Assessment Of The Abdomen

ASSESSMENT OF THE ABDOMEN Abdominal Mapping  Four Quadrants of the Abdomen • Right upper quadrant • Right lower quadrant • Left upper quadrant • Left lower quadrant

Anatomical Mapping  Nine Regions of the Abdomen • Right & Left hypochondriac • Right & Left Lumbar • Right & Left Iliac • Epigastric • Umbilical • Hypogastric

Landmarks of the abdomen  Xiphoid process  Costal margins  Iliac crest  Anterior superior iliac spine  Symphysis pubis  Umbilicus

 Assessment involves: • Inspection • Auscultation • Palpation • Percussion Assessing the Abdomen  Inquire if the client has any history of the following: • Incidence of abdominal pain and associated symptoms • Incidence of constipation or diarrhea • Change in appetite • Food intolerances and food ingested in last 24 hours • Specific signs and symptoms • Previous problems and treatment  Assist the client to a supine position • Arms are placed comfortably at the sides • Place small pillows beneath the knees and the head • Expose the client’s abdomen only from the chest line to the pubic area INSPECTION OF THE ABDOMEN  Inspect the abdomen for skin integrity  Inspect the abdomen for contour and symmetry  Symmetrical / asymmetrical  Flat  Rounded  Protuberant

 Scaphoid  Observe abdominal movements associated with respiration, peristalsis or aortic pulsations  Observe the vascular pattern AUSCULTATION OF THE ABDOMEN  Auscultate the abdomen for bowel sounds • Use the flat disc diaphragm • Ask when the client last ate • Place the diaphragm in each of the four quadrants • Listen for active bowel sound occurring every 5 to 20 seconds  Auscultate the abdomen for vascular sounds • Use the bell of the stethoscope and listen for bruits over the:  Aorta  Renal arteries  Iliac arteries  Femoral arteries  Auscultate for peritoneal friction rubs • Rough grating sounds • Caused by inflammation, infection or abnormal growths Ausculatate the splenic site Auscultate the liver site PERCUSSION OF THE ABDOMEN  Percuss several areas in the four quadrants to determine presence of tympany, dullness or flatness

 Use systematic pattern : RLQ, RUQ, LUQ, LLQ Percussion of the spleen Bimanual percussion for liver inflammation

Bimanual percussion for Kidney inflammation

 Percuss the liver to determine its size • 6 to 12 cm (21/2 to 3 ½ in) in the midclavicular line • 4 to 8 cm (11/2 to 3 in) at the midsternal line PALPATION OF THE ABDOMEN  Perform light palpation first to detect areas of tenderness or muscle guarding • Fingers should be parallel to the abdomen • Use finger pads to depress the abdominal wall about 1 cm • Move finger pads in a slight circular motion  Perform deep palpation over all four quadrants  Depress the abdominal wall about 4 to 5 cm (1 ½ to 2 in)  If mass is present determine:  size  Location  Mobility  Contour  Consistency  Tendernes  Palpate the liver to detect enlargement and tenderness  Palpate the bladder, the area above the pubic symphysis LIFESPAN CONSIDERATION  Infants

• Internal organs of the newborns and infants are proportionately larger, abdomens are rounded and tend to protrude • Umbilical hernias may be present at birth  Children • Pot belly persist until age 3 to 4 years old • May not be able to pinpoint areas of tenderness • Liver can be palpated 1 to 2 cm below the right costal margin Elders • Rounded abdomens are due to increase in adipose tissue and a decrease in muscle tone • Muscle wasting occur • Pain threshold is often higher • Fecal incontinence may occur • Gastrointestinal pain needs to be differentiated with cardiac pain • Stool passes through the intestine at a slower rate • Incidence of colon cancer is higher • Decreased absorption of oral medications • Impaired metabolism of some drugs in the liver