Abdominal Assessment

ABDOMINAL ASSESSMENT

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BARBARA REES, RN, DSN

SUBDIVISION OF ABDOMEN ◗

RIGHT UPPER QUADRANT - RUQ

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RIGHT LOWER QUADRANT - RLQ

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LEFT UPPER QUADRANT - LUQ

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LEFT LOWER QUADRANT - LLQ

ABDOMINAL QUADRANTS

NINE ABDOMINAL QUADRANTS

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

AUSCULTATION FOR BRUITS

PERCUSSION ◗

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TO DETERMINE THE SIZE OF SOLID ORGANS AND PRESENCE OF MASSES, FLUID AND GAS TYMPANIC SOUND PERCUSS IN ALL FOUR QUADRANTS PERCUSS FOR LIVER 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

ON BACK ◗

CHECK FOR RENAL BRUITS

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COSTOVERTEBRAL ANGLE TENDERNESS

PERCUSION OF KIDNEY

IF ABDOMINAL PAIN ◗ ◗ ◗ ◗ ◗

TACHYPNEIC LEANING FORWARD MURPHY’S SIGN ROVSING’S SIGN ILIOPSOAS TEST

ILIOPSOAS TEST

RULES IF IN ABDOMINAL PAIN ◗

DO NOT ADMINISTER PAIN MEDICATIONS, ANTISPASMODICS, ANTICHOLINERGICS, OR SMOOTH MUSCLE RELAXANTS BEFORE A MEDICAL EXAM B/C MASK PAIN

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 ◗