PROCEDURE NORMAL FINDINGS ABNORMAL FINDINGS

INSPECTION
1. Observe skin Skin is paler than the other parts due to Grey Turner sign – purple
coloration unexposed situationsmax discoloration of the flanks

Yellow hue of jaundice is seen

Pale, taut skin may be seen with

ascites

Redness indicate inflammation

Bruises are also seen

2. Note the vascularity Scattered fines veins are seen and dilated Dilated veins indicate cirrhosis of the
of the abdominal skin superficial capillaries of older adults are visible liver, obstruction of inferior vena cava,
under the sunlight ascites and portal hypertension

Spider angioma which is dilated veins

with a central star
3. Note any striae Old, silvery, white stretch marks can be seen Dark bluish-pink is common in
Cushing’s syndrome

Also caused by ascites that stretches

the skin
4. Inspect for scars Pale, smooth minimally raised old scars Nonhealing, redness and
Ask about the scar, its inflammation. Thus, deep scars
source, characteristics and maybe result from burns
measure it and locate to
which quadrant it is located Keloids – excess scar tissue that
resulted from trauma or surgery and
most common in African American
and Asian
5. Assess for lesions No lesions and rashes but flat or raised moles Petechiae – reddish or purple lesions
and rashes are apparent or normal
Changes in mole size, shape and
symmetry
6. Inspect umbilicus Normally the colour is similar to abdominal Cullen’s sign – bluish or purple
skin or even pinkish discoloration of the umbilicus that
indicates intra-abdominal bleeding
7. Observe umbilical Midline and at lateral line Deviated umbilicus is a result of
location pressure from a mass, enlarged
organ, hernia, fluid or scar tissue
8. Assess contour of Inverted no more than 0.5 cm and is round Enlarged everted umbilicus can be
umbilicus and conical seen with distention or hernia
 9. Inspect abdominal Abdomen is flat, rounded, or scaphoid. Evenly Distended abdomen maybe causes of
contour rounded obesity or air or fluid accumulation
Look at the abdomen of the
patient from the side and Causes is the 6F’s (fat, feces, fetus,
measure the abdominal girth fibroids, flatulence and fluid)

Scaphoid – sunken abdomen that

indicate severe weight loss related to
hunger

10. Assess abdominal It is symmetric Asymmetry may be seen with organ

symmetry enlargement, large masses, hernia,
diastasis recti, or bowel obstruction.

To further assess, ask the Abdomen does not bulge when the head is Hernia – protrusion of bowel through
client to raise the head raised abdominal wall

Diastasis recti – bulging between a

vertical midline separation of the
abdominal rectus muscle

Incisional hernia – occurs when a

defect develops in the abdominal
muscle due to surgical incision
11. Inspect abdominal Movements are seen especially in male clients Peritoneal irritation - diminished
movement when the abdominal respiration or change to
client breathes. thoracic breathing in male clients
12. Observe aortic In thin people, slight pulsation of the Vigorous, wide, exaggerated
pulsations abdominal aorta extends in full length pulsation may be seen with
abdominal aortic aneurysm
13. Observe peristaltic Not seen but can be visible to thin people with Waves are increases and progress in
waves slight ripples on the abdominal wall a ripple like fashion from the LUQ to
RLQ with intestinal obstruction

AUSCULTATION
14. Auscultate for bowel Soft clicks and gurgles are heard at a rate of 5 Hypoactive bowel sounds indicate
sounds to 30 per minute. Hyperactive bowel sounds less bowel motility and caused by
Warm the diaphragm of the are loud, prolonged gurgles and are called abdominal surgery or late bowel
stethoscope before using it borborygmi obstruction whereas hyperactive
on the patient indicate increased motility and caused
by diarrhea, gastritis or early bowel
Apply light pressure on a obstruction
tender abdomen starting on
the RLQ and cover all Absent bowel sounds may be
associated with peritonitis or paralytic
Listen for 5 minutes being 1 ileus
min every quadrant to
confirm absence of bowel Increasing pitch of bowel indicate
sounds intestinal distention
Note intensity and pitch and
frequency of the sound
15. Auscultate for Bruits are not heard but when heard in Arterial stenosis – both systolic and
vascular sounds systoles in some clients, maybe normal diastolic bruits occurs when blood
Use bell of stethoscope and flow in an artery is clogged
listen for bruits over
abdominal aorta, renal, iliac
and femoral arteries Not normally heard
Accentuated venous hum heard
Also listen for venous hum in suggests increases collateral
the epigastric and umbilical circulation between portal and
areas systemic venous systems
16. Auscultate for friction No friction rub is present High pitched, rough, grating sound is
rub over the liver and heard when rubbed on the
spleen peritoneum
Listen over the right and left
lower rib cage with When heard over the lower right
diaphragm of stethoscope costal area, metastases is present

When heard on the AAL in the lower

left costal area, associated with
tumor, splenic infarction, infection
PERCUSSION
17. Percuss for tone Generalized tympany dominates the abdomen Hyperresonance is heard over
Lightly percuss all quadrants gaseous distended abdomen
Normal dullness is hear over the liver and
spleen or over a nonevacuated descending Enlarged dullness in enlarged liver or
colon spleen

Abnormal dullness heard in bladder,

large masses or ascites
18. Percuss the span or
height of the liver by
determining its lower
and upper borders. The lower border of liver dullness is located at Difficult to estimate when obscured by
To assess lower border, the costal margin from 1 to 2 cm below and 1 intestinal gas
begin at the RLQ at MCL and to 4 cm in deep inspiration
percuss upward. Note the
change from tympany to
dullness and mark the point The upper border of liver dullness is located
of liver dullness between the 5th and 7th intercostal spaces. Difficult to estimate if obscured by
pleural fluid of lung consolidation
To assess upper border,
percuss over the upper right
chest at the MCL and
percuss downward, noting
from lung resonance to liver
dullness Normal span at MCL is 6 to 12 cm but
decreases after age 50
To assess liver descent, let Hepatomegaly – enlargement of the
the client breathe deep and liver
hold then percuss and
remind client after to exhale Atrophy – decreased span

Measure the distance

between the two marks: this
is the span of the liver
19. Repeat percussion of Liver span of MSL is 4 to 8 cm and scratching Hepatomegaly – liver span that
liver at MSL becomes more intense in the liver exceeds normal limits is characteristic
If cannot percuss, use of liver tumors, cirrhosis, etc.
scratch test where you
auscultate in the RLQ then
over the abdomen upward
the liver
20. Percuss the spleen Oval area of dullness approximately 7 cm Splenomelgay – enlargement of the
Begin posterior to the left wide near the left 10th rib and slightly posterior spleen and caused by traumatic injury
MAL, and percuss to MAL and normal tympany is heard or mononucleosis
downward, noting change
from lung resonance to On inspiration, enlarged spleen
splenic dullness indicate dullness at the last left
interspace at the AAL
Second method is while the
client takes a deep breath,
percuss at the last left
interspace at the AAL
21. Perform blunt No tenderness elicited If there is, due to inflammation or
percussion on the infection such as hepatitis or
liver and the kidneys cholecystitis
Assess tenderness by
percussing the liver by
placing left hand to lower
right anterior rib cage and the
ulnar side of right fist to strike
the left hand Pyelonephritis – tenderness and
kidney infection in the CVA
Perform also this in the
kidneys at the costovertebral
angles over the 12th rib
PALPATION
22. Perform light Nontender and soft. No guarding (no rigidity of Abdomen is rigid and rectus muscle
palpation abdominal muscles) fail to relax with palpation when client
Use fingertips and begin at a exhales
nontender quadrant and
compress to 1 cm in dipping Peritoneal irritation resulted by
motion. Lift fingers then do involuntary reflex guarding
the next areas
Cholecystitis – enlargement of the
gallbladder and has right side
guarding
23. Deeply palpate all Mild tenderness is possible over the xiphoid, Severe tenderness or pain may be
quadrants to aorta, cecum, sigmoid colon, and ovaries with related to trauma, peritonitis, infection,
 delineate abdominal deep palpation. tumors
organs and detect
subtle masses.
Using palmar of the hands
perform bimanual palpation
and compress to a maximum
depth (5-6cm)
24. Palpate for masses No palpable masses are present A mass detected in any quadrant may
Note location, size, shape be due to a tumor, cyst, enlarged
and etc organ, aneurysm
25. Palpate the umbilicus Umbilicus and surrounding area are free of Soft center of umbilicus potential for
and surrounding swellings, bulges, or masses. hernia
areas for swelling,
bulges or masses Hard nodules palpated in or around
the umbilicus indicate metastatic
nodes from gastrointestinal cancer
26. Palpate the aorta. The aorta is 2.5-3.0 cm wide with a A wide, bounding pulse may be felt
Use your thumb and first moderately strong and regular pulse. with an abdominal aortic aneurysm.
finger or use two hands and
palpate deeply in the
epigastrium, slightly to the
left of the midline. Assess
pulsation of the abdominal
aorta

If client is over 50 years of

age or has hypertension,
assess on width of the aorta
27. Palpate the liver Not usually palpable. If the lower edge is felt, it Hard, firm liver may indicate cancer
Stand at right of client and should be firm, smooth, and even.
place left hand under the Nodularity may occur with tumors,
client’s back at 11th and 12th metastatic cancer, late cirrhosis
rib level then lay right hand
parallel to right costal margin Tenderness may be from vascular
and ask client to inhale engorgement, acute hepatitis, or
deeply and gently pull abscess.
inward, upward with fingers
A liver more than 1-3 cm below the
By hooking, stand at right costal margin is considered enlarged
side of patient and curl the due to hepatitis, tumor, cirrhosis
fingers of both hands by the
edge of right costal margin
and ask client to take deep
breath and gently pull inward,
upward with fingers
28. Palpate the spleen. Seldomly palpable at the left costal margin but Enlargement of palpable spleen
Stand at the client’s right if palpated it should be soft and nontender
side, reach over the Splenic notch may be felt and an
abdomen with the left arm, Tympany to dullness is normal here indication of splenic enlargement,
and place your hand under obviously
the posterior lower ribs.
Place your right hand below Feels soft with rounded edge when
the left costal margin with the from infection
fingers pointing toward the
client’s head and ask client to Firm and sharp edge when from
inhale and press inward and chronic disease
upward as you provide
support with your other hand.
29. Palpate the kidneys Not palpable are the kidneys but if palpated, Enlarged kidney due to cyst, tumor, or
To palpate the right kidney, should feel firm smooth and rounded hydronephrosis
support the right posterior
flank with your left hand and
place your right hand in the
RUQ just below the costal
margin at the MCL.

Ask client to inhale to capture

kidney and compress fingers
deeply during peak
inspiration

30. Palpate the urinary No bladder is palpated Distended bladder is round, smooth
bladder and somewhat firm mass extending
Palpate and begin at the far from umbilicus
symphysis pubis and move
upward and outward to
estimate bladder borders

1. how to make ur client ready physically allow the client to empty bladder, let him or her remove
clothes and put on a gown Help to lie on supine with arms
folded across the chest or resting by the sides
2. What do we need to observe generally (so pasabot ani skin coloration, vascularity of the abdominal skin, any
unsay e inspect) striae, scars, lesions and rashes, umbilicus, umbilical
location, contour of umbilicus, abdominal contour,
symmetry,movement (when the client breathes, aortic
pulsations and peristaltic waves

3. what to auscultate in vascular sounds Abdominal aorta, renal iliac artery and femoral artery

4. how to auscultate our patient Begin in the right lower quadrant (RLQ), and move in
sequence up to the right upper quadrant (RUQ), left upper
quadrant (LUQ), and finally the left lower quadrant (LLQ).
5. explain light and deep plpaption Light palpation – test for any palpable mass, rigidity, or
pain on the surface
Deep palpation – testing for any organomegaly ( enlarged
organs)

6. how to perform blunt percussion by placing left hand to lower right anterior rib cage and the
 ulnar side of right fist to strike the left hand

7. how to position hands in doing palpaption

8. katong special techniques, igo ra e ingon di na Test for shifting dullness, fluid wave test, assessment for
magexplain rebound tenderness, psoas sign and obturator sign

9. what to percuss and unsay madunggan