Assessment of the abdomen

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 Assessment of the abdomen
• the largest body cavity"
• Subjective data: ask the client about:
• Nutritional history: appetite, weight loss or gain.
• Gastro intestinal symptoms: dysphagia, nausea,
vomiting, and indigestion.
• Bowel habits: pattern, and stool characteristics.
• Pain: location, quality, pattern, and relationship to
ingestion of food.
• Use of medications: Aspirin, Anti inflammatory
drugs, and steroids.
• Gastro intestinal diagnostic tests and surgeries.
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 Assessment of the abdomen cont..

• The client is placed in the supine position, with

small pillows under the head and knees.
• The abdomen is exposed from the breast to the
symphysis pubis
• start assessment with inspection, auscultation, then
percussion and palpation.
• stand the client right side and carry out assessment
systematically, beginning with the right lower
quadrant. The bladder should be empty.

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 Assessment of the abdomen cont..
• Inspection:
• Under source of light you see exactly changes in
contours.
• * Assess the presence or absence of symmetry,
distention, masses, visible peristaltic waves and
respiratory movement.
• Inspect the abdominal skin for pigmentation e.g.
jaundice, lesions, striae scars, dehydration, general
nutritional status and condition of umbilicus, this
give information about general state health

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 Assessment of the abdomen cont..
• Contour of the normal abdomen is described as: flat,
rounded, or scaphoid.

• N.B: contour is description of the profile line from the rib

margin to the pubic bone.
• Flat contour seen in the muscularly competent and well
nourished individual.
• Rounded abdomen: Normally in infant and toddler, but in
the adult caused by poor muscle tone and excessive
Subcutaneous fat deposition.
• Scaphoid contour “Concave in horizontal line” seen in thin
clients of all ages.
• Inspect for respiratory movements especially for retraction
of the abdominal wall on inspiration which is called
"Czerny's sign “associated with some Central Nervous
System diseases such as chorea”
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 Assessment of the abdomen cont..
• Auscultation :
– Auscultate peristaltic sounds which are normally high
pitched.
• Listen for at least "5" minutes before concluding that
no bowel sounds are present. "Peristaltic sounds may
be quite irregular".
• Duration of single sound may be less than a second
or more than it.
• Stimulation of peristalsis may be achieved by
flicking the abdominal wall with a finger “direct
percussion
• Auscultate vascular sounds: Loud bruits detected
over the aorta may indicate presence of an aneurysm;
the aorta is auscultated superior to the umbilicus.
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 Assessment of the abdomen cont..

• Listen for Peritoneal friction rub over the

area of liver and spleen e.g. spleen
infection, abscess or tumor: best heard over
the lower rib cage in the anterior axillary
line. (rough grating sound like sound of two
pieces of leather being rubbed together).

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 Assessment of the abdomen cont..
Percussion:

•To detecting fluid or gaseous distention and masses and assessing

solid structures within the abdomen.
•Percussion of one for each quadrant to assess areas of tympany and
dullness.
•Potentially painful areas are always percuss last
•Percussion allows you to identity borders of the liver to detect organ
enlargement.
•To detect liver size, start percussion at the right iliac crest and
proceeds up ward on the right mid-clavicular line, when dullness occur
this is the lower border of the liver.
•To detect upper border of the liver percuss, down from the nipple
along mid-clavicular line, then dullness occur “upper border” may be
found in (5,6,7) intercostals space, distance between points lower and
upper is (6-12cm).
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 Assessment of the abdomen cont..
• Stomach position:
• With percussion you can locate the tympanic air
bubble of the stomach by percussing over the left
lower anterior rib cage.
• * Kidney Tenderness:
• In sitting or erect position, use direct or indirect
percussion to assess for kidney inflammation.
• Use ulnar surface of the partially closed fist and
percuss the costo-vertebral angle at the scapular
line.
• If the kidneys are inflamed, client feels tenderness
during percussion
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 Assessment of the abdomen cont..
Palpation:

•* Detect abdominal tenderness and noting the quality of

abnormal distensions or masses.
•* During palpation assess for muscular resistance, distention,
tenderness and superficial organs or masses.
•* Assess for distended bladder if client has inability to void,
•( bladder lies normally below the umbilicus and above
symphysis pubis).
•In deep palpation depress hands (2.5-7.5 cm), "1-3 inch"
•If tenderness present, check for rebound tenderness, if it was
positive indicated peritoneal irritation e.g. appendicitis
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 Assessment of the abdomen cont..
• * Liver:
• "Right upper quadrant under the rib cage":
• * Place your left hand under client’s posterior
thorax at the 11th and 12th ribs and by your right
hand palpate in and up to feel the liver’s edge as
the client inhales.
• * G.B normally not felt and if distended it felt
under liver and may indicate cholecystitis.
• Spleen:
• Generally not palpable in normal adult person,
but in case of spleen enlargement you can palpate
it below costal margin.
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