Assessment of the abdomen

1. JHONEE F. BALMEO
HEALTH ASSESSMENT
ASSESSMENT
OF THE
ABDOMEN

2. Abdomen
The nurse locates and describes abdominal
findings using two common methods of
subdividing the abdomen:
quadrants and regions.

3. Abdomen
The nurse locates and describes abdominal
findings using two common methods of
subdividing the abdomen:
quadrants and regions.

4. Assessment of the abdomen
involves all four methods of
examination
(inspection, auscultation,
palpation, and percussion).

5. Specific organs or parts of organs
lie in each abdominal quadrants and
regions

6. Specific organs or parts of organs
lie in each abdominal quadrants and
regions

7. Tips for Examining the Abdomen
◗ Check if the patient has an empty bladder.
◗ Make the patient comfortable in the supine
position, with a pillow under the head and perhaps
another under the knees.
◗ Ask the patient to keep the arms at the sides or
folded across the chest.
◗ Before you begin palpation, ask the patient to
point to any areas of pain so that you can examine
these areas last.
◗ Warm your hands and stethoscope.
◗ Approach the patient calmly and avoid quick,
unexpected movements. Watch the patient’s face
for any signs of pain or discomfort.
◗ Distract the patient, if necessary, with
conversation or questions.

8. WHAT TO FIND?
INSPECTION
01
AUSCULTATION
02
PERCUSSION
03
PALPATION
04

9. Inspection
Starting from your usual standing position at the right side of the bed, inspect
the abdomen. As you look at the contour of the abdomen, watch for peristalsis.
It is helpful to sit or bend down so that you can view the abdomen tangentially.
● The skin.
Note:
1. Scars. Describe or diagram their
location.
2. Striae. Old silver striae or stretch marks
are normal.
3. Dilated veins. A few small veins may be
visible normally.
4. Rashes or ecchymoses

10. ● The umbilicus.
Observe its contour and location and any
inflammation or bulges suggesting a ventral
hernia.
● The contour of the abdomen
1. Is it flat, rounded, protuberant, or
scaphoid
2. Do the flanks bulge, or are there any
local bulges? Also survey the inguinal
and femoral areas.
3. Is the abdomen symmetric?
4. Are there visible organs or masses?
Look for an enlarged liver or spleen that
has descended below the rib cage.

11. ● Peristalsis. Observe for several
minutes if you suspect intestinal
obstruction. Normally, peristalsis may
be visible in very thin people.
● Pulsations. The normal aortic
pulsation is frequently visible in the
epigastrium.

12. Case Analysis?
What do you see in the Abdomen of this client?

13. Auscultation
Auscultation provides important information about bowel motility. Listen to the
abdomen before performing percussion or palpation because these maneuvers
may alter the frequency of bowel sounds.
Practice auscultation until you are thoroughly familiar with variations in normal
bowel sounds and can detect changes suggestive of inflammation or obstruction.
Auscultation may also reveal bruits, or vascular sounds resembling heart
murmurs, over the aorta or other arteries in the abdomen

14. Auscultation
Occasionally you may hear borborygmi, prolonged gurgles of hyperperistalsis, the
familiar “stomach growling.” Because bowel sounds are widely transmitted through
the abdomen, listening in one spot, such as the right lower quadrant, is usually
sufficient

15. Abdominal Bruits and Friction Rub.
If the patient has high blood pressure,
listen in the epigastrium and in each
upper quadrant for bruits. Later in the
examination. Epigastric bruits confined
to systole are normal.

17. Percussion
Percussion helps you to assess the amount and
distribution of gas in the abdomen, possible
masses that are solid or fluid-filled, and the size
of the liver and spleen.
Percuss the abdomen lightly in all four quadrants
to assess the distribution of tympany and
dullness. Tympany usually predominates because
of gas in the gastrointestinal tract, but scattered
areas of dullness from fluid and feces are also
typical.

18. ● Note any large dull areas suggesting an
underlying mass or enlarged organ. This
observation will guide your palpation.
● On each side of a protuberant abdomen,
note where abdominal tympany changes to
the dullness of solid posterior structures.

20. Palpation Light Palpation.
Identify any superficial organs or masses and any area of tenderness or
increased resistance to your hand. If resistance is present, try to distinguish
voluntary guarding from involuntary muscular spasm. To do this:

22. Your client suddenly ask you where the sigmoid
colon is located in this area of the abdomen: the
best answer is
A. Left upper quadrant
B. Left lower quadrant
C. Right lower quadrant

23. The same client ask you again what is the primary
function of the gallbladder? Your answer is?
A. Store and excrete bile
B. Aid in the digestion of protein
C. Produce alkaline hormones
D. Produce hormones
AWESOME
SLIDE

24. The same client suddently complain of pain
located in the RLQ (PS of 8/10) and according to
the doctor, the client might have appendicitis. To
palpate tenderness of an adult's appendix, where
should you begin?
A. Left lower quadrant
B. Left upper quadrant
C. Right lower quadrant
D. Right upper quadrant

25. You are a student nurse and was assigned in the
Surgical Ward. You are preparing to assess the
abdomen of a hospitalized client 2 days after
abdominal surgery. You should first do what?
A. Palpate the incision site
B. Auscultate for bowel sounds
C. Percuss for tympany
D. Inspect the abdominal area

26. Thank You

27. References
Audrey Berman . . . [et al.]. – 9th ed. (2012) KOZIER &
ERB’S Fundamentals of NURSING Concepts, Process,
and Practice.
Bickley, Lynn S. -11TH ED. (2013) Bates’ guide to physical
examination and history-taking.