ABDOMINAL ASSESSMENT

SUBDIVISION OF ABDOMEN
 RIGHT UPPER QUADRANT - RUQ

 RIGHT LOWER QUADRANT - RLQ

 LEFT UPPER QUADRANT - LUQ

 LEFT LOWER QUADRANT - LLQ

ABDOMINAL QUADRANT
NINE REGIONS
1. Epigastric
2. Umbilical
3. Pubic
4. Right hypocandriac
5. Left hypocandriac
6. Right lumbar
7. Left lumbar
8. Right iliac
9. Left iliac
 RIGHT UPPER QUADRANT
 LIVER
 GALLBLADDER
 DUODENUM
 HEAD OF PANCREAS
 RIGHT KIDNEY AND ADRENAL
 HEPATIC FLEXURE OF COLON
 PART OF ASCENDING AND
TRANSVERSE COLON
 LEFT UPPER QUADRANT
 STOMACH
 SPLEEN
 LEFT LOBE OF LIVER
 BODY OF PANCREAS
 LEFT KIDNEY AND ADRENAL
 SPLENIC FLEXURE OF COLON
 PARTS OF TRANSVERSE AND
DESCENDING COLON
 RIGHT LOWER QUADRANT
 CECUM
 APPENDIX
 RIGHT OVARY AND TUBE
 RIGHT URETER
 LEFT LOWER QUADRANT
 PART OF DESCENDING COLON
 SIGMOID COLON
 LEFT OVARY AND TUBE
 LEFT URETER
 PREPARATION
 EQUIPMENT - STETHOSCOPE,
MARKING PEN, RULER
 PATIENT LIE ON BACK, PILLOW
UNDER HEAD, KNEES SLIGHTLY
FLEXED
 EMPTY BLADDER
 SHORT FINGERNAILS
 HISTORY QUESTIONS
 PAIN IN ABDOMEN
 CHANGE IN APPETITE
 CHEWING AND SWALLOWING
PROBLEMS
 HEARTBURN
 NAUSEA, VOMITING, REGURITATION
 RECTAL BLEEDING
 HISTORY QUESTIONS
 ELIMINATION
 HEMORRHOIDS
 VOIDING DIFFICULTY
 PREVIOUS SURGERY
 WEIGHT GAIN OR LOSS
 TYPE OF DIET
 MEDICATIONS
 SEQUENCE OF ASSESSMENT
 INSPECTION
 AUSCULTATION
 PERCUSSION
 PALPATION
 INSPECTION
 ENTIRE PATIENT
 SKIN
 a. PIGMENTATION
 b. LESIONS
 c. STRIAE
 d. TURGOR
 SUPERFICIAL VESSELS
ABDOMINAL STRIAE
 INSPECTION
 HAIR DISTRIBUTION
 UMBILICUS
 CONTOUR
 a. FLAT
 b. ROUNDED
 c. SCAPHOID
 d. PROTUBERANT (DISTENDED)
 PERISTALSIS
ABDOMINAL CONTOURS
 AUSCULTATION
 ACTIVE BOWEL SOUNDS 5-30/MIN
 HYPOACTIVE 4/MIN OR LESS
 HYPERACTIVE 30 OR MORE /MIN
 BRUITS
 a. AORTA
 b. RENAL
 c. ILIAC
 FRICTION RUB
 PERCUSSION
 TO DETERMINE THE SIZE OF SOLID
ORGANS AND PRESENCE OF MASSES,
FLUID AND GAS
 TYMPANIC SOUND
 PERCUSS IN ALL FOUR QUADRANTS
 PERCUSS FOR LIVER SPAN
 PERCUSS FOR SPLEEN
 PERCUSS BLADDER IF INDICATED
PERCUSSION OF SPLEEN
 PERCUSSION
 IF DULLNESS IN FLANKS - CHECK
FOR SHIFTING DULLNESS
 IF INDICATED CHECK FOR FLUID
WAVE
 PALPATION
 LIGHT PALPATION TO EVALUATE
GENERAL CONDITION, NATURE OF
ANY DISTENTION, AND GROSS
ABNORMALITIES AND PAINFULNESS
 DEEP PALPATION TO DETECT ANY
ORGAN ENLARGEMENT,
ABDOMINAL MASSES OR SWELLINGS
 PALPATE FOR LIVER AND SPLEEN
PALPATION OF LIVER
PALPATION OF SPLEEN
 REBOUND TENDERNESS
 fingers at 90 degree angle with abd., press
deeply, remove fingers quickly. Return to
position of organs causes a sharp pain.
 ON BACK
 CHECK FOR RENAL BRUITS

 COSTOVERTEBRAL ANGLE
TENDERNESS
PERCUSION OF KIDNEY
 IF ABDOMINAL PAIN
 TACHYPNEIC
 LEANING FORWARD
 MURPHY’S SIGN
 ROVSING’S SIGN
 ILIOPSOAS TEST
 ILIOPSOAS TEST
 Raise leg & flex at hip
while examiner pushes
downward.
 lower quad. Pain—
Appendicitis
Obturator muscle test
 - ruptured appendix or pelvic abscess –
 While supine, flex right leg at hip & knee to
90 degrees. Hold the leg just above the
knee, grasp the ankle, & rotate the leg
laterally & medially.
 CONTRAINDICATIONS FOR
ABDOMINAL ASSESSMENT
 NEVER PALPATE IF SUSPECTED
APPENDICITIS OR DISSECTING ABD.
AORTIC ANEURSYM
 NEVER PALPATE WITH POLYCYSTIC
KIDNEYS
 DO NOT PALPATE OF PERCUSS
TRANSPLANTED ORGANS