Assessing the

abdomen





? Ýhe nurse locates and describes
abdominal findings using two common
method
• Subdividing the abdomen into quadrants
and regions
? Vn addition, practitioners often use
certain landmarks to locate abdominal
signs and symptoms
~ 
? Ask the client to urinate since as empty
bladder makes the assessment more
comfortable
? Ensure that the room is warm
6
~

? Examining light
? Ýape measure
? Water soluble skin marking pencil
? stethoscope
~
 

? Explain the procedure
? Observe appropriate infection control
procedure
? Provide client privacy
? Health history taking
? Assist in supine position
V ~



V ~



  
 

Àormal findings Deviation from normal

? ×nblemished skin; ? Presence of rash or

? ×niform color; other lesions;
? Silver-white striae ? Ýense, glistening
(stretch marks) or skin (may indicate
surgical scars ascites, edema)
? Purple striae
(associated with
Cushing¶s diseases)
Vnspect the abdomen for contour and symmetry.
? Observe the abdominal contour while standing
at the client¶s side when the client is supine.
? Ask the client to take a deep breath and to
hold it.
? Assess the symmetry of contour while
standing at the foot of the bed.
? Vf distention is present, measure the abdominal
girth by placing a tape around the abdomen at
the level of the umbilicus.
Àormal Findings Deviation from normal

? Flat, rounded ? Distended

(convex), or
scaphoid (concave)

? Evidence of
? Ào visible enlargement of
enlargement of spleen and liver
spleen and liver
? Symmetric contour
? Asymmetric contour
(localized
protrusion)
{


 

  



~ ~
     
~

Àormal findings Deviation from normal

? Symmetric ? Limited movement

movements caused due to pain or
by respiration; disease process;
? Visible peristalsis in ? Visible peristalsis in
very lean people; non lean-client
? Aortic pulsation in (bowel obstruction);
thin persons at ? Marked aortic
epigastric area pulsation
{


 
 ~

Àormal Findings Deviation from Àormal

? Ào visible vascular ? Visible venous

pattern pattern (dilated
veins) is associated
with liver disease,
ascites and
venocaval
obstruction













  
 


 
  


~

  


Àormal Findings Deviation from normal

? Audible bowel ? Absent, hypoactive,

sounds; or hyperactive bowel
? Absence of arterial sounds;
bruits; ? Loud bruit over
? Absence of friction aortic area (possible
rub aneurysm);
? Bruit over renal or
iliac arteries
’6V{ {
6{6
? Percuss several areas in each of the
four quadrants to determine presence of
tympany(gas in stomach and
instestines) and dullness .
? ×se a systematic pattern: Begin in the
lower left quadrant, then proceed to the
lower right quadrant, the upper right
quadrant, and the upper left quadrant.
Àormal findings Deviation from normal

? Ýympany over the ? Large dull areas

stomach and gas- (associated with
filled bowels; presence of fluid or
dullness specially tumor)
over the liver and
spleen, or a full
bladder
’


 




 


Àormal Finding Deviation from normal

? ^ to 12 cm in the ? Enlarged size

midclavicular line; 4
to 8 cm at the
midsternal line
’



 








 
 

ng.

? Systematically explore all four

quadrants.
Àormal findings Deviation from Àormal

? Ào tenderness; ? Ýenderness and

relaxed abdomen hypersensitivity;
with smooth, Superficial masses;
consistent tension Localized areas of
increased tension
’
 


~~ ~
 




Àormal findings Deviation from normal

? Ýenderness may be ? Generalized or

present near xiphoid localized areas of
process, over tenderness
cecum, and over ? Mobile or fixed
sigmoid colon masses
’ ~

 





  







Àormal Findings Deviation from Àormal

? May not be palpable ? Enlarged

? Border feels smooth ? Smooth but tender
’ ~


 

~

~  
 
   


~ 

 



Àormal findings Deviation from normal

? Àot palpable ? Distended and

palpable as smooth,
round, tense mass

 








  ~~

 
Àormal Deviation from À
? Client perceives sharp,
? Ào rebound stabbing pain as the
tenderness is present examiner releases
pressure from the
abdomen ( Blomberg¶s
sign). Vt suggest peritoneal
irritation.
? Referred rebound
tenderness- pain in the
RLQ during pressure in the
LLQ is a positive Rovsing¶s
sign.
? Cholecystitis- assess R×Q pain or
tenderness which may signal
inflammation of the gallbladder. Press
your finger tips under the liver border at
the right costal margin and ask the client
to inhale deeply.
 Àormal Deviation from Àormal
? Ào increase in pain ? Accentuated sharp
is present pain that causes the
client to hold his or
her breath
(inspiration arrest) is
a positive sign called
Murphy¶s sign and is
associated with
acute cholecystitis.