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Abdomen Physical examination of the abdomen provides significant data relative to the various functions of the gastrointestinal and

genitourinary systems and the abdominal aorta. The order of abdominal assessment is inspection, auscultation, percussion, and palpation. Auscultation is performed second because palpation and percussion can alter the bowel sounds. The abdominal landmarks used for assessment are presented in Figure 27-52. Auscultate the four quadrants, as shown in Figure 27-53, when assessing bowel sounds and listening for vascular bruits. Assessment should always begin in the right lower quadrant (RLQ). Table 27-17 presents the specific areas of the abdomen to be examined and the normal and key findings of this assessment. The nurse should percuss all four quadrants in the same systematic fashion. Visualize each organ in the corresponding quadrant; note when tympany (a lowpitched sound of long duration) changes to dullness (a high-pitched sound of short duration). Light palpation of the abdomen is done in all four quadrants, beginning in the RLQ for resistance, tenderness, and rebound tenderness. Deep palpation is not addressed in Table 27-17 because this assessment technique usually requires supervision during the learning process. If any of the abdominal organs (gallbladder, liver, spleen, fecal-filled colon, or flatus-filled cecum) can be palpated, it is abnormal and should be reported to the nursing supervisor. Assessment of Abdomen: Normal and Key Findings Area of Assessment/Normal Findings Key Findings Abdomen: Inspect, Auscultate, Percuss, and Palpate Place client in a supine position with knees flexed over a pillow, hands at sides or across chest. Drape the client from xiphoid process to symphysis pubis to expose the abdomen. 1. Stand at right side of client. A convex symmetrical profile reveals either a a. Inspect abdomen from rib margin to pubic protuberant abdomen (results of poor muscle bone. Note contour and symmetry (observing tone from inadequate exercise or obesity) or for peristalsis, pulsations, scars, striae, or distension (taut stretching of skin across masses). abdominal wall). Asymmetry may indicate a mass, bowel obstruction, enlargement of abdominal organs, or scoliosis. Old scars are flat with a shiny appearance, blending with clients pigmentation; new scars are raised and reddened. Atrophic lines or streaks reveal linea albicantes (striae) that occur with tumors, obesity, ascites, and pregnancy. Engorged or dilated veins around the umbilicus are associated with circulatory obstruction of superior or inferior vena cava. b. Inspect umbilicus for contour, location, signs of inflammation, or hernia. c. Observe the abdomen for smooth, even respiratory movement. d. Observe for surface motion (visible peristalsis). e. Inspect epigastric area for pulsations. Contour is flat or rounded and bilaterally symmetrical. Umbilicus is depressed and beneath the abdominal surface. Abdomen rises with inspirations and falls with expirations, free from respiratory retractions. Visible peristalsis slowly traverses the abdomen in a slanting downward movement as observed in thin clients. Pulsations of the abdominal aorta are visible in the epigastric area in thin clients. Umbilicus bulging may indicate a hernia. Uneven respiratory movement with retractions may indicate appendicitis. Strong peristaltic movement may indicate intestinal obstruction. Marked pulsations in epigastric area may indicate an aortic aneurysm.

2. Auscultate the four abdominal quadrants using the diaphragm of the stethoscope for bowel sounds (high-pitched). a. Begin by placing the diaphragm on the right lower quadrant (RLQ). Listen for a full minute to the frequency and character of the bowel sounds. b. Repeat step a, proceeding in sequence to right upper quadrant (RUQ), left upper quadrant (LUQ), and left lower quadrant (LLQ). c. Listen at least 5 minutes before concluding the absence of bowel sounds. High-pitched sounds, heard every 5 to 15 seconds as intermittent gurgling sounds in all four quadrants as a result of air and fluid movement in the gastrointestinal tract. Bowel sounds should always be heard at the ileocecal valve area. 3. Auscultate with bell of stethoscope over the aorta, epigastric area, renal arteries, and femoral arteries. Note bruits over each area. Free from audible bruits. 4. Percuss all four quadrants in a systematic fashion. Begin percussion in RLQ, move upward to RUQ, cross over to LUQ, and down to LLQ. Note when tympany changes to dullness. Tympany is heard because of air in the stomach and intestines. Dullness is heard over organs (e.g., the liver). 5. Perform light palpation. Never palpate over areas where bruits are auscultated. a. Instruct client to cough. If client experiences a sharp twinge of pain in a quadrant, palpate that area last. b. With clients hands and forearms on a horizontal plane, use fingerpads to depress the abdominal wall 1 cm in all four quadrants. Begin palpation in RLQ, move upward to RUQ, cross over to LUQ, and down to LLQ. Note texture and consistency of underlying tissue. Should feel smooth with consistent softness.

Hypoactive or diminished bowel sounds are soft and low and widely separated so that only one or two are heard in a 2-minute interval. Hypoactive is normal the first few hours after general anesthesia. Hypoactive sounds may indicate decreased motility of the bowel, such as occurs with peritoneal irritation or paralytic ileus. Absent bowels sounds (none heard for 35 minutes) may signal paralytic ileus, peritonitis, or an obstruction. Hyperactive (loud, audible, gurgling sounds similar to stomach growling; sounds also called borborygmi) may occur with diarrhea or hunger. Rushed, high-pitched or tingling sounds suggest air or fluid under pressure; this may occur in the early stages of an intestinal blockage when heard in the portion of the bowel that precedes the obstruction. A bruit over an abdominal vessel reveals turbulent blood flow suggestive of an aortic aneurysm or partial obstruction (e.g., renal or femoral stenosis). Dullness over the stomach or intestines may indicate a mass or tumor; ascites (excessive fluid accumulation in the abdominal cavity) or full intestines.

Tenderness and increased skin temperature may indicate inflammation. Large masses may be due to tumors, feces, or enlarged organs.