Assignment For Health Assessment

Abdominal Assessment

Name:Kathleen Ellize Lumabi Betchayda Year/Section:1-BSN D Date: May 19, 2022

Please answer the following:

1. Identify the different quadrants, regions of the abdomen, abdominal muscles, and
abdominal viscera.

QUADRANTS:
1. Right Upper Quadrant
2. Left Upper Quadrant
3. Right Lower Quadrant
4. Left Lower Quadrant
ABDOMINAL REGIONS
1. Right Hypochondriac region
2. Epigastric region
3. Right Hypochondriac region
4. Right Lumbar region
5. Umbilical region
6. Left Lumbar region
7. Right iliac (inguinal region)
8. Hypogastric region
9. Left iliac (inguinal region)

ABDOMINAL MUSCLES AND

VISCERA
 ABDOMINAL MUSCLES

1. Rectus Abdominis
2. Linea alba
3. Umbilicus
4. Xiphoid muscles
5. Costal margin
6. External oblique
7. Internal oblique
8. Transverse abdominis
9. Abdominal aponeurosis

ABDOMINAL VISCERA
1. Parotid Gland 13. Descending colon
2. Oral Cavity 14. Sigmoid colon
3. Sublingual gland 15. Rectum
4. Submandibular gland 16. Anus
5. Trachea 17. Vermiform Appendix
6. Esophagus 18. Ascending colon
7. Diaphragm 19. Pancreatic duct
8. Stomach 20. Duodenum
9. Spleen 21. Common bile duct
10. Pancreas 22. Gallbladder
11. Transverse colon 23. Liver
12. Small intestine 24. Pharynx

2. What are the normal and abnormal findings during an inspection, palpation, percussion of the
abdomen?

ASSESSMENT Normal Findings Abnormal Findings

PROCEDURE

Inspection

Observe the coloration Abdominal skin may be paler than
of the skin the general skin tone because this
skin is so seldom exposed to the
natural elements.
● Purple discoloration at the flanks (Grey-Turner
sign) indicates bleeding within the abdominal
wall, possibly from trauma to the kidneys,
pancreas, or duodenum or from pancreatitis.
● The yellow hue of jaundice may be more
apparent on the abdomen. Pale, taut skin may be
seen with ascites (significant abdominal swelling
indicating fluid accumulation in the abdominal
cavity).
● Redness may indicate inflammation.

Note the vascularity of Scattered fine veins may be visible.
the abdominal skin. Blood in the veins located above
the umbilicus flows toward the
head; blood in the veins located
below the umbilicus flows toward
the lower body.
Note any striae New striae are pink or bluish in
(stretch marks) color; old striae are silvery, white,
linear, and uneven stretch marks
from past pregnancies or weight
gain
Inspect for scars Pale, smooth, minimally raised old
scars may be seen
Assess for lesions and Abdomen is free of lesions or
rashes. rashes. Flat or raised brown moles,
however, are normal and may be
apparent.
Observe umbilical Umbilicus is midline at lateral line
location.
Assess the contour of It is recessed (inverted) or
the umbilicus. protruding no more than 0.5 cm,
and is round or conical.
Inspect abdominal Abdomen is flat, rounded, or
contour scaphoid (usually seen in thin
adults; Fig. 23-10). Abdomen should
be evenly rounded.
● Bruises or areas of local discoloration are also
abnormal
● Dilated veins may be seen with cirrhosis of the
liver, obstruction of the inferior vena cava, portal
hypertension, or ascites.
● Dark bluish-pink striae are associated with
Cushing’s syndrome.
● Striae may also be caused by ascites, which
stretches the skin. Ascites usually result from liver
failure or liver disease.
● Non Healing wounds, redness, inflammation.
Deep, irregular scars may result from burns
● Changes in moles including size, color, and border
symmetry. Bleeding moles or petechiae (reddish
or purple lesions) may also be abnormal
● Inspect the umbilicus. Note the color of the
umbilical area. Umbilical skin tones are similar to
surrounding abdominal skin tones or even
pinkish. Cullen’s sign: A bluish or purple
discoloration around the umbilicus (periumbilical
ecchymosis) indicates intra-abdominal bleeding.
Grey-Turner’s sign: bluish or purplish
discoloration on the abdominal flanks.
● A deviated umbilicus may be caused by pressure
from a mass, enlarged organs, hernia, fluid, or
scar tissue.
● An everted umbilicus is seen with abdominal
distention (Abnormal Findings 23-1, p. 503). An
enlarged, everted umbilicus suggests umbilical
hernia.
● A generalized protuberant or distended abdomen
may be due to obesity, air (gas), or fluid
accumulation (Abnormal Findings 23-1, p. 503).
Distention below the umbilicus may be due to a
full bladder, uterine enlargement, or an ovarian
tumor or cyst. Distention of the upper abdomen
may be seen with masses of the pancreas or
gastric dilation.
Assess abdominal Abdomen is symmetric
symmetry
Further assessment Abdomen does not bulge when
client raises head
Inspect abdominal Abdominal respiratory movement
movement when the may be seen, especially in male
client breathes clients
(respiratory
movements).
Observe aortic Observe aortic pulsations
pulsations
Observe for peristaltic Normally, peristaltic waves are not
waves seen, although they may be visible
in very thin people as slight ripples
on the abdominal wall.
Auscultate for bowel A series of intermittent, soft clicks
sounds. and gurgles are heard at a rate of
5–30 per minute. Hyperactive
bowel sounds referred to as
“borborygmus” may also be heard.
These are the loud, prolonged
gurgles characteristic of one’s
“stomach growling.”
Auscultate for vascular Bruits are not normally heard over
sounds abdominal aorta or renal, iliac, or
femoral arteries. However, bruits
confined to systole may be normal
in some clients depending on other
differentiating factors.
● Asymmetry may be seen with organ
enlargement, large masses, hernia, diastasis recti,
or bowel obstruction.
● A hernia (protrusion of the bowel through the
abdominal wall) is seen as a bulging in the
abdominal wall. Diastasis recti appears as a
bulging between a vertical midline separation of
the abdominis rectus muscles. This condition is of
little significance. An incisional hernia may occur
when a defect develops in the abdominal muscles
because of a surgical incision. A mass within the
abdominal wall is more prominent when the head
is raised, whereas a mass below the abdominal
wall is obscured (Abnormal Findings 23-2, p. 504).
● Diminished abdominal respiration or change to
thoracic breathing in male clients may reflect
peritoneal irritation.
● Vigorous, wide, exaggerated pulsations may be
seen with abdominal aortic aneurysm.
● Peristaltic waves are increased and progress in a
ripple-like fashion from the LUQ to the RLQ with
intestinal obstruction (especially small intestine).
In addition, abdominal distention typically is
present with intestinal wall obstruction
● Decreased or absent bowel sounds signify the
absence of bowel motility, which constitutes an
emergency requiring immediate referral.
● Decreased or absent bowel sounds signify the
absence of bowel motility, which constitutes an
emergency requiring immediate referral.
● A bruit with both systolic and diastolic
components occurs when blood flow in an artery
is turbulent or obstructed. This may indicate an
aneurysm or renal arterial stenosis (RAS). When
blood flows through a narrow vessel, it makes a
whooshing sound, called a bruit. However, the
absence of this sound does not exclude the
possibility of RAS.
 ● For a more accurate diagnosis, an ultrasound or
an angiogram is needed.

Listen for venous hum Venous hum is not normally heard
over the epigastric and umbilical
areas
● Venous hums are rare. However, an accentuated
venous hum heard in the epigastric or umbilical
areas suggests increased collateral circulation
between the portal and systemic venous systems,
as in cirrhosis of the liver.

Auscultate for a No friction rub over the liver or ● Friction rubs are rare. If heard, they have a high
friction rub over the spleen is present. pitched, rough, grating sound produced when the
liver and spleen. large surface area of the liver or spleen rubs the
peritoneum. They are heard in association with
respiration.
● A friction rub heard over the lower right costal
area is associated with hepatic abscess or
metastases.
● A rub heard at the anterior axillary line in the
lower left costal area is associated with splenic
infarction, abscess, infection, or tumor

Percussion

Percuss for tone. Generalized tympany predominates ● Accentuated tympany or hyperresonance is heard
over the abdomen because of air in over a gaseous distended abdomen.
the stomach and intestines.
Dullness is heard over the liver and
spleen

Percuss the span or The lower border of liver dullness is

height of the liver by located at the costal margin to 1 to
determining its lower 2 cm below
and upper borders.
On deep inspiration, the lower
border of liver dullness may
descend from 1 to 4 cm below the
costal margin.

To assess the upper The upper border of liver dullness is ● The upper border of liver dullness may be difficult
border, percuss over located between the left fifth and to estimate if obscured by pleural fluid of lung
the upper right chest seventh intercostal spaces. consolidation
at the MCL and
percuss downward,
noting the change
from lung resonance
to liver dullness. Mark
this point: It is the
upper border of liver
dullness

Measure the distance The normal liver span at the MCL is ● Hepatomegaly, a liver span that exceeds normal
between the two 6–12 cm (greater in men and taller limits (enlarged), is characteristic of liver tumors,
marks: this is the span clients, less in shorter clients). cirrhosis, abscess, and vascular engorgement.
of the liver (Fig. 23-15) ● Atrophy of the liver is indicated by a decreased
span. 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, or a paralyzed
diaphragm.
● A liver in a lower or higher position should have a
normal span (Abnormal Findings 22–3, p. 505).

Repeat percussion of The normal liver span at the MSL is ● An enlarged liver may be roughly estimated (not
the liver at the 4–8 cm accurately) when more intense sounds outline a
midsternal line (MSL). liver span or borders outside the normal range.

Percuss the spleen. The spleen is an oval area of ● Splenomegaly is characterized by an area of
dullness approximately 7 cm wide dullness greater than 7 cm wide. The
near the left tenth rib and slightly enlargement may result from traumatic injury,
posterior to the MAL portal hypertension, and mononucleosis

A second method for Normally, tympany (or resonance) is ● On inspiration, dullness at the last left interspace
detecting splenic heard at the last left interspace at the AAL suggests an enlarged spleen (Abnormal
enlargement is to Findings 23-3, p. 505).
percuss the last left
interspace at the
anterior axillary line
(AAL) while the client
takes a deep breath
(Fig. 23-16, p. 492)

Perform blunt Normally, no tenderness is elicited ● Tenderness elicited over the liver may be
percussion on the liver associated with inflammation or infection (e.g.,
and the kidneys hepatitis or cholecystitis)

Perform blunt Normally, no tenderness or pain is ● Tenderness or sharp pain elicited over the CVA
percussion on the elicited or reported by the client. suggests kidney infection (pyelonephritis), renal
kidneys at the The examiner senses only a dull calculi, or hydronephrosis.
costovertebral angles thud.
(CVA) over the twelfth
rib (Fig. 23-17)
Palpation

Perform light palpation Abdomen is nontender and soft.
There is no guarding
● Involuntary reflex guarding is serious and reflects
peritoneal irritation. The abdomen is rigid and the
rectus muscle fails to relax with palpation when
the client exhales. It can involve all or part of the
abdomen but is usually seen on the side (i.e.,
right vs. left rather than upper or lower) because
of nerve tract patterns. Right-sided guarding may
be due to cholecystitis

Deeply palpate all Normal (mild) tenderness is ● Severe tenderness or pain may be related to
quadrants to delineate possible over the xiphoid, aorta, trauma, peritonitis, infection, tumors, or enlarged
abdominal organs and cecum, sigmoid colon, and ovaries or diseased organs.
detect subtle masses with deep palpation. Figure 23-20
illustrates normally palpable
structures in the abdomen

Palpate for masses. No palpable masses are present. ● A mass detected in any quadrant may be due to a
tumor, cyst, abscess, enlarged organ, aneurysm,
or adhesions

Palpate the umbilicus Umbilicus and surrounding area are ● A soft center of the umbilicus can be a potential
and surrounding area free of swellings, bulges, or masses. for herniation. Palpation of a hard nodule in or
for swellings, bulges, around the umbilicus may indicate metastatic
or masses. nodes from an occult gastrointestinal cancer

Palpate the aorta. The aorta is approximately 2.5–3.0
cm wide with a moderately strong
and regular pulse. Possibly mild
tenderness may be elicited.
● A wide, bounding pulse may be felt with an
abdominal aortic aneurysm. A prominent,
laterally pulsating mass above the umbilicus with
an accompanying audible bruit strongly suggests
an aortic aneurysm (Abnormal Findings 23-3, p.
505).

Palpate the liver. The liver is usually not palpable, ● A hard, firm liver may indicate cancer. Nodularity
although it may be felt in some thin may occur with tumors, metastatic cancer, late
clients. If the lower edge is felt, it cirrhosis, or syphilis. Tenderness may be from
should be firm, smooth, and even. vascular engorgement (e.g., congestive heart
Mild tenderness may be normal. failure), acute hepatitis, or abscess.
● A liver more than 1–3 cm below the costal margin
is considered enlarged (unless pressed down by
the diaphragm)
To palpate by hooking,
stand to the right of
the client’s chest. Curl ● Enlargement may be due to hepatitis, liver
(hook) the fingers of tumors, cirrhosis, and vascular engorgement.
both hands over the
edge of the right costal
margin. Ask the client
to take a deep breath
and gently but firmly
pull inward and
upward with your
fingers (Fig. 23-23)

Palpate the spleen The spleen is seldom palpable at ● A palpable spleen suggests enlargement (up to
the left coastal margin. Rarely, the three times the normal size), which may result
tip is palpable in the presence of a from infections, trauma, mononucleosis, chronic
low, flat diaphragm (e.g., chronic blood disorders, and cancers. The splenic notch
obstructive lung disease) or with may be felt, which is an indication of splenic
deep diaphragmatic descent on enlargement. Splenic enlargement may not
inspiration. If the edge of the always be pathologic.
spleen can be palpated, it should be
soft and nontender
Alternatively, asking
the client to turn onto ● The spleen feels soft with a rounded edge when it
the right side may is enlarged from infection. It feels firm with a
facilitate splenic sharp edge when it is enlarged from chronic
palpation by moving disease.
the spleen downward ● Tenderness accompanied by peritoneal
and forward (Fig. inflammation or capsular stretching is associated
23-25). Document the with splenic enlargement.
size of the spleen in
centimeters below the
left costal margin. Also
note consistency and
tenderness

Palpate the kidneys The kidneys are usually not
palpable. Sometimes the lower pole
of the right kidney may be palpable
by the capture method because of
its lower position. If palpated, it
should feel firm, smooth, and
rounded. The kidney may or may
not be slightly tender
● An enlarged kidney may be due to a cyst, tumor,
or hydronephrosis. It can be differentiated from
splenomegaly by its smooth rather than sharp
edge, absence of a notch, and overlying tympany
on percussion (Abnormal Findings 23-3, p. 505)

Palpate the urinary An empty bladder is neither ● A distended bladder is palpated as a smooth,
bladder. palpable nor tender round, and somewhat firm mass extending as far
as the umbilicus. It may be further validated by
dull percussion tones
3. Enumerate the test for rebound tenderness.
● Assess for rebound tenderness. If the client has abdominal pain or tenderness, test for
rebound tenderness by palpating deeply at 90 degrees into the abdomen away from the
painful or tender area (Fig. 23-30A). Then suddenly release pressure (Figure 23-30B). 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.
● Test for referred rebound tenderness. Palpate deeply in the LLQ and quickly release pressure

4. Identify the different abnormal findings for abdominal distention, abdominal bulges, enlarged
abdominal organ & other organ abnormalities.