Chapter 14 Health Assessment

Thompson Essential Health Assessment,
Second Edition
Chapter 14
Assessing the Abdomen
Copyright ©2022 F.A. Davis Company

Functions of the Abdomen
 The abdomen is a complex and challenging

region of the body that communicates with
many different systems.
 Contains many vital organs
 Use a systematic approach
 It is critical for nurses to assess and actively
listen to the patient’s self-report about
abdominal complaints.

A & P of the Abdomen
 Abdomen is the largest cavity in the body.

 Primary site for digestive organs and
contains abdominal vasculature
 Two types of peritoneum lining
• Parietal
• Visceral peritoneum

A & P of the Abdomen (continued_1)
 Abdomen depends on muscles for support

and protection
 There are four pairs of abdominal muscles
• Rectus abdominis
• Transverse abdominis
• Internal abdominal oblique
• External abdominal oblique

A & P of the Abdomen (continued_2)
 Viscera are the internal organs

 Two types of viscera
• Solid viscera
‒ Adrenal glands, kidneys, liver, pancreas, spleen,
ovaries, uterus
• Hollow viscera
‒ Gallbladder, small intestine, stomach, colon, bladder

Liver
 Heaviest and largest excretory organ

 Liver is a highly vascular organ
 Diagnostics
• Aspirate aminotransferase (AST)
• Alanine aminotransferase (ALT)
• Ammonia level
• Bilirubin level
• Liver biopsy

Gallbladder
 Gallbladder and biliary system collect, store,

concentrate, and transport bile to the
intestines to aid in digestion
 Located in the right upper quadrant (RUQ)
 Contracts and releases bile into the common
bile duct
 Diagnostics
• Ultrasound
• Heptobiliary iminodiacetic acid scan

Pancreas
 Accessory organ of digestion

 Pancreas has two primary functions
• Endocrine function that secretes insulin
• Exocrine function that releases pancreatic juices
 Diagnostics
• Amylase and lipase
• Glucose

Stomach
 Muscular, sac-like portion of the lower

alimentary canal
 Three parts of the stomach
• Upper fundus
• Body
• Lower pylorus
 Diagnostics
• Esophagogastroduodenoscopy
• Capsule endoscopy

Spleen
 Highly vascular, ductless organ

 Largest lymph organ in the body
 Part of the reticuloendothelial system
 Diagnostics
• Complete blood count (CBC)

Small Intestine
 Composed of three parts

• Duodenum
• Jejunum
• Ileum
 Contained in the central and lower parts of
the abdominal cavity
 Primary functions are completion of
digestion and absorption of nutrients

Large Intestine
 Large intestine has four segments

• Ascending
• Transverse
• Descending
• Sigmoid colon
 Primary function is the absorption of water
and electrolytes

Veriform Appendix
 A long narrow worm-like tube extending from

the large intestine
 Located in the right lower quadrant about 2 cm
below the ileocecal valve at McBurney’s point
 Function unknown

Diagnostics
 Stool analysis
 Fecal occult blood test (FOBT)
 Stool for culture
 Barium enema
 Sigmoidoscopy
 Colonoscopy
 Virtual colonoscopy uses computed
tomography (CT)

Kidneys and Bladder
 Kidneys lie in the back part of the upper

abdomen.
 Right kidney is lower than the left kidney.
 Kidneys perform many functions including
removing wastes/drugs, balancing body fluids,
releasing hormones, vitamin D production,
and controlling production of red blood cells.
 Bladder is a reservoir.
 Ureters transport urine.

Diagnostics (continued)
 Blood urea nitrogen (BUN)

 Creatinine
 Glomerular filtration rate (GFR)
 Bladder scan

ClickerCheck
The patient states that he has pain in his RUQ

after eating a fatty meal for the past month. He
denies nausea and vomiting. What organ do
you suspect is the source of this pain?
A. Liver
B. Stomach
C. Gallbladder
D. Pancreas

ClickerCheck Answers
Correct answer: C
The gallbladder is located in the right upper

quadrant (RUQ). This organ contracts and
releases bile into the common bile duct and the
bile helps to digest fats.

ClickerCheck (continued_1)
For the past couple of months, the patient has

been c/o pain in their lower abdomen of unknown
etiology. The doctor has scheduled a procedure to
assess the gastrointestinal tract. The patient was
told the he will have to swallow a capsule. Which
diagnostic procedure was ordered?
A. Capsule endoscopy
B. Ultrasound
C. HIDA scan
D. Barium enema
ClickerCheck Answers (continued_1)
Correct answer: A
The capsule endoscopy involves ingesting a

wireless capsule the size of a large vitamin pill.
The capsule contains a small video camera that
will pass naturally through the digestive system
while taking picture of the intestine.

Health History
 Patients with abdominal problems or

pathology may have a wide range of
symptoms.
 Bowel and bladder habits may be a sensitive
topic for the patient.
 Attributes of a symptom
• OLDCARTS: Onset, Location, Duration,
Characteristics, Aggravating/Alleviating factors,
Relieving factors, Treatment, Severity

Health History (continued_1)
 Remember to ask your patient about

• Past medical history
• Past surgical history
• Psychosocial history
• Medication assessment
 Weight
• Weight gain/loss, how much, intentional or
nonintentional

 Appetite
• Changes in appetite, factors affecting appetite or
ability to eat, food intolerances, cultural
considerations
• Anorexia
 Dysphagia
• Difficulty swallowing

 Nausea/vomiting
• When did it start, pattern, color of emesis
• Hematemesis
• Projectile vomiting

Dehydration
 Individuals with prolonged vomiting may

become dehydrated.
 Assess for signs of dehydration.
• See Box 14-1.

 Indigestion or heartburn
• Timing, duration, medications, pattern
• Pyrosis
• Dyspepsia
 Gastroesophageal reflux disease (GERD)
 Abdominal or pelvic pain
• Ask the patient to describe the pain in his or her
own words.

 Constipation or diarrhea
• Normal bowel habits, color, consistency, blood in
stool, laxative use, constipation
• Perceived constipation
 Flatulence
• Problems with gas, bloating, belching, burping
• Flatulence and bloating can be influenced by our
diet, how much air is swallowed (aerophagia)
with eating, and some intestinal disorders

 Urination
• Frequency, incontinence, back pain, difficulty
starting the stream
• Dysuria
• Renal or colic pain
 Skin
• Changes in color or texture
• Jaundice
 Out of country travel
• Risk for hepatitis A, B, C
The patient describes his abdominal pain as

“dull and crampy.” He points to both the RUQ
and LUQ. How would you classify this type of
abdominal pain?
A. Referred pain
B. Parietal pain
C. Visceral pain
D. Peritoneal pain

ClickerCheck Answer (continued_2)
Correct answer: C
Visceral pain is dull, gnawing, cramping or

burning; poorly localized; originates in the
abdominal organs

The nurse is collecting dinner trays to put back in the
dietary cart. She sees that the patient ate less than
25% of her dinner. The nurse states, “I see that you
did not eat much for dinner. Would you like me to
order you a different meal?” The patient responds,
“No, I just do not have an appetite.” The nurse will
document:
A. Patient has melena.
B. Patient is experiencing pyrosis.
C. Patient has emesis.
D. Patient is anorexic.
Correct answer: D
Anorexia is loss of appetite.

Melena is black tarry stool.
Pyrosis is heartburn.
Emesis is vomitus.

Preparation for Assessment
 Sequence change for this assessment:

• Inspection
• Auscultation
• Indirect percussion
• Palpation (light and deep)

Preliminary Steps
 Instruct patient to empty the bladder.

 Position patient in the supine position, with
head on a pillow and arms by their side. If
the patient is unable to flex knees, place a
pillow under the knees.
 Expose the abdomen, place a drape over the
patient’s symphysis pubis and chest area for
women.

Preliminary Steps (continued)
 If the patient states that he or she has

abdominal pain, say that you will assess the
painful abdominal area last.

Abdominal Mapping
 Abdominal mapping is the process of

dividing the abdomen into quadrants or
regions.
 During the assessment, visualize the
underlying structures for each quadrant or
region.
 There are two types of mapping
• Four-quadrant
• Nine-region

Abdominal Mapping (continued)
Four-Quadrant Nine-Region

Four-Quadrant Mapping
 Extend the midsternal line from the xiphoid

process through the umbilicus to the pubic
bone.
 Draw a horizontal line at the umbilicus to form:
• Right upper quadrant (RUQ)
• Right lower quadrant (RLQ)
• Left upper quadrant (LUQ)
• Left lower quadrant (LLQ)
 See Table 14-1 for abdominal organs in each
quadrant.
Nine-Region Mapping
 Extend the right and left midclavicular line to

the groin.
 Draw a horizontal line across the lowest
edge of the costal margin.
 Draw a second horizontal line at the level of
the iliac crest.
 Creating these lines divides the abdominal
area into nine regions.

Technique 14-1: Inspecting the Abdomen
 Purpose: To assess abnormalities in shape,

skin, or movement of the abdomen
 Inspect at two positions: At the patient’s side
and standing at the patient’s feet
• Contour, size, and symmetry
• Size and position and of the umbilicus
• Condition of skin: Color, lesions, veins, hernias,
hair distribution
• Movements, pulsations, and peristalsis

Inspecting the Abdomen

Inspecting the Abdomen (continued)
Normal Findings Abnormal Findings
 Contour (flat or  A scaphoid, distended, or
rounded) protuberant
 Bilaterally  Increased peristaltic waves
symmetrical  Pulsations
 Umbilicus midline  Distention
 Skin smooth and  Ascites
intact without  Diastasis recti
pulsations or visible
 Hernia
peristalsis
 Cullen’s Sign
Using the nine-region abdominal mapping, in

what quadrant is the bladder located?
A. Suprapubic
B. Epigastric
C. Umbilical
D. Left inguinal

Correct answer: A
The bladder is located in the suprapubic or

hypogastric region.

Technique 14-2: Auscultating Bowel
Sounds
 Purpose: To assess a pattern of bowel
sounds
 Equipment: Stethoscope, PPE (if needed)
 Place the diaphragm of the stethoscope on
the abdomen at the ileocecal valve (RLQ).
 Note characteristics and frequency of the
bowel sounds.
• See Table 14-2.

Types of Bowel Sounds
 Borborygmus are loud,
gurgling sounds made by
the movement of gas
through the intestines.
 Hyperactive are loud,
high-pitched sounds.
 Hypoactive are slow,
decreased sounds.
 Absent means no sounds
are heard.

Auscultating Bowel Sounds
Abnormal Findings Normal Findings
 5 to 34 clicks or gurgles  Hyperactive
per minute  Hypoactive
 No bowel sounds

Technique 14-2A: Auscultating Vascular
Sounds
 Purpose: To assess a
normal pattern of blood
flow in the abdominal
vasculature
 Equipment: Stethoscope,
PPE (if needed)
 With the bell of the
stethoscope, press down
firmly to listen over the
aorta, renal, iliac, and
femoral arteries.
 Auscultate over the liver
(bell) for a venous hum.
Auscultating Vascular Sounds
 No bruit sounds are  Bruits
heard over arteries.  Venous hum
 Friction rub

Technique 14-3: Percussing the Abdomen
 Purpose: To assess the
density and size of
abdominal structures, air,
solid or fluid-filled masses
in the abdomen
 Using indirect percussion,
percuss over each
quadrant and note the
quality of sounds.
 Follow one of the two
patterns for percussion.

Percussion Patterns

Percussing the Abdomen
 Tympany in all four  Excessive high-pitched
quadrants tympanic sounds
 Dullness over organs  Dullness
 Pain

The patient is complaining that he has been

constipated for the past 6 days but has very
small bouts of diarrhea. You auscultate for
bowel sounds and do not hear any sounds.
What should you do?
A. Call the doctor immediately.
B. Listen for at least 3 to 5 minutes.
C. Palpate the abdomen to stimulate peristalsis.
D. Document hypoactive bowel sounds.
Correct answer: B
Listen for 3 to 5 minutes before documenting

that there are no bowel sounds.

Technique 14-4: Palpating the Abdomen
 Purpose: To assess surface characteristics,

tenderness, enlarged organs, or fluid in the
abdominal cavity
 Warm your hands by rubbing them together
prior to palpating the abdomen.
 If your patient is ticklish, have him or her
rest a hand on top of your hand while you
palpate.
 Always palpate tender areas last.

Technique 14-4A: Light Palpation
 Purpose: To assess for surface characteristics

and tenderness
 Equipment: PPE (if needed)
 Using the finger pads of one hand, press down
about ½ inch.
 Lightly palpate in a clockwise direction.
 Lift your fingers gently as you move to a
different area.
 Watch patient’s facial expression for signs of
pain or abdominal guarding.
Light Palpation
 No tenderness  Tenderness is present
 Smooth surface  Mass is felt
characteristics

Technique 14-4B: Deep Palpation
 Purpose: To assess for location of internal

organs, enlarged organs, masses, or
tenderness
 Place your nondominant hand on top of your
dominant hand.
 Palpate deeply; press down about 1.5–2
inches using a circular or a dipping motion in a
clockwise direction.
 Lift your hands gently as you move to different
areas.
Deep Palpation
 No masses  Masses are palpated
 No enlarged organs  Enlarged organs
 No tenderness  Tenderness or pain is
present

Light vs Deep Palpation
Light Palpation Deep Palpation

Technique 14-4C: Palpating the Bladder
 Purpose: To assess for a distended bladder

 Ask the patient when he or she last emptied
the bladder.
 Lightly palpate for a distended bladder
between symphysis pubis and umbilicus.
 Note the size and location of the bladder.

Palpating the Bladder
 An empty bladder is not  A distended bladder is
palpable. palpated as a smooth,
 A partially filled bladder round, and firm mass
will feel firm and extending as far up as
smooth. the umbilicus.

Technique 14-5: Percussing for
Costovertebral Tenderness
 Purpose: To assess tenderness or
inflammation of the kidney
 Place patient in a sitting position.
 Stand facing the patient’s back.
 Using indirect blunt or fist percussion, thump
over the 12th rib at the costovertebral angle
on the back.

Percussing for Costovertebral Tenderness
 Elicits no pain.  Tenderness or pain is
felt.

Healthy People 2030
 Cancer Goal: Reduce the number of new

cancers and cancer-related illness, disability,
and death.
 There are three objectives specific to
reducing colon cancer:
1. Increase the proportion of adults who receive
colorectal cancer screening based on the recent
guidelines.
2. Reduce invasive colon cancer.
3. Reduce the colorectal cancer death rate.
Colon Cancer Screening
 The American Cancer Society (ACS)

recommends that individuals be screened for
colon cancer depending on personal history or
family history.
• The ACS recommends that beginning at age 45,
both men and women at average risk for colon
cancer follow recommended screening schedules.

Colon Cancer Screening (continued)
 United States Preventive Service Task Force

recommends screening for colorectal cancer
(CRC) in adults, beginning at age 50 years and
continuing until age 75 years.

You start to lightly palpate a patient’s abdomen

and she starts giggling and says she is very ticklish.
What should you do?
A. Stop light palpation and start deep palpation.
B. Skip this assessment technique and move to
percussion.
C. Warm both hands and use the bimanual
technique.
D. Have her rest her hand on top of your hand
while you palpate.
Correct answer: D
If your patient is ticklish, have her rest her hand

on top of your hand while you palpate.

A patient is c/o a very bloated abdomen. She

reports that she has not had a bowel movement
in 7 days. You are inspecting the abdomen and
assess a large distended abdomen. How will you
document the abdomen?
A. Flat
B. Scaphoid
C. Rounded
D. Protuberant
Correct answer: D
A protuberant abdomen
is prominent convexity of
the abdomen.

Chapter 14 Health Assessment

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Chapter 14 Health Assessment

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Thompson Essential Health Assessment,

Copyright ©2022 F.A. Davis Company

 The abdomen is a complex and challenging

Copyright ©2022 F.A. Davis Company

 Abdomen is the largest cavity in the body.

Copyright ©2022 F.A. Davis Company

 Abdomen depends on muscles for support

Copyright ©2022 F.A. Davis Company

 Viscera are the internal organs

Copyright ©2022 F.A. Davis Company

 Heaviest and largest excretory organ

Copyright ©2022 F.A. Davis Company

 Gallbladder and biliary system collect, store,

Copyright ©2022 F.A. Davis Company

 Accessory organ of digestion

Copyright ©2022 F.A. Davis Company

 Muscular, sac-like portion of the lower

Copyright ©2022 F.A. Davis Company

 Highly vascular, ductless organ

Copyright ©2022 F.A. Davis Company

 Composed of three parts

Copyright ©2022 F.A. Davis Company

 Large intestine has four segments

Copyright ©2022 F.A. Davis Company

 A long narrow worm-like tube extending from

Copyright ©2022 F.A. Davis Company

Copyright ©2022 F.A. Davis Company

 Kidneys lie in the back part of the upper

Copyright ©2022 F.A. Davis Company

 Blood urea nitrogen (BUN)

Copyright ©2022 F.A. Davis Company

The patient states that he has pain in his RUQ

Copyright ©2022 F.A. Davis Company

The gallbladder is located in the right upper

Copyright ©2022 F.A. Davis Company

For the past couple of months, the patient has

The capsule endoscopy involves ingesting a

Copyright ©2022 F.A. Davis Company

 Patients with abdominal problems or

Copyright ©2022 F.A. Davis Company

 Remember to ask your patient about

Copyright ©2022 F.A. Davis Company

Copyright ©2022 F.A. Davis Company

Copyright ©2022 F.A. Davis Company

 Individuals with prolonged vomiting may

Copyright ©2022 F.A. Davis Company

Copyright ©2022 F.A. Davis Company

Copyright ©2022 F.A. Davis Company

The patient describes his abdominal pain as

Copyright ©2022 F.A. Davis Company

Visceral pain is dull, gnawing, cramping or

Copyright ©2022 F.A. Davis Company

Anorexia is loss of appetite.

Copyright ©2022 F.A. Davis Company

 Sequence change for this assessment:

Copyright ©2022 F.A. Davis Company

 Instruct patient to empty the bladder.

Copyright ©2022 F.A. Davis Company

 If the patient states that he or she has

Copyright ©2022 F.A. Davis Company

 Abdominal mapping is the process of

Copyright ©2022 F.A. Davis Company

Copyright ©2022 F.A. Davis Company

 Extend the midsternal line from the xiphoid