▪ Ask client to void before examining the abdomen

▪ R: a full bladder can interfere with abdominal assessment

▪ Place client in supine position with arms at sides or at the
center of the chest
▪ Place a small pillow under the client’s knees to relax the
abdominal muscles
▪ Because percussion and palpation can alter intestinal
activity, assess the abdomen in the following sequence:
inspection, auscultation, percussion and palpation.
▪ Note condition of the skin and abdominal contour - the
skin should be smooth and intact with varying
amounts of hair.
▪ Contour should be flat, concave, or rounded
depending on the client’s body type.
▪ Note any areas of distention or irregular contour –
suggests obstruction, hernia, tumor or previous surgery
▪ Bulging flanks and glistening, taut skin are abnormal
findings and suggest ascites.
▪ Inspect for rashes, discoloration, scars, petechiae,
striae (stretch marks) and dilated veins.
▪ Scars – should correlate with history of past
surgical procedures.
▪ Striae – indication of changes in weight, should
correlate with reported changes in weight.
▪ Note shape, position, color and presence of any
discharge at the umbilicus.
▪ The umbilicus should be concave, located at the
midline, with no evidence of drainage and the same
color as the abdominal skin.
▪ Observe for peristaltic movement or abdominal
pulsation.
▪ Normally, peristaltic movements are not visible but
abdominal pulsations may be observed in a very
thin client.
▪ Ask client to raise head and shoulders off the table and
observe for a raised ridge or bulge between the rectus
abdominal muscle.
▪ This raised ridge, known as diastasis recti, is a separation of
the rectus muscle caused by conditions of sustained intra-
abdominal pressure such as obesity or pregnancy.
▪ Diastasis recti is not a true hernia and for most clients, of no
clinical significance.
▪ Inspection and examination of the rectal area occurs after the
abdominal examination.
▪ Note the frequency and character of bowel sounds.
▪ Normal bowel sounds occur irregularly at a rate of
5 to 35 per minute.
▪ Loud, high pitched bowel sounds (borborygmi)
represent hyperactivity of the GI tract.
▪ Borborygmi may be present in clients who are
hungry or who have gastroenteritis or they may be
present in early intestinal obstruction.
▪ Auscultation of the abdomen follows inspection, so
the abdomen is already exposed. When conducting
auscultation, begin in the right lower quadrant and
progress clockwise to the right upper quadrant, left
upper quadrant, and the left lower quadrant.

▪ RLQ RUQ LUQ LLQ

▪ Hypoactive bowel sounds occur at a rate of one or
fewer every minute.
▪ To determine the absence of bowel sounds, listen for a
total of 5 minutes or at least 1 minute per quadrant.
▪ Absence of bowel sounds does not mean absence of
bowel peristalsis.
▪ Hypoactive or absent bowel sounds indicate the need
for further assessment of bowel function.
▪ Using the bell of stethoscope, auscultate abdomen
for vascular sounds.
▪ A bruit, a venous hum, and a friction rub are
examples of abnormal sounds that may be
auscultated during the examination.
▪ Bruits are auscultated over major blood vessels
indicate turbulent blood flow, such as aneurysm or
partial obstruction of a vessel.
▪ A continuous venous hum heard in the
periumbilical area indicates engorged liver
circulation.
▪ Friction rubs sound like two pieces of leather
rubbing together and suggest hepatic tumor when
heard loudest over the lower right rib cage or
splenic inflammation when heard loudest over
the lower ribcage in the anterior axillary line.
▪ Percuss the abdomen to determine the size and
location of abdominal organs to detect fluid, air or
masses.
▪ Percuss all quadrants or regions, and compare the
sounds to expected findings.
▪ Normally, high-pitched, loud, or “musical”
(tympanic) sounds are heard over gaseous areas
and dull (thud-like) sounds are heard over fluid or
solid organs.
▪ Percussion can be used to determine the size and
position of the liver and spleen and to assess the
level of distended bladder.
▪ Do not percuss the abdomen if you suspect an
abdominal aneurysm or if the client has undergone
abdominal organ transplant.
▪ Palpate the abdomen in a systematic, quadrant to
quadrant, region to region manner, beginning with non
tender areas and progressing to painful ones.
▪ Start with light palpation, depressing 1 to 2 cm.
▪ Palpate for masses or areas of tenderness. Note any
areas of involuntary abdominal rigidity or guarding.
▪ McBurney’s point is located in the right lower
quadrant midway between the umbilicus and the
anterior iliac crest. Localization of pain in this area
suggests appendicitis.
▪ Use deep palpation to determine the size and shape of
abdominal organs and masses.
▪ Use caution when examining any tender areas.
▪ Rebound tenderness suggests peritoneal
inflammation.
▪ To elicit rebound tenderness, depress the abdomen
deeply over the area of tenderness and then quickly
release it. If rebound tenderness is present, the client
feels an increase in pain and tenderness upon release.
▪ Provide information about the nature and severity of
upper GI tract or nutritional problems.
▪ Laboratory tests, radiography, ultrasonography,
endoscopy, cytology, gastric analysis and other
tests are commonly used.
▪ Radiography is the most widely used diagnostic
procedure for the study of soft tissues and bones.
▪ A radiograph, commonly called an “x-ray”, is an
image of a negative film made by exposing the film
to x-rays that have passed through the body.
▪ Tissue is called radiopaque when transmission of x-
rays is partially blocked. Bones appear white on x-
ray film.
▪ Tissues are radiolucent when they allow x-rays to
penetrate.
▪ Upper gastrointestinal series
▪ Also known as a Barium Swallow, permits
radiologic visualization of the pharynx, esophagus,
stomach, duodenum, and jejunum.
▪ It can aid in the detection of strictures, ulcers,
tumors, polyps, hiatal hernias, or motility
problems.
▪ Dysphagia and obstruction (swallowing disorder)
▪ GERD
▪ Mediastinal masses
▪ Heart burn
▪ Persistent vomiting
▪ Assessment of fistula
▪ Regurgitation
▪ Tumors, ulcers, precancerous growth
▪ Enlarged esophageal veins
▪ Allergy to contrast media
▪ Perforation
▪ Aspiration
▪ Tracheoesophageal fistula
▪ The client drinks a radiopaque contrast medium
(barium) while standing in front of a fluoroscopy
tube.
▪ The client may also be asked to assume other
positions, such as lying on the x-ray table and
turning left or right.
▪ To prevent the swallowed barium from interfering
with tests such as barium enemas and gallbladder
radiographs, a barium swallow is usually done last.
▪ Single Contrast
▪ Thin Barium – 100% w/v
▪ 60 ml to 70 ml

▪ Double Contrast
▪ Thick Barium – 200% w/v to 250% w/v
▪ 15 ml to 20 ml
▪ Low fiber diet 2-3 days before the test
▪ NPO (food or fluids) for 6 – 8 hours before test
▪ Instruct client about procedure and barium
preparation.
▪ Barium has thick consistency and chalky taste
▪ Drink up to 16 ounces of barium for the
procedure
▪ Test last about 45 minutes
▪Laxative is given to help expel the barium
and prevent fecal impaction.
▪Assess abdomen for distention and observe
stool to determine whether barium has been
eliminated.
▪Initially stool is white, but should return to
normal brown color within 72 hours
▪A distended abdomen and constipation may
indicate barium impaction.
▪Client with ostomies should be closely
monitored for retained barium.
▪Because the barium swallow is commonly
performed on an outpatient basis, inform the
client that the stool maybe white for up to 72
hours after the procedure.
▪Contact physician immediately if constipation
and abdominal distention occur.
▪ Also known as videofluoroscopy or an
oropharyngeal motility study, is performed to
assess swallowing and the risk of aspiration.
▪ Client sitting in a chair equipped with
videofluoroscopy
▪ Asked to swallow small amount of barium mixed in
liquids and foods of various textures.
▪ During the procedure, a speech therapists or
radiologist observes the client for difficulty with
swallowing.
▪Clients are maintained on NPO status before
the procedure.
▪Maintain hydration with intravenous fluids if
client is expected to remain NPO for an
extended period.
▪Nothing should be ingested by mouth until
the speech therapist, radiologist or physician
has evaluated the test results.
▪If diet alterations, consult a registered
dietitian, speech therapist, or both to be
collaboratively develop an appropriate and
adequate nutrition plan.
▪It is administered for the radiographic
animation (with or without fluoroscopy) of the
large intestine.
▪Barium sulfate (single-contrast technique)
or Barium sulfate and air (double contrast
technique) are instilled rectally.
▪The test is indicated for clients with a history
of altered bowel habits; lower abdominal
pain; or passage of blood, mucus, or pus in
the stools.
▪The test helps to detect tumors, diverticula,
stenoses, obstructions, inflammation,
ulcerative colitis and polyps.
▪ Adequate preparation is essential
▪ Low residue or clear liquid diet for 2 days
before the test to reduce feces volume.
▪ Potent laxative and oral liquid preparation is
given for cleaning the bowel the day before the
test.
▪ NPO (nil per os, nothing by mouth) after
midnight
▪ The morning of examination, a suppository or
cleansing enema may be administered.
▪ If active bleeding or an ileostomy, different bowel
preparations may be needed.
▪ If ultrasonography, abdominal scan or
colonoscopy is also indicated, it should be
performed first because barium interferes with
these tests.
▪ Duration of procedure: 60 – 90 minutes,
uncomfortable
▪ Barium impaction is a serious complication after
lower GI series.
▪ Laxative or cleansing enema is often given after
the test to empty the large bowel.
▪ Stools are white for 24 – 72 hours after the
examination.
▪ Encourage increase fluid intake to prevent fecal
impaction
▪ Instruct to report any pain, bloating or absence of
stool or bleeding.
▪It is an x-ray (radiograph) of the abdominal
organs. Organs include the spleen, stomach,
and intestines.
▪Identify abnormalities, such as tumors,
obstructions, abnormal gas or fluid
collections and strictures.
▪The client may be required to lie flat or sit in
the upright position for the x-ray.
▪The test is done in a hospital radiology
department. Or, it may be done in the health
care provider's office by an x-ray
technologist.
▪Men will have a lead shield placed over the
testes to protect against the radiation.
▪You lie on your back on the x-ray table. The x-
ray machine is positioned over your
abdominal area. You hold your breath as the
picture is taken so that the picture will not be
blurry. You may be asked to change position
to the side or to stand up for additional
pictures.
▪No discomfort
▪ You wear a hospital gown during the x-ray
procedure. You must remove all jewelry.
▪ Tell your provider the following:
▪ If you are pregnant or think you could be pregnant
▪ Have an IUD inserted
▪ Have had a barium contrast x-ray in the last 4 days
▪ If you have taken any medicines such as Pepto
Bismol in the last 4 days (this type of medicine can
interfere with the x-ray)
▪The x-ray will show normal structures for a
person your age.
▪ Abdominal masses
▪ Buildup of fluid in the abdomen
▪ Certain types of gallstones
▪ Foreign object in the intestines
▪ Hole in the stomach or intestines
▪ Injury to the abdominal tissue
▪ Intestinal blockage
▪ Kidney stones
▪It helps to identify pathophysiologic
processes in the pancreas, liver, gallbladder,
spleen and retroperitoneal tissues.
▪Used to identify fluid, masses (such as
tumors), adipose tissues, abscesses, and
hematomas.
▪ Physical examination is enhanced by ultrasound
techniques because palpable masses and areas of
tenderness can be correlated with anatomic
structures while the client is on the examining
table.
▪ NPO for 8 – 12 hours – gas may interfere with the
procedure
▪ Reassure client test is painless and safe.
▪ No specific Postprocedure precautions or
observations related to ultrasound.
▪a noninvasive procedure that uses powerful
magnets and radio waves to produce pictures
of the inside of the abdomen without
exposure to ionizing radiation (x-rays).
▪MRI uses radio waves very close in frequency
to those of ordinary FM radio stations, so the
scanner must be located within a specially
shielded room to avoid outside interference.
▪ The patient lies on a narrow table which slides
into a large tunnel-like tube within the scanner.
▪ An IV may be placed in a small vein of the hand or
forearm, if contrast medium will be used.
▪ Operated by a technologist.
▪ Several sets of images are usually required, each
taking from 2-15 minutes.
▪ Duration: 1 hour or more
▪No preparatory tests, diets, or medications are
usually needed, unless the colon needs to be
cleansed (with preparations such as a laxative
or an enema).
▪An MRI can be performed immediately after
other imaging studies. Depending on the area
of interest, the patient may be asked to fast
for 4 to 6 hours prior to the scan.
▪Certain metallic objects are not allowed into
the room. Items such as jewelry, watches, credit
cards, and hearing aids can be damaged.
▪Pins, hairpins, metal zippers, and similar
metallic items can distort the images.
▪Removable dental work should be taken out
just prior to the scan. Pens, pocketknives, and
eyeglasses can become dangerous
projectiles.
▪People with cardiac pacemakers cannot be
scanned and should not enter the MRI area.
▪Contraindicated to people with metallic
objects in their bodies such as inner ear
(cochlear) implants, brain aneurysm clips,
some artificial heart valves, older vascular
stents, and recently placed artificial joints.
▪CT Scanning is used to identify masses, such
as neoplasms, cysts, focal inflammatory lesions,
and abscess of the liver, pancreas, and pelvic
areas.
▪Also aids in evaluating local tumor spread,
especially if barium studies suggest tumor
growth beyond the bowel wall.
▪ To distinguish normal bowel from abnormal
intraperitoneal masses, dilute oral barium or other
contrast media may be administered.
▪ The client is place in supine on the examination table
and asked to lie still and hold breath when instructed.
▪ NPO for 6 – 12 hours before the procedure.
▪ Report any history of allergies to iodine. Non iodine
contrast may be used when allergic to iodine.
▪ No follow up care needed. Painless, primary discomfort
may be from the need to lie still on the table.
▪Gastric emptying scan
▪ to determine how quickly the stomach
empties.
▪Bleeding Scan
▪ determine the location of bleeding in the
digestive tract.
▪Meckel scan
▪ to identify a small intestine problem called a
Meckel diverticulum.
▪ Gastric emptying study, also known as a gastric emptying
scan, or gastric emptying scintigraphy.
▪ A test to determine the time is takes a meal to move
through a person’s stomach. It is typically ordered by
physicians for patients with frequent vomiting,
gastroparesis, abdominal pain, early satiety and pre-
operative evaluation.
▪ NPO after midnight. The client should not eat or drink
anything after midnight the day before the test, and until
after the test is completed.
▪ You will start by eating a light meal, often eggs (scrambled)
and toast together with water. The food will contain a small,
harmless amount of radioactive material called a tracer.
▪ After you finish eating, you will lie down on an x-ray table.
▪ The radiologist will take images of your abdomen, using a
scanning device.
▪ The radiologist will watch the movements of the radioactive
tracer on a monitor. The tracer will show how food travels
through your stomach.
▪ Additional images will be taken over the next few hours to
see how long it takes for food to move out of your stomach
and into your gastrointestinal tract.
▪ You will be allowed to get up and leave the exam room
during this time period.
▪ Your provider will let you know when you need to return for
imaging. It's usually at around 1, 2, and 4 hours after the first
image was taken.
▪ A GI bleeding scan is an imaging test that can help detect the
origin of gastrointestinal bleeding.
▪ During the test, blood (3-5ml) will be drawn from the vein. The
drawn blood will be mixed with a radiopharmaceutical
(radioactivetracer) called Technetium-99m for 30 minutes. The
blood cells will then be reinjected into your client’s vein by the
same technologist who took client’s blood.
▪ A special camera, called a gamma camera, is used to take
pictures of the abdomen once the blood cells have been
reinjected.
▪ Duration: approximately 2 hours.
▪ A GI bleeding scan may be done when client is vomiting
blood or passing blood in her stool. The scan can detect
and localize a small amount of bleeding providing it occurs
during the time of the exam.
▪ There is no patient prep needed for this exam.
▪ A diagnostic imaging procedure that detects the
abnormally-located gastric mucosa.
▪ A radiopharmaceutical called Technetium-99m is injected
into client’s veins. Technetium-99m has a tiny amount of
radioactive molecules in it.
▪ A special camera, called a gamma camera, is used to take
pictures of the abdomen once the radiopharmaceutical has
been injected.
▪ Common to children