposure to infectious dz.
Recent stressful life
events
Possibility of Pregnancy
Techniques for Exam
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Provide privacy
Good lighting/appropriate temp in rm
Expose the abdomen
Empty bladder
Position pt supine, arms by side & head on
pillow with knees slightly bent or on a pillow
Warm stethoscope & hands
Painful areas last
Distraction techniques
Inspection
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Overall observation
Abd contour- flat,
scaphoid, round,
protuberant
Abd symmetry and skin
color - note any masses,
striae, scars, veins,
pigmentation
Pulsations
Auscultation
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Always done before
percussion &
palpation
Use diaphragm of
stethoscope
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Listen lightly
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Start with RLQ
Auscultation
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What makes a bowel sound?
Note character & frequency of bowel sounds (530 times/minute)
Sounds like…..
Listen for 5 minutes before documenting absent
bowel sounds
Listen for bruits- aortic, renal, iliac, femoral
Hyper- gastroenteritis, obstruction, hungry
Hypo- pregnancy, peritonitis
Percussion
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Gently tapping on the skin to create a
vibration
Detect fluid, gaseous distention and
masses
Tympany- gas (dominant sound because
of air in sm intestine)
Dullness- solid masses, distended bladder
Percuss liver, spleen ,kidneys
Palpation of Abdomen
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Light palpation- depress about 1 cm. Assess skin
pulsations. Always done first- clockwise
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Deep palpation- depress skin about 5-8 cm.
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Always assess tender areas last.
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Watch pt’s expression during palpation
Inspection Abnormal Findings
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Visible or distended veins- ascites
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Visible peristalsis- obstruction
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Spider nevi (cutaneous angiomas)- cirrhosis
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Asymmetry/ Distention- mass or intestinal
obsruction
Color changes- jaundice, bluish/cyanotic
Abnormal Auscultation
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Absence/Hyperactive bowel sounds“borborygmi”
Bruits- “swoosh”
Peritoneal Friction Rub- rough, grating heard
over liver & spleen- inflammation of peritoneal
surface from tumor, infection, etc.
Percussion Abnormal Findings
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Enlarged organs, palpable masses,
distention, ascites
Marked tenderness
Palpation Abnormal Findings
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Tenderness- rebound- done away from painful
area- done at end of exam
Masses- document location, size, shape, mobile,
pulsating, smooth, nodular, firm
Firmness or muscle guarding/rigidityintraabdominal bleeding- DO NOT CONTINUE TO
PALPATE!!!!!!
Special Procedures
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Fluid Wave- need 3 hands- feel for impulse of
the wave of fluid across the abdomen= ascites
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Rebound Tenderness- Blumberg’s Sign
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Iliopsoas Muscle Test- thigh muscle lift R leg and
push down on R thigh= appendicitis
Obturator Test- lift R leg and rotate at 90
degrees= muscle is irritated by appendicitis
Murphy’s Sign- “inspiratory arrest” palpate the
liver should be painless= cholecystitis
Special Procedures
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McBurney’s Point- RLQ midclavicular=
appendicitis
Referred pain- location of pain is not necessarily
where the involved organ is! May be felt where
the organ was located in fetal development ex:
spleen= L shoulder pain/ kidney= groin pain
Hooking technique- palpate the liver- feeling for
the liver edge
Special Procedures
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Cullen’s Sign- bluish discoloration around
the umbilicus EMERGENCY!!!
Kehr’s Sign- abd pain radiating to R
shoulder= spleen or pancreatitis
Sample Documentation
Normal ExamAbdomen soft, rounded and symmetric without
distention; no lesions or scars, or visible
peristalsis. Aorta midline without bruit or visible
pulsation; umbilicus inverted and midline
without herniation; bowel sounds present in all 4
quadrants. Liver, kidney and spleen nonpalpable; no tenderness on palpation. Reports
good appetite; no constipation, nausea or
diarrhea. Voiding well and denies laxative use.
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