Assessing The Abdomen

ASSESSING THE
ABDOMEN
PREPARED BY: EMMAN M. PARANGUE, R.N.
ASSESSING THE ABDOMEN
ABDOMEN
• Bordered superiorly by the costal margins
• Inferiorly by the symphysis pubis and inguinal
canals
• Laterally by the flanks
ABDOMINAL QUADRANTS
• Four quadrants - right upper quadrant (RUQ), right lower
quadrant (RLQ), left lower quadrant (LLQ), left upper
quadrant (LUQ)
• 2 imaginary lines (vertical/midline; horizontal/lateral)
• Regions commonly used - epigastric, umbilical, hypogastric

or suprapubic
Right Upper Quadrant
• Ascending and transverse colon
• Duodenum; gall bladder; hepatic flexure of colon;
liver
• Pancreatic head; pylorus; right adrenal gland
• Right kidney; right ureter
Right Lower Quadrant
• Appendix • Right ovary and tube
• Ascending colon; • Right ureter

cecum • Right spermatic cord
• Right kidney
Left Upper Quadrant
• Left adrenal gland • Transverse descending
• Left kidney colon
• Left ureter
• Pancreas, spleen, stomach

Left Lower Quadrant
• Left kidney
• Left ovary and tube
• Left ureter
• Left spermatic cord
• Descending and sigmoid colon
Abdominal Wall Muscles
3 muscle layers from back, around flanks, to front:
external and internal abdominus oblique, transverse

abdominus
Internal Anatomy
• Parietal peritoneum; visceral peritoneum
• Different body systems
– Gastrointestinal
– Reproductive (female)
– Lymphatic, and urinary
Internal Anatomy (Cont’d)
• Solid viscera: liver, pancreas, spleen, adrenal
glands, kidneys, ovaries, uterus
• Hollow viscera: stomach, gallbladder, small

intestine, colon, bladder
Solid Viscera: Liver
• Is the largest solid organ in the body. It is
located below the diaphragm in the RUQ
of the abdomen.
Pancreas
• Located mostly behind the stomach deep in the
upper abdomen.
• Two functions: endocrine gland and accessory

organ of digestion.
Spleen
• 7 cm wide
• Functions: to filter the blood of cellular debris,

to digest microorganisms, and to return the
breakdown products to the liver.
Kidneys
• Are located high and deep under the diaphragm.
• Functions: filtration and elimination of metabolic

waste products.
Uterus and Ovaries
• Pregnant uterus may be palpated above the level
of the symphysis pubis in the midline.
• The ovaries are located in the RLQ and LLQ, and

are normally palpated only during a bimanual
examination of the internal genitalia.
Hollow Viscera: Stomach
• It is a distensible, flask-like organ located in the
LUQ just below the diaphragm and between the
liver and spleen.
• Main function: to store, churn, and digest food.

Gallbladder
• A muscular sac approximately 10 cm long, functions
primarily to concentrate and store the bile
needed to digest fat.
Small Intestine
• Is actually the longest portion of the digestive
tract (approximately 7.0 m long) but is named for
its small diameter.
• Functions: digestion and absorption of nutrients.

Colon
• Or large intestine, has a wider diameter than
the small intestine (approximately 6.0 cm).
• (Ileocecal valve)→ Cecum→ Ascending colon→

transverse colon→ descending colon→ sigmoid
colon
• Palpation of abdominal viscera depends on
location, structural consistency, size
• Viscera normally not palpable
– Pancreas; spleen; stomach, gallbladder,
small intestine
• Vascular structures: abdominal aorta; right
and left iliac arteries
Current Symptoms
• Abdominal pain
• Factors that precipitate pain or make it worse
• Description and location of pain
• Other symptoms
• Recent weight gain or loss
History
Past
– Abdominal surgery/trauma/injury/medications
– Abdominal pain and treatment
– Lab work or gastrointestinal studies
History
Family
– Stomach, colon, liver cancer
– Abdominal pain, appendicitis, colitis, bleeding,
hemorrhoids
– Nutrition responsible in family
Lifestyle and Health Problems
• Smoking • Exercise
• Alcohol use • Stress
• Diet
• Antacid
• Medications
• Fluid intake
Mechanism and Sources of Abdominal Pain
Types of pain
– Visceral
– Parietal
– Referred
Preparing the Client
• Empty the bladder
• Remove clothes and to put on a gown
• Lie supine with the arms folded across the
chest or resting by the sides
Equipment
• Small pillow or rolled blanket
• Centimeter ruler
• Stethoscope (warm the diaphragm and bell)
• Marking pen
ABDOMINAL DISTENTION
ABDOMINAL BULGES
Inspection
• Observe the coloration of the skin
• Note the vascularity of abdominal skin
• Note any striae
• Inspect for scars
• Assess for lesions and rashes
Inspection (Cont’d)
• Inspect
– Umbilicus; abdominal contour; abdominal
movements when client breathes
• Assess abdominal symmetry
• Observe aortic pulsations
• Observe for peristaltic waves
Auscultation
• Auscultate for
– Bowel sounds
– Vascular sounds
– Friction rub over the liver and spleen
Percussion
• Percuss for tone
• Percuss the span or height of the liver by
determining its lower and upper borders
• Percuss the spleen
• Perform blunt percussion on the liver
Palpation
• Perform light palpation
• Deeply palpate all quadrants to delineate

abdominal organs and detect subtle mass
Palpation
• Palpate for masses
• Palpate the umbilicus and surrounding area
for swellings, bulges, or masses
SPECIAL ABDOMINAL TESTS
Palpation (Cont’d)
Palpate
– Aorta
– Liver
– Spleen
– Kidneys
– Urinary bladder
Special Abdominal Tests (Cont’d)
Test for appendicitis
– Rebound tenderness
– Rovsing’s sign
– Referred rebound tenderness
– Psoas sign; obturator sign
– Perform hypersensitivity test

Test for cholecystitis
– Murphy’s sign
– Accentuated sharp pain causes the client
to hold breath
Which test should a nurse perform on a client
with ascites?
a. Fluid wave test
b. Rovsing’s sign
c. Psoas sign
d. Obturator sign
a. Fluid wave test.
The nurse should perform the fluid wave test
on a client with ascites. Rovsing’s sign, psoas
sign, and obturator signs are assessed to test
for appendicitis.
Thank You! God Bless!
Prepare for a post-test and Return Demonstration

Assessing The Abdomen

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ASSESSING THE

• 2 imaginary lines (vertical/midline; horizontal/lateral)

• Regions commonly used - epigastric, umbilical, hypogastric

• Ascending colon; • Right ureter

• Left kidney colon

• Pancreas, spleen, stomach

external and internal abdominus oblique, transverse

• Hollow viscera: stomach, gallbladder, small

• Two functions: endocrine gland and accessory

• Functions: to filter the blood of cellular debris,

• Functions: filtration and elimination of metabolic

• The ovaries are located in the RLQ and LLQ, and

• Main function: to store, churn, and digest food.

• Functions: digestion and absorption of nutrients.

• (Ileocecal valve)→ Cecum→ Ascending colon→

• Small pillow or rolled blanket

• Stethoscope (warm the diaphragm and bell)

• Deeply palpate all quadrants to delineate

– Referred rebound tenderness

– Psoas sign; obturator sign

– Perform hypersensitivity test

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