ABDOMINAL ASSESSMENT

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ABDOMINAL ASSESSMENT
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Abdominal Assessment

• Patient needs to be exposed from above the
  xiphoid process to the symphysis pubis.
• Also, make sure your patient does not have a full
  bladder.
• Place patient in a supine position pillow under
  the head and knees.
• Helps to relax abdominal muscles.

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Abdominal Assessment

• Have patient point out any areas of pain or
  tenderness.
• Examine these last.
• During exam continue to monitor your patients
  facial expression for pain and discomfort.
• Use inspection, auscultation, percussion, and
  palpation to perform the exam.

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Abdominal Assessment

• Always auscultate before percussing or palpating.
• These manipulations may alter your patients
  bowel motility and resulting bowel sounds.

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Abdominal Assessment

• Inspect the skin of the abdomen and flanks for
• Scars
• Dilated veins
• Stretch marks
• Rashes
• Lesions
• Pigmentation changes

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Abdominal Assessment

• Look for discoloration over the umbilicus
• Cullens Sign discoloration over the umbilicus
• Grey Turners Sign discoloration over the
  flanks
• These are both late signs suggesting
  intra-abdominal bleeding

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Abdominal Assessment

• Assess the size and shape of your patients
  abdomen to determine
• Scaphoid (concave)
• Flat
• Round
• Distended
• Ask the patient if it is its usual size and shape

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Abdominal Assessment

• Check for
• Bulges
• Hernias
• Distended Flanks
• Ascites appears as bulges in the flanks and
  across the abdomen and indicates edema caused by
  CHF, or liver failure.

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Abdominal Assessment

• Look at your patients umbilicus
• Note location and contour and observe for any
  signs of herniation or inflammation.
• Check for
• Visible pulsation
• Visible peristalsis (wavelike motion of organs
  moving their contents through the digestive
  tract). May indicate bowel obstruction.
• Visible masses

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Abdominal Assessment

• Next auscultate for bowel sounds and other sounds
  such as bruits throughout the abdomen.
• Gently place the diaphragm on your patients
  abdomen and proceed systematically, listening for
  bowel sounds in each quadrant.
• Note location, frequency, and character
• Normal bowel sounds consist of a variety of
  high-pitched gurgles and clicks that occur every
  5-15 seconds.

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Abdominal Assessment

• More frequent sounds indicate increased bowel
  motility in conditions such as diarrhea or an
  early intestinal obstruction.
• You may hear loud, prolonged, gurgling sounds
  known as borborygmi.
• These indicate hyperperistalsis.
• Decreased or absent sounds suggest a paralytic
  ileus or peritonitis

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Abdominal Assessment

• Bruits are swishing sounds that indicate
  turbulent blood flow.
• Listen in areas over abdominal blood vessels such
  as the aorta and renal arteries
• Presence indicates abdominal aortic aneurysm or
  renal artery stenosis

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Abdominal Quadrants Posterior
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Abdominal Quadrants Anterior
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Abdominal Assessment

• Percussing the abdomen produces different sounds
  based on the underlying tissues.
• Sounds help you detect excessive gas and solid or
  fluid-filled masses
• Also help you determine the size and position of
  solid organs such as the liver and spleen
• Percuss the abdomen in the same sequence you used
  for auscultation

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Abdominal Assessment

• Note the distribution of tympany and dullness
• Expect to hear tympany in most of the abdomen
• Expect dullness over the solid abdominal organs
  such as the liver and spleen

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Abdominal Assessment

• Palpate the abdomen last to detect
• Tenderness
• Muscular rigidity
• Superficial organs and masses
• Before you begin palpation, ask your patient if
  he has any pain or tenderness
• Palpate that area last, using gentle pressure
  with a single finger

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Abdominal Assessment

• Ask him to cough and tell you if and where he
  experiences any pain
• This is typical for peritoneal inflammation

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Abdominal Assessment

• Light palpation by moving your hand slowly and
  just lifting it off the skin.
• Use same sequence as for auscultation and
  percussion
• Watch for patients face for signs of discomfort

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Abdominal Assessment

• Identify any masses and note
• Size
• Location
• Contour
• Tenderness
• Pulsations
• Mobility

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Abdominal Assessment

• Abdominal pain upon light palpation suggests
  peritoneal irritation or inflammation
• If rigidity or guarding while palpating,
  determine whether it is voluntary (patient
  anticipates the pain) or involuntary (peritoneal
  inflammation)

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Abdominal Assessment

• Next palpate deeply to detect large masses or
  tenderness
• Use one hand on top of another and push down
  slowly.
• Assess for rebound tenderness by pushing slowly
  and then releasing your hand quickly off the
  tender area.

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Abdominal Assessment

• If you note a protruding abdomen with bulging
  flanks and dull percussion sounds in dependent
  areas, you might perform two tests for ascites.

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Ascites/Test 1

• Assess for areas of tympany and dullness while
  your patient is supine
• Lie him on one side
• Percuss again, noting once more any areas of
  tympany and dullness
• If your patient has ascites, the area of dullness
  will shift down to the dependent side and the
  area of tympany will shift up.

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Ascites/Test 2

• Test for fluid wave, ask an assistant to press
  the edge of his hand firmly down the midline of
  your patients abdomen
• With your fingertips, tap one flank and feel for
  the impulses transmission to the other flank
  through excess fluid
• If you detect the impulse easily, suspect ascites