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The College of Maasin

“Nisi Dominus Frustra”

College of Nursing
Maasin City, Southern Leyte

Year & Section:______________________


Collecting Objective Data: PHYSICAL EXAMINATION
 Assessing the abdomen can be challenging, considering the number of organs of
the digestive system and the need to distinguish the source of clinical signs and
 Sequence for abdominal assessment involves: INSPECTION, AUSCULTATION,
PERCUSSION and PALPATION (auscultate after you inspect so as not to alter the
client’s pattern of bowel sounds)
 Adjust the bed level as necessary throughout the examination and approach the
client from the right side
 Ease client’s anxiety by explaining each aspect of the examination, answering
the client’s question
 Drape client’s genital area and breast (in women) when these are not being
 Warm hands are essential for abdominal examination (cold hands cause the
client to tense the abdominal muscles)

 As part of a comprehensive health examination
 To explore gastrointestinal complaints
 To assess abdominal pain, tenderness, or masses

Preparing the Client:

 Ask the client to empty the bladder before beginning the examination to
eliminate bladder distention and interference with an accurate examination
 Instruct the client to remove clothes and to put on a gown
 Help the client to lie supine with the arms folded across the chest or resting by
the sides (a flat pillow may be placed under the client’s head for comfort)
 Slightly flex the client’s legs by placing a pillow or rolled blanket under the
client’s knees to help relax the abdominal muscles
 Drape the client with sheets so the abdomen is visible from the lower rib cage to
the pubic area
 Instruct the client to breathe through the mouth and to take slow, deep breaths
(this promotes relaxation)
 Before touching the abdomen, ask the client about painful or tender area (these
areas should always be assessed at the end of the examination)

 Small pillow or rolled blanket
 Centimeter ruler
 Stethoscope
 (warm the diaphragm and bell)
 Marking pen

Physical Assessment:
 Evaluates the following abdominal structures such as skin, stomach, bowel,
spleen, liver, kidneys, aorta and bladder
 Remember to auscultate after inspection and before percussion and finally to
 Common abnormal findings include abdominal edema or swelling, signifying
ascites, abdominal masses signifying abnormal growths or constipation,
unusual pulsations such as seen with an aneurysm of the abdominal aorta and
pain associated with appendicitis
Assessment Procedure Normal Findings Abnormal Findings
1. observe the coloration Abdominal skin may be Purple discoloration at the
of the skin paler than the general skin flanks (Grey Turner’s sign)
tone because this skin is indicates bleeding within
so seldom exposed the wall, possible from
trauma to the kidneys,
pancreas or duodenum or
from pancreas

The yellow hue of jaundice

may be more apparent on
the abdomen

Pale, tightly stretch skin

may be seen with ascites
(significant abdominal
swelling indicating fluid
accumulation in the
abdominal cavity)

Redness may indicate


Bruises or areas of local

discoloration are also
2. note the Vascularity of Scattered fine vein may be Dilated veins may be seen
the abdominal skin visible, blood in the veins with cirrhosis of the liver,
located above the obstruction of the inferior
umbilicus flows toward the vena cava, portal
head; hypertension, or ascites
Blood in the veins located
below the umbilicus flows
toward the lower body
3. note any striae Old, silvery, white striae or Dark-bluish-pink striae are
stretch marks from past associated with Cushing’s
pregnancies or weight gain syndrome
are normal
Striae may also be caused
by ascites, which stretches
the skin. Ascites usually
results from liver failure or
liver disease
4. Inspect the umbilicus. Umbilical skin tones are Bluish or purple
a. Note the color of the similar to surrounding discoloration around the
umbilical area abdominal skin tones or umbilicus (Cullen’s sign)
even pinkish indicates intra-abdominal
b. observe umbilical bleeding
location Umbilicus is midline at A deviated umbilicus may
lateral line be caused by pressure from
a mass, enlarged organs,
hernia, fluid, or scar tissue
5. Inspect abdominal Abdomen is flat, rounded A generalized distended
contour. or scaphoid (usually seen abdomen may be due to
a. look across the abdomen in thin adults) obesity, air (gas), or fluid
at eye level from the Abdomen should be evenly accumulation
client’s side, from behind rounded Distention below the
the client’s head and from umbilicus may be due to a
the foot of the bed full bladder, uterine
b. measure abdominal enlargement, or an ovarian
girth as indicates tumor or cyst
Distention of the upper
abdomen may be seen with
masses of the pancreas or
gastric dilation
6. assess abdominal Abdomen is symmetric Asymmetry may be seen
symmetry with organ enlargement,
a. look at the client’s large masses, hernia, or
abdomen as she lies in a bowel obstruction
relaxed supine position
1. Auscultate for bowel A series of intermittent, Absent bowel sounds may
sounds soft clicks and gurgles are be associated with
Use the diaphragm of the heard at a rate of 5 to 30 peritonitis or paralytic ileus
stethoscope and make sure per minute
that it is warm before you High pitch tinkling and
place it on the client’s Hyperactive bowel sounds rushes of high-pitched
abdomen that may be heard sounds with abdominal
normally are the loud, cramping usually indicate
a. apply light pressure or prolonged gurgles obstruction
simply rest the stethoscope characteristic of stomach
on a tender abdomen growling (these hyperactive
b. begin in the RLQ and bowel sounds are called
proceed clockwise, covering “borborygmi”)
all quadrants
c. confirm bowel sounds in Bowel sounds normally
each quadrant occur every 5 to 15
d. listen for up to 5 seconds
minutes (minimum of 1
minute per quadrant) to
confirm absence of bowel
e. note the intensity, pitch
and frequency of sounds
2. Auscultate for vascular Bruits are not normally A bruit both systolic and
sounds. heard over abdominal aorta diastolic components
a. Use the bell of the or renal, iliac or femoral occurs when blood flow in
stethoscope to listen for arteries an artery is turbulent or
bruits (low-pitched, obstructed
murmur like sound) over
the abdominal aorta and This usually indicates
renal, iliac and femoral aneurysm or arterial
arteries stenosis
1. Percuss for tone. Generalized tympany Accentuated tympany or
a. lightly and predominates over the hyperesonance is heard
systematically Percuss all abdomen because of air in over a gaseous distended
quadrants the stomach and intestines abdomen

Normal dullness is heard An enlarged area of

over the liver and spleen dullness is heard over an
enlarged liver or spleen

Abnormal dullness is heard

over a distended bladder,
large masses or ascites
2. Percuss the liver span
or height of the liver by
determining its lower and
upper borders
TO ASSESS LOWER The lower border of liver The lower border of the
BORDER dullness is located at the liver dullness may be
a. begin in the RLQ at the costal margin to 1 to 2 cm difficult to estimate when
mid-clavicular line (MCL) below obscured by intestinal gas
b. Percuss upward
c. note the change from
tympany to dullness
d. mark this point (it is the
lower border of liver
dullness The upper border of liver
The upper border of the dullness may be difficult to
TO ASSESS THE UPPER liver dullness is located estimate if obscured by
BORDER between the left fifth and pleural fluid or lung
a. Percuss over the upper seventh intercostal spaces consolidation
right chest at the MCL and
Percuss downward
b. note the change from
resonance to liver dullness
c. mark this point (it is the
upper border of liver
dullness) The normal liver span at Hepatomegaly, a liver span
the MCL is 6 to 12 cm that exceeds normal limits
measure the distance (greater in men and taller (enlarged), is
between the two marks clients, less in shorter characteristics of liver
(this is the liver span) clients) tumors, cirrhosis, abscess
and vascular engorgement
A liver in a lower position
than normal may be
caused by emphysema,
whereas a liver in a higher
position than normal may
be caused by an abdominal
mass, ascites
3. Perform blunt Normally no tenderness is Tenderness elicited over
percussion on the liver. elicited the liver may be associated
This is to assess for with inflammation or
tenderness in difficult-to- infection (hepatitis or
palpate structures cholecystitis)
a. Percuss the liver by
placing your left hand flat
against the lower right rib
b. use the ulnar side of
your right fist to strike
your left hand
4. perform blunt Normally no tenderness or Tenderness or sharp pain
percussion on the pain is elicited or reposted elicited over the CVA
kidneys at the by the client suggests kidney infection
costovertebral angles The examiner sense only a (pyelopnephritis), renal
(CVA) over the twelfth rib dull thud calculi
5. Perform light Abdomen is nontender and Involuntary reflex guarding
palpation. soft. There is no guarding is serious and reflects
Light palpation is used to peritoneal irritation
identify areas of tenderness
and muscular resistance The abdomen is rigid and
a. using fingertips, begin the rectus muscle fails to
palpation in a nontender relax with palpation when
quadrant client exhales (it can
b. compress to a depth of 1 involve all or part of the
cm in a dipping motion abdomen but is usually
c. gently lift the fingers and seen on the side (right vs.
move to the next area (to left rather than upper or
minimize voluntary lower)
guarding ( a tensing or
rigidity of the abdominal
muscles usually involving
the entire abdomen)
6. Deeply palpate all Normal (mild) tenderness is Severe tenderness or pain
quadrants to delineate possible over the xyphoid, may be related to trauma,
abdominal organs and aorta, cecum, sigmoid peritonitis. Infection,
detect subtle masses colon and ovaries with tumors or enlarged or
a. using the palmar surface deep palpation diseased organs
of the fingers, compress to
a maximum depth (5 to
b. perform bimanual
palpation if you encounter
resistance or to assess
deeper structures
7. palpate for masses No palpable masses are A mass detected in any
a. note their location, size present quadrant may be due to
(cm), shape, consistency, tumor, cyst, abscess,
pulsatility, tenderness and enlarged organ, aneurysm
mobility or adhesions

8. palpate the aorta The normal aorta is a wide bounding pulse may
a. use your thumb and approximately 2.5 to 3.0 be felt with an abdominal
first finger or use two cm wide with a moderately aortic aneurysm
hands strong and regular pulse a prominent, laterally
b. palpate deeply in the pulsating mass above the
epigastrium, slightly to the umbilicus with an
left of midline accompanying audible
c. assess the pulsation of bruit strongly suggests an
the abdominal area aortic aneurysm
9. palpate the liver The liver is usually not A hard, firm liver may
Note consistency and palpable, although it may indicate cancer
tenderness be felt in some thin clients Nodularity may occur with
If the lower edge is felt, it tumors, metastatic cancer,
BIMANUAL PALPATION should be firm, smooth late cirrhosis
a. stand at the client’s right and even Tenderness may be from
side vascular engorgement,
b. place your left hand hepatitis, abscess
under the client’s back at
the level of eleventh to
twelfth ribs
c. lay your right hand
parallel to the right costal
d. ask the client to inhale
then compress upward and
inward with your fingers

a. stand to the right of the
client’s chest
b. curl the fingers of both
hands over the edge of the
right costal margin
c. ask the client to take a
deep breath and gently but
firmly pull inward and
upward with your fingers


Assessment Procedure Normal Findings Abnormal Findings
1. perform the fluid wave No fluid wave is Movement of a fluid wave
test – a special technique transmitted against the resting hand
to detect ascites suggests large amounts of
a. client should remain fluid are present (ascites)
b. ask the client to place
the ulnar side of the hand
and the lateral side of the
forearm firmly along the
midline of the abdomen
c. firmly place the palmar
surface of your fingers and
hand against one side of
the client’s abdomen
d. use your other hand to
tap the opposite side of the
abdominal wall
1. assess for rebound No rebound tenderness is Abdominal pain and
tenderness (Rovsing’s present tenderness may indicate
Sign) peritoneal irritation
a. palpate deeply in the (appendicitis)
abdomen where the client The client has rebound
has pain then suddenly tenderness when he or she
release pressure perceives sharp, stabbing
b. listen and watch for the pain as the examiner
client’s expression of pain releases pressure from the
c. ask the client to describe abdomen (Blumberg’s sign)
which hurt more (the
pressing in or the
releasing) and where on the
abdomen the pain occurred
2. Assess for Psoas sign No abdominal pain is Pain in the RLQ (Psoas
a. raise the client’s right present sign) is associated with
leg from the hip and place irritation of the iliopsoas
your hand on the lower muscle due to appendicitis
thigh (an inflamed appendix)
b. ask the client to try to
keep the leg elevated as
you apply pressure
downward against the
lower thigh
3. assess for Obturator No abdominal pain in Pain in the RLQ indicates
sign present irritation of the obturator
a. support the client’s right muscle due to appendicitis
knee and ankle or a perforated appendicitis
b. flex the hip and knee
and rotate the leg
internally and externally
1. assess RUQ pain or No increase in pain is Accentuated sharp pain
tenderness, which may present that causes the client to
signal cholecystitis hold his or her breath is a
(inflammation of the positive Murphy’s sign and
gallbladder) is associated with acute
a. press your fingertips cholecystitis
under the liver border at
the right costal margin
b. ask the client to inhale