Abdomen

Surface Anatomy

locates and describes abdominal findings using two

common methods of subdividing the abdomen:
quadrants and
regions.

4 Quadrants

Regions of the Abdomen

Epigastric:

area between costal margins

Umbilical: area around umbilicus
Suprapubic or hypogastric: area above pubic
bone.
or
RUQ
RLQ

LUQ
LLQ

Assessment of the abdomen

 inspection,
auscultation,
palpation,

and
percussion.

 Inspection

first, followed by auscultation,

Auscultation is done before palpation and percussion
because palpation and percussion cause movement or
stimulation of the bowel,
which can increase bowel motility and thus heighten
bowel sounds, creating false results.
Ask the patient to breathe slowly and deeply through
the mouth during the examination to promote
relaxation.

 painful

areas of the abdomen -assess at the end of

the examination.

 Use

a warm stethoscope
lighting - adequate
hands - warm
fingernails are trimmed short.
supine position with the head slightly elevated and
arms at the sides.
Place small pillows under the head and knees for
comfort.

 Ask

the client to urinate since an empty bladder

makes the assessment more comfortable.

Ensure

that the room is warm since the client will

be exposed.

Health history
History

of abdominal pain
History of indigestion, nausea or vomiting,
constipation or diarrhea
History of food allergies
Appetite and usual food and fluid intake
Usual bowel and bladder elimination patterns

History of gastrointestinal disorders, such as

peptic ulcer disease,
bowel disease,
gallbladder disease,
liver disease,
appendicitis

 History

of urinary tract disorders such as

infections, kidney stones, or kidney disease
History of abdominal surgery or trauma
Type and amount of prescribed and over-thecounter medications used
Amount and type of alcohol ingestion
For women, menstrual history

Equipment
Examining light
Tape measure (metal or unstretchable cloth)
Skin-marking pen
Stethoscope

 introduce

self
verify the clients identity
Explain to the client
Perform hand hygiene
Provide for client privacy.

Inquire about the following:

incidence

of abdominal pain;

its location,
onset,
sequence, and
chronology;
its quality(description);
its frequency; associated symptoms (e.g., nausea,
vomiting, diarrhea);

INSPECTION

INSPECTING THE ABDOMEN

Skin

color and surface characteristics,

umbilicus,
contour,
symmetry,
peristalsis,
pulsations, and
visible masses.

 The

skin color may be slightly lighter than exposed

areas.

Fine

white or silver lines (striae) -weight gain or

pregnancy.

The

umbilicus should be centrally located and may

be flat, rounded, or concave.

 Observe

the abdominal contour (line from the rib

margin to the pubic bone)

Flat,

rounded (convex), or scaphoid (concave)

Distended

 Ask
No

the client to take a deep breath and to hold it.

evidence of enlargement of liver or spleen

Evidence

of enlargement of liver or spleen

 symmetry

of contour - abdominal girth

Asymmetric contour, e.g.,
Localized protrusions around umbilicus,
hernia or tumor

 The

abdomen should be evenly rounded or

symmetric, without visible peristalsis.
pulsation may normally be visible.
Observe

the vascular pattern.

No visible vascular pattern
dilated veins is associated with liver disease, ascites,
and venocaval obstruction

Abnormal findings
swelling

of the abdomen (ascites) and

abdominal masses or unusual pulsations.
Presence of rash or other lesions
Tense, glistening skin (may indicate ascites,
edema)
Purple striae (associated with Cushings disease
or rapid weight gain and loss)

AUSCULTATING
BOWEL SOUNDS
AND
VASCULAR SOUNDS

 Warm

the hands and the stethoscope diaphragms.

Rationale: may cause the client to contract the

abdominal muscles, and these contractions may be
heard during auscultation
Audible bowel sounds

DEVIATIONS FROM NORMAL

Hypoactive,

i.e., extremely soft andinfrequent

(e.g., one per minute).

indicate decreased motility (surgery, inflammation,

paralytic ileus, or late bowel obstruction.)

 Hyperactive/increased,

i.e., highpitched, loud,

rushing sounds that occur frequently (e.g., every 3
seconds) also known as borborygmi.

indicate increasednintestinal motility (diarrhea, an

early bowel obstruction, or the use of laxatives.)

 True

absence of sounds (none heard in 3 to 5

minutes)
indicates a cessation of intestinal motility.

For Bowel Sounds

Use

the diaphragm.
Place diaphragm of the stethoscope in each of the
four quadrants
Listen for active bowel soundsirregular gurgling
noises occurring about every 5 to 20 seconds.

 Before

documenting bowel sounds as absent, the

nurse must listen for 2 minutes or longer in each
abdominal quadrant.

For Vascular Sounds

Use

the bell of the stethoscope over the aorta, renal

arteries, iliac arteries, and femoral arteries.
Listen for bruits.
Absence
Loud

of arterial bruits

bruit over aortic area (possiblen aneurysm)

Bruit over renal or iliac arteries

Peritoneal Friction Rubs

Friction

rubs may be caused by inflammation,

infection, or abnormal growths.

Absence
Friction

of friction rub

rub

Percussion of the Abdomen

 Percuss

several areas in each of the four quadrants

to determine presence of tympany (gas in stomach
and intestines) and
Dullness (decrease, absence, or flatness of
resonance over solid masses or fluid).

 Use

a systematic pattern:

Begin

in the lower right quadrant,

proceed to the upper right quadrant,
the upper left quadrant, and
the lower left quadrant.

 NORMAL FINDINGS
Tympany

over the stomach and gas-filled bowels;

dullness, especially over the liver and spleen, or a
full bladder

 DEVIATIONS
Large

FROM NORMAL

dull areas (associated with presence of fluid

or a tumor)

Palpation of the Abdomen

 Watch

the patients face for nonverbal signs of

pain during palpation.
Palpate each quadrant in a systematic manner,
noting muscular resistance,
tenderness,
enlargement of the organs, or
masses.

 If

the patient complains of abdominal pain, palpate

the area of pain last.

The

abdomen should normally be soft, relaxed,

and free of tenderness.

Abnormal findings include

involuntary rigidity,
spasm, and
pain
may indicate
trauma,
peritonitis,
infection,
tumors, or enlarged or diseased abdominal organs.

 PALPATING

THE LIVER
Palpate the liver by placing the left hand under
the patients lower right rib cage
Palpate

gently inward & upward with fingertips

while patient takes a deep breath

 The

normal liver edge should feel firm and smooth

and may be mildly tender.
Abnormal findings include
Hard and firm liver edge (found in cancer of the liver),
Nodularity (found with tumor, metastatic cancer,
cirrhosis of the liver), and
pain (from vascular engorgement as in congestive
heart failure, hepatitis, or abscess).

 Spleen:
Left

hand left lower rib cage

Press right hand below the left costal marginwhile patient takes deep breath
Not

palpable

 KIDNEY:
Usually

felt in people with very relaxed abdominal

muscles
Solid, firm, smooth elastic mass

 Palpation

of the Bladder
Palpate the area above the pubic symphysis if the
clients history indicates possible urinary retention.
Not palpable
Distended

and palpable as smooth, round, tense

mass (indicates urinary retention)

 Aorta:
With

thumb and index finger

Press deeply in the epigastric region
Soft

& pulsatile

Normal Age-Related Variations

INFANTS
Internal

organs of newborns and infants are

proportionately larger than those of older children
and adults
The infants liver may be palpable
Umbilical hernias may be present at birth.

 CHILDREN
Toddlers

-pot belly appearance,

Late preschool and school-age -leaner and have a
flat abdomen.
Peristaltic waves may be more visible than in
adults.
The liver is relatively larger than in adults.

 OLDER ADULTS
Decreased

bowel sounds
Decreased abdominal tone
Liver border palpated more easily
The rounded abdomens -increase in adipose tissue
and a decrease in muscle tone.
Stool passes through the intestines at a slower rate

GI Variations with pregnancy

Decrease

in gastric motility
High incidence of N, V (r/t pregnancy hormones) and
heartburn or acid reflux
Bowel sounds diminished r/t enlarged uterus
displacing intestines
Linea nigra- increased pigmentation of abd midline
Striae Gravidarum

Sample Documentation
Normal

ExamAbdomen soft, rounded and symmetric without

distention; no lesions or scars, or visible peristalsis.
Aorta midline without bruit or visible pulsation;
umbilicus inverted and midline without herniation;
bowel sounds present in all 4 quadrants. Liver, kidney
and spleen non-palpable; no tenderness on palpation.
Reports good appetite; no constipation, nausea or
diarrhea. Voiding well and denies laxative use.

Normal Examination findings

I examined this elderly gentlemans abdomen. On
general inspection from the end of the bed he
appeared comfortable at rest. There were no
peripheral signs of abdominal or liver disease. His
abdomen was soft and non-tender with no
distension. There were no palpable masses or
organomegaly. Bowel sounds were present.
In summary, this is an elderly gentleman with
normal abdominal examination.