Assessment of the Abdomen

Anatomical landmarks
◦ Xiphoid process ◦ Umbilicus ◦ Costal margins ◦ Symphysis pubis ◦ Iliac crest ◦ Anterior superior iliac spine

Four Quadrants of Abdomen

Right Upper Quadrant

Right Lower Quadrant

◦ Liver ◦ Portions of ascending and transverse colon ◦ Pylorus valve of stomach ◦ Hepatic flexure of colon ◦ Duodenum ◦ Right kidney and adrenal gland ◦ Appendix and cecum ◦ Right ureter ◦ Ascending colon ◦ Right spermatic cord ◦ Bladder if distended ◦ Uterus if enlarged ◦ Ovary

Four Quadrants of Abdomen

Left Upper Quadrant ◦ Tip of medial lobe of liver ◦ Portions of transverse and descending colon ◦ Spleen ◦ Splenic flexure of colon ◦ Stomach ◦ Left kidney and adrenal gland ◦ Pancreas Left Lower Quadrant ◦ Sigmoid colon ◦ Left ureter ◦ Descending colon ◦ Left spermatic cord ◦ Bladder if distended ◦ Uterus if enlarged ◦ Ovary

Collecting SUBJECTIVE DATA

Chief complaint / present illness ◦ Abdominal pain ◦ Constipation ◦ Indigestion ◦ Diarrhea ◦ Nausea ◦ Vomiting

Collecting SUBJECTIVE DATA  Chief complaint / present illness
◦ Fecal incontinence ◦ Jaundice ◦ Dysuria ◦ Urinary frequency ◦ Urinary incontinence ◦ Hematuria, blood in stool ◦ Weight loss, weight gain 

Collecting SUBJECTIVE DATA

Symptom characteristics ◦ Onset and duration ◦ Prior evaluation or treatment ◦ Getting better or worse ◦ Home or prescribed treatment ◦ Character or quality ◦ Others in family with similar symptoms ◦ Associated symptoms ◦ Alterations in activities of daily living ◦ Location, radiation ◦ Factors that relieve or exacerbate symptoms

Nursing history to determine

Past Medical History (have you had, have you ever had)  Perinatal history ◦ Pregnancies, abortions, miscarriages ◦ Birth defects ◦ Infant feeding problems ◦ Prematurity ◦ Short bowel syndrome

Nursing history to determine
              

Illnesses / infectious disease Acute GI infections Irritable bowel Hepatitis GERD PID, STI’s Constipation HIV Food allergies / intolerance UTI’s Cystic fibrosis Diverticulitis Colitis Ulcers Gallbladder illness

Nursing history to determine
Immunizations  Hepatitis B  Cholera  Hepatitis A  Typhoid  Rota virus Other  Laboratory test  Stool cultures  Organ biopsy  Abdominal x-ray, sonograms, ultrasounds  Sigmoid or colonoscopy  Urinalysis  Ova and parasites  H. pylori tests

Nursing history to determine
Operations / hospitalizations / ER visits  Abdominal surgery  Recurrent abdominal pain  Appendicitis  Organ inflammation (liver, pancreas, gallbladder)  Trauma to abdomen  Acute gastroenteritis (AGE)  Births  Blood transfusions Accidents (unintentional injury)  Car  Falls  Bike  Skateboard

Nursing history to determine

Medication use (What prescriptions)  Antibiotics  Folk remedies  Laxatives  Birth control  Suppositories, enemas  Iron and vitamins  Antacids  Chronic steroid or ASA use  Ulcer medications  Folk remedies  Chronic steroid or ASA use  Birth control  Iron and vitamins

Nursing history to determine

Family History (is there a hx of any of the ff)  Infectious conditions (hepatitis, AGE)  Constipation, irritable bowel  Ulcers, diverticulitis, inflammatory bowel  Gallbladder disease  Symptoms similar to CC  Colon cancer, ovarian cancer  Ova and parasites

Nursing history to determine

Personal and Social History (what types, do you, how much)  Nutrition  Last menstrual period  Sexual practices and protection  Substance use, including caffeine, alcohol, tobacco  Recent stress  Weight gain or loss  Anorexia, bulimia, dieting  Travel outside of country

Preparing the Client:  Have child empty bladder  Have child lie supine with hips and knees flexed  Drape for privacy  Tell child what you will do before you do it  Have warm room and warm hands  Have good light source  Examine identified painful areas last  Equipment :  Small pillow or rolled blanket  Tape measure  Stethoscope  Marking pin

Collecting OBJECTIVE DATA

Collecting OBJECTIVE DATA
Inspection Skin  Scars  Lesions  Striae – old silver striae or stretch marks  Rashes  Dilated veins, vein pattern (hepatic cirrhosis or inferior vena cava obstruction) Umbilicus  Location  Contour , Signs of inflammation or bulging, hernia Contour  Symmetrical / asymmetrical  Scaphoid (concave or hollowed)  Flat  Protuberant


Rounded 

Collecting OBJECTIVE DATA

Causes of Abdominal Distention  Obesity  Neoplasms  Pregnancy  Feces  Tympanitis  Ascites  (Six “F’s”: Fat, Fluid, Flatus, Fetus, Fecus, Fatal growths) Location of Distention  Xiphoid Diastasis recti  Umbilicus Pregnancy, distended bladder  Pubis - Umbilical hernia  Midline - Diaphragmatic hernia

Collecting OBJECTIVE DATA

Normal Variations of Contour with Age  Infant-toddler ◦ Protuberant  Preschool age child ◦ Rounded, lumbar lordosis  School age child ◦ Scaphoid  Adolescent / adult ◦ Varied

Collecting OBJECTIVE DATA

Inspection ◦ Peristalsis  May be seen in thin individuals or with obstructive conditions (intestinal obstruction) ◦ Pulsation Pulsations of descending aorta may be seen in thin individuals in the epigastrium ◦ Respirations Abdominal breathing normal until school age Intercostal breathing occurs with Respiratory distress Abdominal inflammation Pneumonia or pleural effusion may cause

Auscultation ◦ To assess Bowel sounds – (normal sounds consist of clicks & gurgles) ◦ Vascular sounds (bruits sounds) ◦ Organ size, location  Warm stethoscope before use ◦ Increased bowel sounds  Diarrhea  Diverticulitis  Colic  Intussusception  Malrotation ◦ Decreased bowel sounds

Collecting OBJECTIVE DATA

Collecting OBJECTIVE DATA
 Total

obstruction  Peritonitis  Paralytic ileus  Severe ascites  Absence of bowel sounds established after 5 minutes of listening ◦ Scratch test for liver size  Intensity of sound increases as you approach liver edge  

Collecting OBJECTIVE DATA

Techniques for Relaxation of Children for Percussion and Palpation
 Pacifier

to encourage relaxation with sucking  Flex knees and hips  Use of puppets or toys  Distraction, support of caregiver  Involve them in procedure  Reassure procedure will not hurt 

Collecting OBJECTIVE DATA

Percussion ◦ Percussion is excellent for assessing organ size, presence of masses, fluid or gas. ◦ Tympany  stomach, bowel ◦ Resonance  bowel ◦ Dullness  liver ◦ Flat  thigh  Tympany ◦ High pitch note elicited over air filled structures, such as viscera and stomach.

Collecting OBJECTIVE DATA
Dull ◦ Short high-pitched sound with little resonance. Found in solid or fluid filled organs adjacent to air containing organs, i.e., liver, spleen, distended bladder.  Flat ◦ Very short, high-pitched sound produced over tissue which contains no air, i.e., muscle, large solid mass.

Collecting OBJECTIVE DATA
Percuss ◦ 4 quadrants for gas or masses (Solid or fluid filled) ◦ Liver span ◦ Spleen size ◦ Costovertebral angle (CVA) tenderness  Liver percussion ◦ At right mid-clavicular line, start below umbilicus and percuss upward until dullness of sound heard ◦ Liver usually @ right costal margin +/- 2 cm ◦ Size and shape of liver vary

Collecting OBJECTIVE DATA

Spleen Percussion ◦ Splenic dullness may be heard near left 10th rib posterior to the mid-axillary line  Usually not found unless enlarged Obscured by air in the colon ◦ Percuss at 10th intercostal space to determine dullness with deep breath ◦ For spleenomegaly

 Percuss the lowest interspace in the left anterior axillary line – usually tympanitic

Percussion for tenderness of liver or kidneys ◦ Place palm of one hand over organ. Strike hand with ulnar surface of other hand. If organ is inflamed, this will result in pain.

Palpation  Light palpation
◦ ◦ ◦ ◦

Collecting OBJECTIVE DATA
Assessment of skin turgor Muscle tone/resistance Superficial lesions or masses Areas of tenderness  Assess for masses or enlarged organs Mass descriptors Location Mobility Size Pulsation Shape Tenderness Consistency

Deep palpation
◦ ◦ ◦ ◦ ◦ ◦ ◦

Collecting objective data
◦ Liver
 

    

Normally palpable near right costal margin, mid-clavicular line. Palpate with right hand starting below umbilicus and moving upward until liver palpable. Remember the liver is a superficial organ.
◦ Spleen

Difficult to palpate unless enlarged Deep palpation under L costal margin at the anterior axillary line Will descend with deep inspiration Can roll person to R side to move spleen towards midline

Collecting objective data

Kidneys

 

 

Difficult to palpate unless enlarged With hands perpendicular to midline between rib cage and iliac crest, press hands gently but firmly together. Have person take deep breath. May feel kidney slide between hands. Right kidney normally lower than left kidney.

Stool

Firm, movable, mildly tender, elongated mass often palpable in sigmoid colon

Bladder

 

If distended, bladder is palpable midline above symphysis pubis Smooth round mass, not moveable

Special maneuvers  Rebound tenderness  Psoas maneuver  Obturator sign  Murphy’s sign Rebound Tenderness at McBurney Point  Sharp pain when pressure released in RLQ suggest appendicitis Obturator Muscle Test  Flex R leg at hip & knee. Rotate leg laterally & medially.  Pain in hypogastric region may indicate ruptured appendix Iliopsoas Muscle Test  Ask to raise the R leg flexing at the hip while pressing  down on lower thigh. Lower quadrant pain may indicate appendicitis. Murphy’s Sign  Client complains of sharp pain when trying to take a deep breath while examiner performs deep palpation in URQ.  Inflamed gallbladder descends during inspiration resulting in pain 

Collecting objective data

Common Abnormal Abdominal Findings

Hernias  Protrusions of the peritoneum or intestine through a weakened spot in musculature of abdominal wall. Umbilical hernias rarely need intervention. Inguinal and femoral hernias are usually surgically corrected.
◦ Inspection - Assess for bulges with crying or bearing down. ◦ Auscultation - Assess for hums or bruits should not be present. May hear bowel sounds. ◦ Percussion - Can not percuss hernia. ◦ Palpation- Mass soft, nontender and retractable. Measure opening in musculature

Common Abnormal Abdominal Findings Pyloric Stenosis  Hypertrophy of the pyloric valve prevents feed from leaving the stomach. Infant initially feeds well but then develops persistent  vomiting. Inspection  Peristalicwave over stomach area Projectile vomiting Auscultation  Hyperactive sounds over stomach area  Hyperactive sounds over intestines Percussion  Resonant stomach sounds. Contents expelled. Palpation  An enlarged, firm, “olive shape” mass may be palpable in RUQ. Needs to be referred to MD for ultrasound testing and then surgery.

Common Abnormal Abdominal Findings

Appendicitis  Appendicitis is the most common cause of acute surgical abdomen in childhood.

Inspection

◦ Rare in early childhood, becoming more frequent after age 10. ◦ History includes dull aching, steady peri-umbilical pain that localizes to RLQ after 4-6 hours. ◦ Nausea and vomiting frequently occur but there is no change in bowel habits. Low grade fever may be present. ◦ Note guarding or pain with walking or coughing. Abdominal distention may be present. Prefer supine position with knees flexed.

◦ Bowel sounds may be decreased or hyperactive. Need to auscultate RLL of lungs carefully to rule out lobar pneumonia with referred pain. Percussion ◦ Increased tenderness may make percussion too uncomfortable to perform.

Auscultation

Palpation


◦ Tenderness over area of inflamed appendix, usually RLQ (McBurney point). ◦ Rebound tenderness localized to same area. Unable to palpate inflamed appendix. Rectal exam usually finds right-sided tenderness.

Common Abnormal Abdominal Findings Abdominal pain Inspection

Auscultation

◦ Limitation of movement or alterations in breathing pattern (shallow or chest breathing) are important assessment criteria. Watch client climb on or off the exam table ◦ Periumbilical pain less likely to be serious than other locations ◦ Evaluate for weight loss or gain ◦ Bowel sounds may be increased or decreased ◦ Friction rub may be heard with pleural inflammation or peritoneal inflammation ◦ Percussion over areas of inflammation may result in pain ◦ Watch facial expressions as you attempt to distract individual. Those who watch you have more pain. ◦ Palpation may identify localized or generalized pain. ◦ Watch facial expressions as you attempt to distract during palpation. ◦ Firm but gentle palpation is best.

Percussion

Palpation

Common Abnormal Abdominal Findings

Pregnancy Inspection

◦ Enlargement of lower abdomen, midline ◦ Enlargement of breast ◦ Linea nigra, increase facial pigmentation, striae

Auscultation
◦ Fetal heart sounds

Percussion
◦ Dull mass in lower abdomen ◦ Displaced tympany of bowel and stomach

Palpation
◦ Fetal outline ◦ Fundus of uterus 

Sign up to vote on this title
UsefulNot useful