Abdominal Assessment

NUR 3910410 Health Assessment

Helen P. Montana, MS, ANP, RN-BC

Sequence in abdominal assessment
 Sequence for rest of body systems:
 Inspect, Percuss, Palpate, Auscultate

 Sequence for abdominal assessment

 Inspection
 Auscultation
 Percussion
 Palpation

 The difference is based on the fact that physical

handling of peritoneal contents may alter bowel sounds.
Quadrants and Regions
of the Abdomen
Organs and Common Conditions
Inspection

 Inspect for contour, shape, symmetry, lesions, scars, striae

and vascularity

 Contour: flat, scaphoid (concave), protuberant

(convex)
 Rounded abdomen common in children, for adults it's the
result of poor muscle tone from inadequate exercise
 Localized enlargement may indicate hernia, tumor, cysts,
bowel obstruction, or enlargement of abdomen.
Inspection
 Color
 Cullen’s sign – bluish color of the umbilicus, sign of bleeding
in the umbilicus
 Grey Turner’s sign – bruising on the flanks indicating
peritoneal bleeding.
 Jaundice – caused by liver disease or biliary tract
obstruction

 Scars – surgery, injury

 Striae (stretch marks) sign of past weight changes or

pregnancy
 Purple striae - Cushing’s disease
Inspection
 Lesions or nodules
 May not be related to gastrointestinal diseases
 Enlarged umbilical node may signal metastatic cancer
 Spider angiomas – spiderlike blood vessels on the skin may signal
liver disease

 Peristalsis
 Not normally seen on the surface of the abdomen
 Visible peristalsis – sign of intestinal obstruction

 Pulsations
 Pulsation in upper midline – visible in thin adults
 Marked pulsations – increased pulse pressure or abdominal
aortic aneurysm
Auscultation
 Normal gut sounds – gurgling sounds occurring 5-35 per minute –
heard with the diaphragm of the stethoscope.
 Decreased sounds/decreased gut activity – no sounds for 1 min
 Decreased after abdominal surgery or infection, or injury, constipation
 Absent sounds ( no sounds for 5 min) – ominous sign
 Can be a sign of intestinal obstruction, intestinal perforation, or
intestinal ischemia, infarction, paralytic ileus
 Hyperactive bowel sounds
 Increased peristaltic movement
 Diarrhea
 Malabsorption states – absorption of nutrients impaired, i.e. Crohn’s
disease

 Borborygmi – rumbling or growling sound of the stomach

 Hungry, after meals, normal sound
Percussion

 Technique – hyperextend middle finger of your

nondominant hand and place this finger firmly against your
patient’s abdomen. With the end (not the pad) of your
dominant middle finger against your patient’s abdomen.

 Percuss for tone

 Tympany – usually present in most of the abdomen caused by
air in the gut, higher pitch than the lungs
 Resonance – a lower-pitched and hollow sound
 Dullness – flat sound without echoes; the liver, spleen, and fluid
in the peritoneum (ascites) give a dull note.
 Unusual dullness – a clue to an underlying mass
Palpation
 Do light palpation in all 4 quadrants
 Depress abdominal wall no more than 1 cm

 Assessing for fluid wave – test for ascitis

 Patient lies supine.
 Assistant presses ulnar surface of hand downward into the
patient’s mid abdomen
 Examiner tap flanks with right hand hand while placing fingertips
of left hand along other flank.
 Examiner left hand receives impulse or shock wave on opposite
flank.
 Examiner should anticipate lag between tap and impulse
received.
 Test is positive if the impulse is felt, implying that it was passed by
ascitic fluid.
Assessing for rebound tenderness

 See video’s in moodle

 Rovsing’s sign
 Psoa’s sign
 Obturator sign

 Assessing for cholecystitis

 Murphy’s sign