HEALTH

ASSESSMENT
Abdomen
 Bordered superiorly by the costal margins
 Bordered inferiorly by the symphysis pubis and inguinal canals
 Bordered laterally by the flanks
Abdominal Quadrants
 Four quadrants: right upper quadrant (RUQ), right lower quadrant (RLQ), left
lower quadrant (LLQ), left upper quadrant (LUQ)
 Two imaginary lines (vertical/midline- from tip of the sternum to symphysis
pubis, horizontal/lateral- from umbilicus across the abdomen)
 Regions commonly used: epigastric, umbilical, hypogastric, or suprapubic
Right Upper Quadrant
 Ascending and transverse colon
 Duodenum (first part of small intestine), pylorus (small bowel or ileum),
 gallbladder, hepatic flexure of colon, liver
 Pancreatic head, right adrenal gland
 Right kidney(upper pole), right ureter
Right Lower Quadrant
 Appendix
 Ascending colon, cecum
 Right kidney
 Right ovary and tube
 Right ureter
 Right spermatic cord
Left Upper Quadrant
 Left adrenal gland
 Left kidney
 Left ureter
 Pancreas, spleen, stomach
 Transverse descending colon
Left Lower Quadrant
 Left kidney
 Left ovary and tube
 Left ureter
 Left spermatic cord
 Descending and sigmoid colon
9 REGIONS:
RIGHT EPI LEFT
HYPOCHONDRI GASTRIC HYPOCHONDRI
AC REGION REGION AC REGION
RIGHT UMBILLICAL LEFT LUMBAR
LUMBAR REGION REGION
REGION
RIGHT ILIAC HYPO LEFT ILIAC
(INGUINAL) GASTRIC (INGUINAL)
REGION REGION REGION
Abdominal Wall Muscles
 Three muscle layers from back, around flanks, to front: external and internal
abdominus oblique, transverse abdominus
 Abdominal wall muscles protect internal organs; allow normal compression of
internal organs during functional activities
Question #1
Is the following question true or false?
The abdominal wall allows normal compression during functional activities such
as childbirth.
Answer to Question #1
True.
The abdominal wall allows normal compression during functional activities such
as childbirth.
Internal Anatomy #1
 Parietal peritoneum; visceral peritoneum
 Different body systems:
 Gastrointestinal
 Reproductive (female)
 Lymphatic and urinary
Internal Anatomy #2
 Abdominal viscera can be divided into two:
 Solid viscera: liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus
 Palpation of abdominal viscera depends on location, structural consistency,
size
Internal Anatomy #2
 Solid viscera
 Liver-largest solid organ in the body
 LOC: RUQ, below the diaphragm
 Fx: accessory digestive organ
 metabolic and regulatory functions: glucose storage, clotting factors
formation, bile formation
Internal Anatomy #2
 Solid viscera
 Kidney- filtration and elimination of metabolic wastes
10x 5 x 2.5 cm
 LOC: high and deep under the diaphragm, T12 to L3
 Tenderness- best assessed at costovertebral angle (bellow Rib 12)
 Abdominal viscera can be divided into two:
 Hollow viscera: stomach, gallbladder, small intestine, colon, bladder
 Stomach: distensible, flask-like organ
 Loc:LUQ, below the diaphragm, in between the liver and spleen
 FX: store, churn and digest food
 Gallbladder- muscular sac, 10 cm long
 Loc: near the posterior surface of the liver, lateral MCL
 Fx: store and concentrate bile needed for fat digestion
 Abdominal viscera can be divided into two:
 Hollow viscera: stomach, gallbladder, small intestine, colon, bladder
 Small intestine: longest portion (7 m long, 2.5 cm in diameter)
 FX: digestion and absorption of nutrients
 Colon: 6.o cm in diameter
 FX: water absorption
 Bladder: distensible muscular sac
 Loc: behind the pubic bone, midline of abdomen
 FX: temporary receptacle for urine
Internal Anatomy #3
 Viscera normally not palpable:
 Pancreas, spleen, gallbladder, small intestine
 Vascular structures: abdominal aorta; right and left iliac arteries
Question #2
Is the following question true or false?
The small intestine is normally palpated during a physical assessment.
Answer to Question #2
False.
The small intestine is not normally palpated during a physical assessment.
Risk Assessment for Peptic Ulcer Disease
 Presence of Helicobacter pylori in gastrointestinal tract
 Excessive alcohol intake
 Regular use of nonsteroidal anti-inflammatory medications (NSAIDs), as well
as bisphosphonates
 Smoking cigarettes or chewing tobacco
 Serious illness (especially if on respirator)
 Radiation treatments
 Zollinger–Ellison syndrome-
 Uncontrolled stress
Client Education #1
 Wash hands frequently with soap and water.
 Eat foods that have been cooked completely.
 Use all recommended cautions when taking pain relievers, such as taking as
low a dose over as short a length of time as possible; take pain medications
with food; avoid drinking alcohol while on the pain medications.
 Avoid excessive alcohol intake (more than one drink per day for women and
two drinks per day for males).
Client Education #2
 Avoid or stop smoking and chewing tobacco.
 If medications are ordered by your primary health care provider, follow the
directions carefully and report if there are continuing symptoms, symptoms
worsen, or more serious symptoms occur (such as severe pain, vomiting with
bleeding, tarry stools).
Risk Assessment for Gastroesophageal
Reflux Disease
 Obesity
 Hiatal hernia- compression
 Pregnancy
 Smoking (weakens esophageal sphincter)
 Dry mouth
 Asthma
 Diabetes
 Delayed stomach emptying
 Connective tissue disorders, such as scleroderma
 Alcohol consumption (weakens esophageal sphincter)
Current Symptoms
 Abdominal pain
 Factors that precipitate pain or make it worse
 Description and location of pain
 Other symptoms
 Recent weight gain or loss
History
 Past:
 Abdominal surgery, trauma, injury, medications
 Abdominal pain and treatment
 Lab work or gastrointestinal studies
 Family:
 Stomach, colon, liver cancer
 Abdominal pain, appendicitis, colitis, bleeding, hemorrhoids
 Nutritional habits in family
Lifestyle and Health Problems
 Smoking
 Alcohol use
 Diet
 Antacid
 Medications
 Fluid intake
 Exercise
 Stress
Preparing the Client
 Empty the bladder.
 Remove clothes and put on a gown.
 Lie supine with the arms folded across the chest or resting by the sides.
 Drape the client.
 Breathe through the mouth; take slow, deep breaths.
Equipment
 Small pillow or rolled blanket
 Centimeter ruler
 Stethoscope (warm the diaphragm and bell)
 Marking pen
Inspection #1
 Observe the coloration of the skin.
 Usually paler than the rest of the body skin
 Grey-Turner sign: pale flanks, indicates abdominal
bleeding
 Yellowish- Jaundice
 Redness- inflammation
 Observe for bruises or other discoloration
 Note the vascularity of abdominal skin.
 Dilated veins may be seen in cirrhosis of the liver
 Note any striae.
 For abdominal skin stretch
 Dark bluish-pink striae are associated w/ Cushing Syndrome (increase sugar-g,
salt-m, sex-ad)

 Inspect for scars.

 Surgery or trauma, Keloids (excessive scar tissue)
 Assess for lesions and rashes.
 Changes in moles ABCDE
Inspection #2
 Inspect:
 Umbilicus- inverted or protruding no more than 0.5 cm, round
 abdominal contour- flat, rounded, scaphoid abnormal: distended/ protuberant
 abdominal movements when client breathes
 Assess abdominal symmetry.
 Asymmetrical,- organ enlargement
 Observe aortic pulsations- abdominal aortic aneurysm
 Observe for peristaltic waves.-not seen
 Abnormal: ripple like LUQ -> RUQ, abd. obstruction
Auscultation
 Auscultate for: (diaphragm of stethoscope, warm, light pressure)
 Start: RLQ -> Clockwise
 Bowel sounds
Normal findings: series of intermittent about 5-15 max 30/min soft clicks and gurgles (=
Breath sounds)

Hyperactive bowel sounds/ “borborygmus”- stomach growling

Abnormal: “Hyperactive” rushing, tinkling, high-pitched (means very rapid motility in
early bowel obstruction)
Ex: Gastroenteritis, Diarrhea, use of laxatives
Auscultation
 Auscultate for: (diaphragm of stethoscope, warm, light pressure)
 Start: RLQ -> Clockwise
 Bowel sounds
Abnormal: “Hypoactive”- diminished bowel motility
Ex: Paralytic ileus following abdominal surgery, inflammation of peritoneum, late bowel
obstruction
Small intestine- first few hours
Stomach- 24-48 hours
Colon- 3-5 days
Auscultation
 Vascular Sounds- bruits make a whooshing sound when blood flows through a
narrow vessel
 Ex: renal aortic stenosis or aneurysm

 Venous Hum- not heard normally

 If present, epigastric and umbilical areas because of increase collateral
circulation as heard in liver cirrhosis

 Friction Rub- no friction rub is present over liver or spleen

Percussion
 PATTERN:
RUQ LUQ

RLQ LLQ
Percussion
 Percuss for tone.
 NORMAL: Generalized tympany because of AIR (stomach and intestines)
• Dullness: Liver and Spleen
 ABNORMAL: Hyperesonance- gaseous distended bladder
 Enlarged area of Dullness: enlarged liver/spleen
 Percuss the span or height of the liver by determining its lower and upper
borders.
 -located 1-2 cm below the costal margin
Percussion
 Ask the client to inhale and hold

 Percuss from RLQ at the MCL upward

 Exhale

 Percuss the spleen.

 Approx 7cm wide
 Loc: L 10th Rib and slightly posterior to MAL
 Perform blunt percussion on the liver.
 Normal: No tenderness
 Palpation #1
 Perform light palpation.
 Involving the 9 regions

 N: non tender and soft

 AB: involuntary reflex guarding- rigid abdomen and rectus muscle fails to relax
during expiration

 Deeply palpate all quadrants to delineate abdominal organs and detect subtle
masses.

 Deep Bimanual

 N: mild tenderness (xiphoid, aorta, cecum, sigmoid colon,ovaries)

 AB: severe tenderness or pain (trauma, peritonitis, infection, tumors, enlarged or

diseased organ)
 Palpate for masses.
 Size, shape, consistency, demarcation, pulsality, tenderness and mobility

 N: no palpable masses

 AB: Tumor, Cyst, Abscess, Enlarged organ

 Palpate the umbilicus and surrounding area for swellings, bulges, or masses.
 N: free of swelling and masses

 AB: wide, bounding pulse may be felt (AAA)

Palpation #2
 Palpate:
 Aorta
 Liver
 Spleen
 Kidneys
 Urinary bladder
Question #3
Is the following statement true or false?
The nurse should begin the collection of objective data by palpating the client.
Answer to Question #3
False.
The nurse should begin the collection of objective data by inspection the client.
Special Abdominal Tests #1
 Tests for ascites:
 Test for shifting dullness.
 Perform the fluid wave test.
Special Abdominal Tests #2
 Tests for appendicitis:
 Blumberg’s Sign- Rebound tenderness upon palpation and quick release

 Psoas sign- Pain on extension of right hip

 Obturator sign- pain with internal rotation of right hip

 Rovsing’s sign- LLQP -> RLQP

 Mcburney’s sign- pain at mcburney’s point

Special Abdominal Tests #3
 Test for cholecystitis:
 Murphy sign- RUQP or tenderness
Curl finger, grab with thumb, indirect fist percussion
Question #4
Which test should a nurse perform on a client with ascites?
A. Fluid wave test
B. Murphy sign
C. Psoas sign
D. Obturator sign
Answer to Question #4
A. Fluid wave test.
The nurse should perform the fluid wave test on a client with ascites. Murphy
sign is used to test for cholecystitis and the psoas sign and obturator signs are
performed to test for appendicitis.
Mechanism and Sources of Abdominal
Pain
 Types of pain:
 Visceral
 Parietal
 Referred
Abdominal Distention
 Pregnancy (normal)
 Fat
 Feces
 Fibroids and other masses
 Flatus
 Ascitic fluid
Abdominal Bulges
 Umbilical hernia
 Epigastric hernia
 Diastasis recti
 Incisional hernia
Enlarged Abdominal Organs
 Enlarged liver
 Enlarged nodular liver
 Liver higher than normal
 Enlarged spleen
 Aortic aneurysm
 Enlarged kidney
 Enlarged gallbladder
Older Client
❖ Dilated superficial capillaries without a pattern may be seen in older clients. They are
more visible in sunlight.

❖ Assess older adult clients carefully for acute abdominal conditions as sensitivity to pain
may diminish with aging.
Analysis of Data
 Wellness diagnosis
 Risk diagnosis
 Actual diagnosis
 Collaborative problems
 ABDOMINAL
ASSESSMENT
• Liver
• gallbladder
• Pylorus
• duodenum
• head of pancreas
• portions of ascending and transverse colon
ABDOMINAL EXAMINATION
RUQ

FOUR ABDOMINAL
QUADRANTS
RLQ
• Cecum
• Appendix
• Portion of the ascending colon
• Lower portion of right kidney
• Bladder (if distended)
FOUR ABDOMINAL QUADRANTS
• Left liver lobe
• Stomach
• Body of Pancreas
• Splenic flexure of colon
• Portions of transverse & descending colon
LUQ

LLQ
• Sigmoid colon
• Portion of descending colon
• Lower portion of left kidney bladder (if distended)
NINE ABDOMINAL REGIONS
NINE ABDOMINAL REGIONS

• Right lobe of liver

• Gallbladder
• part of the duodenum
• hepatic flexure of the
colon
• upper half of the right
kidney
• suprarenal gland
NINE ABDOMINAL REGIONS

• ascending colon
• lower half of the right
kidney
• part of the duodenum
and jejunum
NINE ABDOMINAL REGIONS

• cecum
• Appendix
• Lower end of the ileum
• right ureter
• Right spermatic cord
• Right ovary
NINE ABDOMINAL REGIONS

• aorta
• pyloric end of
stomach
• part of duodenum
• pancreas
• part of liver
NINE ABDOMINAL REGIONS

• Omentum
• mesentry

• lower art of duodenum

• Part of the jejunum and ileum
NINE ABDOMINAL REGIONS

• Ileum
• Bladder
• uterus
NINE ABDOMINAL REGIONS

• stomach
• Spleen
• Tail of pancreas
• splenic flexure
of colon
• Upper half of
the left kidney
• Suprarenal gland
NINE ABDOMINAL REGIONS

• descending
colon
• lower half of
the left kidney
• part of the
jejunum and
ileum
NINE ABDOMINAL REGIONS

• sigmoid colon
• left ureter
• left spermatic
cord
• Left ovary
 INSPECTION (Supine Position)
Inspect for:

1. Scars
2. Shape
3. Symmetry discoloration
4. Muscular development
5. The umbilicus
6. Extra movements
(respiratory, pulsation,
presence of peristaltic
waves)
 ABDOMINAL EXAMINATION
INSPECTION (Supine Position)
normal findings

1. skin texture and color should be consistent with rest of body

2. stria may be present
3. umbilicus is normally flat or concave midway between xiphoid and
symphysis pubis
4. abdomen may be flat, concave or convex; all three are normal if there is
symmetry
5. you may note peristalsis movement or aortic pulse
6. voiding: steady, straight stream with no pain or post void dribble
 ABDOMINAL EXAMINATION
Palpate:
PALPATION (Supine Position)
• to confirm findings of pain and
tenderness, rigidity, rebound
tenderness
• Rebound tenderness is elicited by
pressing into the abdomen with
the palpating fingers and quickly
releasing the pressure
• Increased pain with the
release of pressure indicated
peritoneal inflammation
 ABDOMINAL EXAMINATION
PALPATION (Supine Position)
normal findings

1. soft with no palpable masses, no tenderness or rigidity

2. bladder noted as a bulge in abdomen when filled with more

than 500cc of urine

1. deep palpation may produce tenderness - liver, kidneys,

spleen inguinal nodes generally not palpable
 ABDOMINAL EXAMINATION
bowel sounds to determine:
AUSCULTATION (Supine Position)
1. peristalsis
2. vascular sounds
3. Friction rubs

• Bowel sounds are caused by air

mixing with fluid during peristalsis
• May vary according to the amount
of food which has been eaten bowel motility - normal findings:
• Note for frequency, intensity and • audible in all quadrants
location
vascular sounds - normal findings
• no vascular sounds over aorta or
femoral arteries
• Renal artery bruits can be heard
ABDOMINAL EXAMINATION
PERCUSSION (Supine Position)
help identify normal or abnormal presence of air and fluid in the abdomen

normal findings

1. tympany over stomach and

intestines;
2. dullness over liver, spleen,
pancreas, kidneys and
distended (>150cc) bladder
 ABDOMINAL PALPATION EXAMINATION
LEOPOLD’S MANEUVER
methods to determine position, presentation and engagement of fetus

They will include:

1. Determination of what is in the fundus

2. Evaluation of the fetal back and extremities
3. Palpation of the presenting part above the symphysis, and
4. Determination of the direction and degree of flexion of the head.

Before performing Leopold’s Maneuver, ask the mother to empty the bladder,
warm hands, and apply them to the mother’s abdomen with firm and gently
pressure
LEOPOLD’S MANEUVER

It will determine which part of the fetus is

in the fundus.

1. Place pals on each side of the upper

abdomen and palpate around the
fundus
2. You would feel a hard, round, movable
object if the head is in the fundus
3. You would feel soft and have an
irregular shape and are more difficult
to move if the buttock is in the fundus
LEOPOLD’S MANEUVER

1. Move hand downward over each side

of the abdomen, applying firm, even
pressure.
2. The fetus’s back which is a smooth,
hard surface should be felt on one side
of the abdomen.
3. The hands, feet, elbows, and knees
which are as irregular knobs and
lumps will be felt on the opposite side
of the abdomen.
LEOPOLD’S MANEUVER

It will determine fetal position

1. Place hand above the symphysis

pubis
2. Bring thumb and fingers together and
grasp the part of fetus between them
that may be the head or the buttocks
LEOPOLD’S MANEUVER

It is used in the late stage of pregnancy to

determine how far the fetus has descended
into the pelvic inlet.

1. Place hand on the sides of the lower

abdomen close to the midline
2. Slide hands downward and press inward
3. If you have determined that the buttocks
are in the fundus, then feel for the head
4. If you cannot feel the head, it probably
has descended
End of the slides...

Thank you!