ABDOMINAL ASSESSMENT

◗ BARBARA REES,
RN, DSN
 SUBDIVISION OF ABDOMEN
◗ RIGHT UPPER QUADRANT - RUQ

◗ RIGHT LOWER QUADRANT - RLQ

◗ LEFT UPPER QUADRANT - LUQ

◗ LEFT LOWER QUADRANT - LLQ

ABDOMINAL QUADRANTS
NINE ABDOMINAL
QUADRANTS
 RIGHT UPPER QUADRANT
◗ LIVER
◗ GALLBLADDER
◗ DUODENUM
◗ HEAD OF PANCREAS
◗ RIGHT KIDNEY AND ADRENAL
◗ HEPATIC FLEXURE OF COLON
◗ PART OF ASCENDING AND
TRANSVERSE COLON
 LEFT UPPER QUADRANT
◗ STOMACH
◗ SPLEEN
◗ LEFT LOBE OF LIVER
◗ BODY OF PANCREAS
◗ LEFT KIDNEY AND ADRENAL
◗ SPLENIC FLEXURE OF COLON
◗ PARTS OF TRANSVERSE AND
DESCENDING COLON
 RIGHT LOWER QUADRANT
◗ CECUM
◗ APPENDIX
◗ RIGHT OVARY AND TUBE
◗ RIGHT URETER
 LEFT LOWER QUADRANT
◗ PART OF DESCENDING COLON
◗ SIGMOID COLON
◗ LEFT OVARY AND TUBE
◗ LEFT URETER
 PREPARATION
◗ EQUIPMENT - STETHOSCOPE,
MARKING PEN, RULER
◗ PATIENT LIE ON BACK, PILLOW
UNDER HEAD, KNEES SLIGHTLY
FLEXED
◗ EMPTY BLADDER
◗ SHORT FINGERNAILS
 HISTORY QUESTIONS
◗ PAIN IN ABDOMEN
◗ CHANGE IN APPETITE
◗ CHEWING AND SWALLOWING
PROBLEMS
◗ HEARTBURN
◗ NAUSEA, VOMITING, REGURITATION
◗ RECTAL BLEEDING
 HISTORY QUESTIONS
◗ ELIMINATION
◗ HEMORRHOIDS
◗ VOIDING DIFFICULTY
◗ PREVIOUS SURGERY
◗ WEIGHT GAIN OR LOSS
◗ TYPE OF DIET
◗ MEDICATIONS
 SEQUENCE OF ASSESSMENT
◗ INSPECTION
◗ AUSCULTATION
◗ PERCUSSION
◗ PALPATION
 INSPECTION
◗ ENTIRE PATIENT
◗ SKIN
◗ a. PIGMENTATION
◗ b. LESIONS
◗ c. STRIAE
◗ d. TURGOR
◗ SUPERFICIAL VESSELS
ABDOMINAL STRIAE
 INSPECTION
◗ HAIR DISTRIBUTION
◗ UMBILICUS
◗ CONTOUR
◗ a. FLAT
◗ b. ROUNDED
◗ c. SCAPHOID
◗ d. PROTUBERANT (DISTENDED)
◗ PERISTALSIS
ABDOMINAL CONTOURS
 AUSCULTATION
◗ ACTIVE BOWEL SOUNDS 5-30/MIN
◗ HYPOACTIVE 4/MIN OR LESS
◗ HYPERACTIVE 30 OR MORE /MIN
◗ BRUITS
◗ a. AORTA
◗ b. RENAL
◗ c. ILIAC
◗ FRICTION RUB
AUSCULTATION FOR BRUITS
 PERCUSSION
◗ TO DETERMINE THE SIZE OF SOLID
ORGANS AND PRESENCE OF MASSES,
FLUID AND GAS
◗ TYMPANIC SOUND
◗ PERCUSS IN ALL FOUR QUADRANTS
◗ PERCUSS FOR LIVER
◗ PERCUSS FOR SPLEEN
◗ PERCUSS BLADDER IF INDICATED
PERCUSSION OF SPLEEN
 PERCUSSION
◗ IF DULLNESS IN FLANKS - CHECK
FOR SHIFTING DULLNESS
◗ IF INDICATED CHECK FOR FLUID
WAVE
 PALPATION
◗ LIGHT PALPATION TO EVALUATE
GENERAL CONDITION, NATURE OF
ANY DISTENTION, AND GROSS
ABNORMALITIES AND PAINFULNESS
◗ DEEP PALPATION TO DETECT ANY
ORGAN ENLARGEMENT,
ABDOMINAL MASSES OR
SWELLINGS
◗ PALPATE FOR LIVER AND SPLEEN
PALPATION OF LIVER
PALPATION OF SPLEEN
REBOUND TENDERNESS
 ON BACK
◗ CHECK FOR RENAL BRUITS

◗ COSTOVERTEBRAL ANGLE
TENDERNESS
PERCUSION OF KIDNEY
 IF ABDOMINAL PAIN
◗ TACHYPNEIC
◗ LEANING FORWARD
◗ MURPHY’S SIGN
◗ ROVSING’S SIGN
◗ ILIOPSOAS TEST
ILIOPSOAS TEST
 RULES IF IN ABDOMINAL
PAIN
◗ DO NOT ADMINISTER PAIN
MEDICATIONS, ANTISPASMODICS,
ANTICHOLINERGICS, OR SMOOTH
MUSCLE RELAXANTS BEFORE A
MEDICAL EXAM B/C MASK PAIN
 CONTRAINDICATIONS FOR
ABDOMINAL ASSESSMENT
◗ NEVER PALPATE IF SUSPECTED
APPENDICITIS OR DISSECTING ABD.
AORTIC ANEURSYM
◗ NEVER PALPATE WITH POLYCYSTIC
KIDNEYS
◗ DO NOT PALPATE OF PERCUSS
TRANSPLANTED ORGANS