ABDOMINAL ASSESSMENT

The assessment of the abdominal structures in the abdominal quadrants: skin, stomach, bowel,
spleen, liver and kidneys.

PURPOSES
-To explore gastrointestinal complaints
-To assess abdominal pain, tenderness or masses
-To monitor the client post-operatively
CONSIDERATIONS
-Avoid touching tender or painful areas
-Perform light palpation before deep palpation.
–Work with the client to promote relaxation.
-Make sure the patient does not have a full bladder.
-Patient needs to be exposed from above the xiphoid process to the symphysis pubis.
REMINDER
Firmness or muscle guarding or rigidity = intraabdominal bleeding = DO NOT CONTINUE TO
PALPATE!!!!!
RULES IF IN ABDOMINAL PAIN
DO NOT ADMINISTER PAIN MEDICATIONS, ANTISPASMODICS, ANTICHOLINERGICS, OR
SMOOTH MUSCLE RELAXANTS BEFORE A MEDICAL EXAM
CONTRAINDICATIONS FOR ABDOMINAL ASSESSMENT
NEVER PALPATE IF SUSPECTED APPENDICITIS OR DISSECTING ABDOMINAL AORTIC
ANEURSYM
NEVER PALPATE WITH POLYCYSTIC KIDNEYS
DO NOT PALPATE OF PERCUSS TRANSPLANTED ORGANS
HISTORY QUESTIONS
What type of foods do you typically eat?
Are there any foods that you cannot eat? If so, why?
How many cups of tea, coffee, cola or caffeinated beverages do you drink per day?
Do you smoke? If so, how much and at what age did you start?
Do you drink alcohol? If so, how many drinks per day? Per week?
Do you use recreational drug?
Do you have any abdominal pain?
EQUIPMENT
Stethoscope
Tape Measure
Pen and record form
Pillows (2)
SEQUENCE OF ASSESSMENT
Inspection
Auscultation
Percussion
Palpation
Auscultate AFTER inspection and BEFORE percussion; Palpate last
Auscultation is done first because percussion and palpation cause movement or stimulation of
the bowel which can increase bowel motility and thus heighten bowel sounds creating false result.

PROCEDURES RATIONALE
1. Introduce yourself and verify client’s identity. Introducing self to the
patient helps build rapport;
Correct patient identification
is fundamental to patient’s
safety.
2. Explain the purpose of the examination. To reduce client’s anxiety
and increase cooperation

3. Assemble equipment and perform hand hygiene. To conserve time and

energy; To prevent the
transmission of
microorganisms
4. Screen the client. Provide for client privacy
5. Have the client void prior to the exam. To enhance client comfort
and prevent tension in the
abdominal muscle and so
that you do not mistake a full
bladder for a mass.
6. Position client supine, arms at sides with small pillows under the To facilitate easy
head and knees assessment and helps to
relax abdominal muscles.

7. Inspect the abdomen for size, symmetry and Normal Findings:

contour. Abdomen is flat, slightly
rounded (convex) or
Stand at the client’s side and view across the concave; symmetric
abdomen contour; no visible masses
If distention is present, use a tape measure to or distention are present; No
measure girth at the level of the umbilicus appearance of bulges
Ask patient to raise his head to check for bulges
Abnormal Findings:
Measuring abdominal girth Asymmetric contour: organ
M:94 cm (IR) to 102 cm (GIR) enlargement, large masses,
F: 80 CM (IR) to 88 cm (GIR) hernia, bowel obstruction,
distended abdomen, Bulges
CONTOUR: or mass appear
FLAT, ROUNDED, SCAPHOID, PROTUBERANT, DISTENDED,
SCITIC

Hernias: an abnormal protrusion from one anatomic space to

another
8. Observe the condition of skin and skin color; lesions, scars, Normal Findings:
striae, superficial veins, and hair distribution. Abdominal skin may be
paler than the general skin
tone; Scattered fine veins
may be visible. Old, silvery,
white striae or stretch marks
from past pregnancies or
weight gain are normal.
Abdomen is free of lesions
or rashes.

Abnormal Findings:
Grey Turner Sign: Purple
discoloration of the flanks
indicates bleeding within the
abdominal wall, possibly
from trauma to the kidneys,
pancreas or duodenum or
from pancreas. Yellow hue
of jaundice may be more
apparent on the abdomen
Pale, taut skin may be seen
with ASCITES (abdominal
swelling indicating fluid
accumulation in the
abdominal cavity.
 Redness: indicate
inflammation
Bruises or areas of local
discoloration are also
abnormal.
9. Note abdominal movements. Note position, contour, and color of Normal Findings:
the umbilicus. Symmetric movements
caused by respiration;
NAVEL TYPE: Visible peristalsis in very
PROTRUDING NAVEL, DEEP AND ROUND, OVAL SHAPE, lean people; aortic
VERTICAL/OBLONG, OFF-CENNTRE NAVEL, HORIZONTAL pulsations in thin persons at
NAVEL epigastric area
Umbilical skin tones: similar
to surrounding abdominal
skin tones
Contour: protruding not
more than 0.5 cm, round.
Location: midline at lateral
line

Abnormal Findings:
Limited movement due to
pain or disease process;
visible peristalsis in non-lean
clients (with bowel
obstruction); marked aortic
pulsations Cullen’s sign:
bluish or purple discoloration
around the umbilicus (intra-
abdominal bleeding)
Protrusion of the umbilicus:
hernia/mass
10. Auscultate the abdomen for bowel sounds, using the diaphragm Normal Findings:
of the stethoscope. Audible sounds; A series
Ask the client when he/she last ate. (Bowel sounds are loudest of intermittent,
5 or 6 hours after the person eats.) soft clicks and gurgles are
Auscultate in all four quadrants of the abdomen. heard at a rate of
Auscultate for a minute before determining the absence of 5-30 sounds per minute
peristaltic sounds. Note the frequency and character of bowel Borborygmi: hyperactive
sounds. bowel sounds which are
CLICK THE LINK: loud, prolonged gurgles.
Auscultation Abdomen Bowel Sounds
https://www.youtube.com/watch?v=1Xc7RYkz-CE Abnormal Findings:
Bowel Sounds Hypoactive bowel sounds:
https://www.youtube.com/watch?v=C1xR44PJ_c0 diminished bowel motility
(causes: abdominal surgery
ABSENT (NO BS FOR 5 MINS) or late bowel obstruction
HYPOACTIVE (LESS THAN 5/MIN) Hyperactive bowel
ACTIVE (5-30 PER MIN) sounds: increase bowel
HYPERACTIVE (>30 PER MIN) motility (causes: diarrhea,
gastroenteritis, early bowel
obstruction
Decreased or absent
bowel sounds: absence of
bowel motility = emergency,
 requires immediate referral;
maybe associated with
peritonitis or paralytic ileus.
Loud bruit over aortic area
(possible aneurysm); bruit
over renal or iliac arteries;
friction rub
11. Use the stethoscope bell to listen for bruits over the aorta and Normal Findings:
renal, femoral, and iliac arteries. No audible bruits are
present.
Auscultation for bruits Abnormal Findings:
Bruits are low pitched, vascular sounds, resembling murmur Loud bruit over aortic area
Bruits are swishing sounds that indicate turbulent blood flow. (possible aneurysm)
Listen in areas over abdominal blood vessels such as the
aorta and renal arteries
Presence indicates abdominal aortic aneurysm or renal artery
stenosis
CLICK THE LINK: Renal artery bruit
https://www.youtube.com/watch?v=PrlTdsJ7lWg

CLICK THE LINK: ABDOMEN- INSPECTION & AUSCULTATION

https://www.youtube.com/watch?v=o6eqiMbKLpo&list=PLOyKvUe
h9rG02jsZ-rACZY1tdgSD_YdE3&index=24

12. Percuss the abdomen using indirect percussion to assess at Normal Findings:
multiple sites in all four quadrants. Tympany with dullness
Estimate organ by noting the change in sounds as you over organs or fluid is
percuss over the liver, spleen, and bladder. present, no tenderness
Abnormal Findings:
CLICK THE LINK: PERCUSSION OF ABDOMEN Extremely high pitched
https://www.youtube.com/watch?v=5ERuM1JDYAA tympanic sounds are heard
with distention; extensive
dullness= organ
enlargement/mass
 Percussion is done to determine the size and density of the
structures and organs inside of the abdominal cavity, and to detect
the presence of air or fluid.
Percussion of the abdomen helps assess for intestinal distention,
free fluid, solid masses, hepatomegaly, and splenomegaly.
Percussion is CONTRAINDICATED in patients with suspected
aortic aneurysm, appendicitis, or those who have received
abdominal organ transplants
Percuss in all 9 sections to assess for tympany and dullness

13. Use a fist or blunt percussion to percuss the costovertebral Normal Findings:
angle (where the end of the rib cage meets the spine) bilaterally to No tenderness is elicited.
assess for kidney tenderness. Abnormal Findings:
CLICK THE LINK: Percussion of the Kidneys Tenderness or sharp
https://www.youtube.com/watch?v=obIdJsgi_gs elicited over the
costovertebral angle (CVA):
Kidney infection
(pyelonephritis), renal
calculi.

14. Palpate the abdomen: Normal Findings:

Begin with light palpation by pressing down 1–2 cm in a rotating No tenderness; relaxed
motion. Identify surface characteristics, tenderness, muscular abdomen with smooth,
resistance, and turgor consistent tension.
Abnormal Findings:
CLICK THE LINK: PALPATION OF ABDOMEN Tenderness and
https://www.youtube.com/watch?v=0HFOaH11JmI&t=4s hypersensitivity; superficial
masses;
localized areas of increased
tension

LIGHT PALPATION
-Identify any masses and note:
Size, Location, Contour, Tenderness, Pulsations, Mobility, Light
palpation by moving your hand slowly and just lifting it off the skin.
-Use same sequence as for auscultation and percussion
-Watch for patient’s face for signs of discomfort
-Abdominal pain upon light palpation suggests peritoneal
irritation or inflammation
-If rigidity or guarding while palpating, determine whether it
is voluntary (patient anticipates the pain) or involuntary (peritoneal
inflammation)

15. Perform deep palpation over all quadrants to palpate organs Normal Findings:
and mass. No palpable masses are
present; Normal tenderness
is possible over the xiphoid,
aorta, cecum, sigmoid colon
and ovaries with deep
palpation.

Abnormal Findings:
Generalized or localized
areas of tenderness; mobile
or fixed masses
16. Palpate the liver Normal Findings:
Place right hand at patient’s mid-clavicular line under and parallel The liver is usually not
to the costal margin. palpable
Place left hand under patient’s back at the lower ribs and press although it may be felt in
upward to elevate the liver toward the abdominal wall. some thin
Ask patient to inhale and deeply exhale while pressing in and up clients.
with the right fingers Mild tenderness maybe
CLICK THE LINK: examination of the liver normal.
https://www.youtube.com/watch?v=DBif1jjAfKk&t=60s Abnormal Findings:
Hard, firm liver: cancer
Nodules: tumors, late
cirrhosis
Enlarged liver
17. Palpate the spleen. Normal Findings:
Stand at patient’s right side. The spleen is seldom
Reach across the client to place left hand under the palpable at the left
costovertebral angle and pull upward to move the spleen anteriorly. costal margin. If it can be
Place right hand under the left costal margin and have the client palpated, it
take a deep breath. should be soft and
During exhalation, press your hands together (inward) to try nontender.
to palpate the spleen. Abnormal Findings:
CLICK THE LINK: Examination of the Spleen Palpable spleen:
https://www.youtube.com/watch?v=rKsqO1tAKvs enlargement which may
result from trauma, cancers.
The spleen feels soft with
a rounded edge
when it is enlarged from
infection.
16. Do after care, hand washing and record accurate data To prevent the spread of
microorganisms and to
facilitate continuity of care