SUMMARY OF ASSESSMENT TECHNIQUES FOR ABDOMINAL ASSESSMENT

POSITIONING AND PREPARATION Rationale/Purpose

A full bladder will make the examination uncomfortable and can reduce
Instruct client to void prior the start of procedure. the accuracy of the fundal height measurement.

Position the client in a supine position with arms folded over the chest or at the sides.
Place a pillow underneath the client's knees to slightly flex the knees.
Cover the upper and lower body parts of with a bed sheet,leaving the abdomen
exposed from xiphoid process to just above the symphysis pubis. Confirm abdominal
The described position helps ensure abdominal muscle relaxtion to avoid
putting additional pressure over the abdomen.
This allows full visualization and access to client's abdomen. Verify presence
and location of abdominal pain to assess the area last.

pain location, if present.

INSPECTION
Abdominal Skin Characteristics
Assess for the abdominal skin tempertaure, color, scars, striae, vascuarities, rashes,
ecchymoses and other lesion. Note for its characteristics (size, shape, color, texture,
location, and presence of discharge).
Umbilicus, Buldges and Mass
Observe for umbilical location, color and contour including presence of mass or
buldges suggesting of ventral hernia. Emphasize for any buldging or mass by
having the client flex his head.
Abdominal Contour and Symmetry.
Contour:
While the client lies flat /supine on the bed, sit beside the client. Look across the
abdomen at a level slightly higher than the client's abdomen.
Symmetry
While standing at the foot of the bed, observe for abdominal symmetry while client
lies in a relaxed position.
Measure abdominal girth:
Measured the abdominal girth by placing a tape around the abdomen at the
level of the umbilicus.
Observe for abdominal movements.
Observe for abdominal respiratory movements, aortic pulsations and peristalsis.

AUSCULTATION
Bowel sounds
Recent intake could have increased peristaltic activity. Warm hands and
Ask for client's last intake. Warm hands and the diaphragm of the stethoscope the steth to avoid startling the client of the coldness of the steth.

Auscultate each of the four abdominal using the diaphragm for at least one minute
beginning at the right lower quandrant proceeding in a clockwise direction noting for
the intensity, pitch and frequency of bowel sounds. Use light pressure when
auscultating painful/tender areas.
Vascular Sounds
Use the bell of the stethoscope to listen for: Use bell because bruit and venous hum are low-pitched
(a) Bruits at over the abdominal aorta and renal, iliac, and femoral arteries sounds. See sites of auscultation in the PPT
(b) Venous hum in the epigastric and umbilical areas
Peritoneal Friction Rubs
Use diaphragm because friction rub is high-pitched sounds.
Use the diaphragm of the stethoscope to listen for friction rub over the liver and
See sites of auscultation in the PPT
spleen.
PERCUSSION
Abdominal Tone
To determine areas of dullness and tympany. See pattern of
Percuss several areas in each of the four quadrants to determine presence of
percussion in the PPT
tympany and dullness following a systematic patter.
Vertical Liver Span at Midclavicular Line This is done to evaluate liver size and assess for
(a) Lower border or Liver Dullness hepatomegaly.
Starting RLQ along the midclavicular line, percuss upward toward the liver. Note
the change from tympany to dullness and mark this point.
(b) Upper Border of Liver Dullness
Begin percussion on the right midclavicular line at an area of lung resonance
around the third intercostal space. Continue downward until the percussion tone
changes to from resonance to liver dullness and mark this point.

(c) Measure the distance between the two points

Vertical Liver Span at Midsternal Line
(a) Lower border of Liver Dullness
Starting just above the umbilicus, percussed upward toward the liver along the
midsternal line. Noted the change from tympany to dullness and marked this
point.

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 (b) Upper Border of Liver Dullness
Begin percussion at the body of the sternum along the third intercostal space
and continue downward until the percussion tone changes from flat to liver
dullness and mark this point.
(c) Measure the distance between the two points
Liver Descent
(a) Ask the client to take a deep breath and hold it while percussing from the
RLQ along the midclavicular line toward the liver. Note the change from
tympany to liver dullness and mark this point. Done to evaluate for hepatic enlargement and displacement
(b) Ask the client to exhale and measure the distance of point of lower border
liver dullness during deep inhalation from the right costal margin along the mid-
clavicular line.
Spleen (as shown in the LD video)
(a) Reposition the patient to right side-lying position with left knee flexed and
identify the left anterior axillary line.
(a) To assess the sides of the spleen, percuss the left anterior chest wall roughly
from the border of cardiac dullness at the 6th rib to the anterior axillary line and To evaluate for splenomegaly
down to the costal margin. Percuss for tympany and dullness.

(c) Check for a splenic percussion sign.

Percussed the lowest interspace in the left anterior axillary line. Then asked the
client to take a deep breath, and percussed again.
Liver Blunt Percussion
While client is lying suping, percuss the liver by placing the left hand flat against
To assess for liver tenderness if liver is difficult to palpate
the lower right anterior rib cage, use the ulnar side of the right fist to strike the left
hand and ask for any pain.
Kidney Punch
Reposition the patient to sitting position and placed left hand at the
To assess for kidney tenderness
costovertebral angle over the twelfth rib, use the ulnar side of the right fist to
strike the left hand and ask for any pain.
Test for Ascites To assess for ascites
Test for Shifting Dullness
(a)While client is in a supine position, percuss the flanks from the bed upward
toward the umbilicus, noting the change from dullness to tympany and mark this
point.
(b)Reposition the patient to a sidelying position, percuss the abdomen from bed
upward, noting the change from dullness to tympany
Fluid Wave Test
(a)While client is in a supine position, ask the client or an assistant to press the
edges of both hands firmly down the midline of the abdomen.
(b) Tap one flank sharply with fingertips, feel for a fluid wave transmitted across
the abdomen to opposite flank.
PALPATION
Light Palpation
With client lying relaxed in a supine position, begin with a light, systematic
palpation of all four quadrants, or nine regions, using the fingerpads, initially To assess for tenderness and presence of mass
avoiding any areas that the patient had identified as painful. Observe for reports
of pain, tenderness, guarding behavior and masses.
Deep Palpation
Compress the abdoment to a maximum depth (5–6 cm) using the palmar
Done to feel for internal organs and masses
surface of the hands, initially avoiding the painful areas and palpated for muscle
resistance or masses.
Umbilicus and Surrounding Area
Perform moderate palpation at the umbilical ring noting fro any presence of To assess for tenderness and presence of mass
masses, swelling, nodules, and granulation.
Abdominal Aorta
Use thumb and index finger or used both hands to deeply palpate the To assess for abdominal aortic pulsation which may indicate
epigastrium, slightly to the left midline for presence of abdominal aortic possibility of abdominal aortic aneurysm
pulsations
Liver
(a) Place the left hand under the client's back at the level of the 11th and 12th
ribs while the right hand is laid parallel to the right costal margin with fingertips To assess for liver contour, surface, presence of nodules,
pointing toeards client's head. tenderness and irregularity
(b) Instruct client to take a deep breath, then compressed the fingertips upward
and inward to the lower border of the liver and assess for contour, surface,
presence of nodules, tenderness, and irregularity

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 (c)Palpated the liver by hooking (alternative technique)
Stand on the client's right side facing his or her feet. Press in and up toward the
costal margin with your fingers, and ask the patient to take a deep breath, To assess for liver contour, surface, presence of nodules,
gently and firmly pull inward and upward with the fingers. Palpate for the liver tenderness and irregularity
edge as it descends to meet the fingers noting for contour, surface, presence of
nodules, tenderness, and irregularity.
Spleen
(a) Stand at the client's right side. Reach over the abdomen with left hand under
the posterior lower ribs and pulled up gently. Place the right hand below the left
costal margin, pressed in toward the spleen.
(b) Ask the client to take a deep breath then press inward and upward using To assess for splenomegaly
the right hand as the left hand provided support.
(c) Begin palpation below the costal margin and tried to feel the tip or edge of
the spleen as it comes down to meet the fingertips. Note for any tenderness and
assessed the splenic contour.
Repeat the procedure with the client lying on the right side with legs somewhat Repositioning the patient allows better access to the spleen
flexed at the hips and knees as needed
Kidneys
(a) Stand at the patient’s right side, placed the left hand under the patient’s
right posterior flank and the right hand at the right costal margin at the MCL.

(b) Instruct the client to take a deep breath then compressed the fingers duing
peak inspiration. To assess for kidney enlargement
(d) Ask the client to exhale and hold his/her breath briefly and gradually release
the pressure of right hand to feel the righy kidney slipping beneath the fingers.

(e) Palpate the left kidney with the procedure reversed.

Urinary Bladder
Begin palpating at the symphysis pubis and move upward and outward to To assess for extent of distention
estimate bladder borders.
Test for Appendicitis/Peritoneal Irritation
Rebound Tenderness (Blumberg's Sign)
(a) Palpate deeply at 90 degrees into the abdomen halfway between the
umbilicus and the anterior iliac crest (McBurney's Point). Then suddenly release
pressure.
(b) Listen and watch for the client's expression of pain. Ask the client to describe
which hurt more - the pressing in or the releasing - and where on the abdomen
the pain occurred.
Referred Rebound Tenderness (Rovsing's Sign)
Palpate deeply in the LLQ and quickly release pressure. Assess for pain location.

Test for Psoas Sign

Reposition to left side-lying position and hyperextend client's right leg.
See images of the technique in the PPT
Test for Obturator Sign
Support the client's right knee and ankle and flex the hip and knee, and rotate
the leg internally and externally.
Hypersensitivity Test
Position client supine with knees slightly flexed supported by a pillow underneath.
Stroke the abdomen with a sharp object (e.g., broken cotton tipped applicator
or tongue blade) or grasp the fold of skin with your thumb and index finger and
quickly let go. Do this several times along the abdominal wall. Note for
complaints of pain or exaggerated sensation.
Test for Murphy's Sign (Test for Cholecystitis)
Press your fingertips under the liver border at the right costal margin and ask the
client to inhale deeply. Note for any increase in pain felt.

Please see PPT for the normal and abdnormal findings.

Sample Documentation:
Physical Exam Findings: Abdominal skin is tan, free of striae, scars, lesions, or rashes. Umbilicus is midline and recessed with no bulges. Abdomen is round,
distended, symmetric, and without bulges or lumps. No diastasis recti noted with neck flexion. No respiratory movement, peristaltic waves, or aortic pulsations
noted. Bowel sounds (10 per minute) present with moderately pitched gurgles × 4 quadrants. No bruits, venous hums, or friction rubs auscultated. Percussion
reveals generalized tympany with dullness over the liver, spleen, and descending colon. Liver span is 8 cm at the MCL and 6 cm at the MSL. No tenderness with
blunt percussion over the liver or kidneys. No abdominal tenderness or guarding with light palpation. Mild tenderness over the xiphoid, aorta, cecum, and
sigmoid colon with deep palpation. No rebound tenderness. Palpable firm mass noted in LLQ. Liver, spleen, kidneys, and urinary bladder not palpable. No
evidence of fluid wave or shifting dullness. No ballottable masses. Negative psoas sign, obturator sign, Rovsing’s sign and Murphy’s sign.

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