Assessing the Abdomen

abdominal assessment sequence :

Inspection
Auscultation
Percuss
Palpation
 Preparation:
• Ask patient to void, to promote comfort during the procedure.
• Position patient in a supine position, arms on side ,bends the knees slightly.
• Bending the knees will help to relax the abdomen and make palpation easier.
• Expose abdomen, nurse’s hands and diaphragm of the stethoscope must be
warm.
• Sequence : Inspection, Auscultation, Percussion, Palpation( IAPP)
preparation
• SEQUENCE OF EXAMINATIONS OF THE QUADRANTS :
- Right Lower quadrant, Right upper quadrant,
Left upper quadrant, Left lower quadrant
( RLQ, RUQ, LUQ, LLQ)
 Assessing the abdomen
Inspection of the abdomen : have Patient lie on his back
• Skin integrity ;
- unblemished skin, uniform color, striae, surgical scars
Deviations : presence of rash, lesions, tense glistening skin( ascites, edema)
• Contour and symmetry:
- flat, rounded( convex) scaphoid( concave), symmetric contour
Deviations:
-distended, asymmetric
-Asymmetric contour
Observe abdominal movements
- symmetric movements caused respiration,
- visible peristalsis in very lean people
- aortic pulsations in thin persons at epigastric area
Deviations:
limited movement due to pain or disease
Visible peristalsis, marked aortic pulsations
Vascular patterns
• No visible visual pattern
Deviations:
• Visible venous pattern( dilated veins)
Auscultate abdomen
for:
)
1. Bowel sounds ; audible bowel sounds heard in 4 quadrants high
pitched occurs 5-30 times per minute.
• Listen for full 5 minutes if no bowel sounds is heard.
Deviations: absent, hypoactive or hyperactive bowel
sounds
2. Vascular sounds: absence arterial bruits
Deviations: loud bruit over aortic area( aneurysm)
3. Peritoneal friction rubs: absence of friction rubs
• Deviations: bruit or renal or iliac arteries
 Palpate abdomen
To detect areas of tenderness
a. Light palpation (depress about 1cm)
Normal findings:
No tenderness; relaxed abdomen with smooth, consistent tension
Deviations from normal :
tenderness and hypersensitivity
Superficial masses
Localized areas of increased tension
b.Deep palpation ( 1.5 to 2 inches deep)
DEEP PALPATION
• It is the indentation of the abdomen performed by pressing the distal half of the palmar
surfaces of the fingers into the abdominal wall.
• The abdominal wall may slide back and forth while the fingers move back and forth
over the organ being examined.
• Deeper structures, like the liver, and retro peritoneal organs, like the kidneys, or masses
may be felt with this method.
• In the absence of disease, pressure produced by deep palpation may produce tenderness
over the cecum, the sigmoid colon, and the aorta.
 LIVER PALPATION
• There are two types of bi manual palpation recommended for palpation
of the liver. The first one is the superimposition of the right hand over
the left hand.
• Ask the patient to take 3 normal breaths.
• Then ask the client to breath deeply and hold. This would push the liver
down to facilitate palpation.
• Press hand deeply over the RUQ
 PALPATION OF THE LIVER

• the second methods:

• The examiner’s left hand is placed beneath the client at the level of the right 11th and 12th
ribs.
• Place the examiner’s right hands parallel to the costal margin or the RUQ.
• An upward pressure is placed beneath the client to push the liver towards the examining
right hand, while the right hand is pressing into the abdominal wall.
• Ask the client to breath deeply.
• As the client inspires, the liver maybe felt to slip beneath the examining fingers.
Palpation of the liver
Normal Findings:
• The liver usually can not be palpated in a normal adult. However, in
extremely thin but otherwise well individuals, it may be felt the costal
margins.
• When the normal liver margin is palpated, it must be smooth, regular in
contour, firm and non-tender.
Palpate the liver to detect enlargement and tenderness

May be palpable , border feels smooth

No tenderness
Deviations:
Enlarged , smooth but tender;
Nodular( growth of abnormal tissue) or hard
Liver span >12cm or <6cm indicate
hepatomegaly or cirrhosis( scarring or fibrosis)
• Palpate for the liver with one or two hands palm down moving upward 2-
3 cm at a time towards the lower costal margin( medial margin of the 7th
to 10th ribs).
• Have the patient take a deep breath.
The liver will move downward due to the
downward movement of the diaphragm.
Feel for the liver to hit the caudal (tail)
aspect of your palpating hand.
Palpate bladder for possible urinary retention

• Palpate area above the pubic symphysis

Not palpable
Deviations from normal:
Distended and palpable as
smooth, round, tense
( indicates urinary retention )
Normal Findings: Inspection
• Skin color is uniform, no lesions.
• Some clients may have striae or scar.
• No venous engorgement.
• Contour may be flat, rounded or scapoid
• Thin clients may have visible peristalsis.
• Aortic pulsation maybe visible on thin clients.