Abdominal Assessment Flashcards
Solid Viscera
viscera that maintains a characteristic shape regardless of their contents
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus
Hollow Viscera
the shape of the viscera depends on their contends
- typically not palpable unless distended with
contents (feces, urine, etc)
stomach, gallbladder, small intestine colon bladder
Abdominal Quadrants in Anatomical Position
RLQ - right lower quadrant
RUQ - right upper quadrant
LUQ - left upper quadrant
LLQ - left lower quadrant
Health History Points (9)
- Changes in Appetite - eating, weight
- Difficulty Swallowing
- Food Intolerance - to what? what happens?
- Abdominal Pain - OPQRSTU
- Nausea/ Vomiting -
- Bowel Habits - frequency, quality, recent changes
- Previous Abdominal History
- Medications - laxatives
- Alcohol and Tobacco - risk for cancers
- Nutrition - assess for nutritional deficits and
malnutrition
Anorexia
loss of appetite
- occurs with gastro-intestinal disease, as an
adverse effect of medication, pregnancy, or with
psychological disorders
Dysphagia
Difficulty swallowing
- occurs with disorders of the throat or esophagus
Pyrosis
heartburn caused by reflux of gastric acid
Belching
excessive burping
- can occur with food intolerance
- can be indicative of a hiatal hernia
Hematemesis
blood in the vomit
- occurs with stomach or duodenal ulcers
Melena
black and tarry feces due to gastrointestinal bleeding
- if taking iron supplements, black feces might
occur without the tarry texture
Inspection Points
- Demeanor
- Contour, Symmetry of the abdomen
- Umbilicus
- Skin
- Pulsations or Movement
Inspection: Demeanor
observe the patient for signs of pain, discomfort or distress:
- flexion of the knees
- grimacing
- involuntary rigidity
- voluntary guarding
Voluntary Guarding
voluntary contraction of the abdominal musculature to avoid unpleasant sensation (cold, pain, tickles)
- occurs bilaterally
- muscles relax during exhalation
- often involves pushing examiner away
Involuntary Rigidity
involuntary tightening of the abdominal musculature that occurs in response to underlying inflammation
- constant
- unilateral
- same area experiencing rigidity often becomes
painful when the patient increases intra-
abdominal pressure
Inspection: Contour, Symmetry
Positioning - standing on the patient’s right side, look at the abdomen from above, and from the side to note the contour
a. flat or rounded –> normal
b. scaphoid - associated with extreme weight
loss, malnutrition
c. perturbant - associated with obesity, ascites,
pregnancy
Notes:
- the abdomen should be symmetrical
bilaterally
- no bulging, pulsations, visible masses, or
asymmetrical shapes should be present
Inspection: Umbilicus
the umbilicus should be midline and inverted
- if everted, note whether or not this is normal
for the patient –> can become everted with
ascites, hernias, or masses
- inspect for signs of discoloration,
inflammation or hernia
Inspection: Skin
- Colour - should be uniform, consistent with ethnicity
- note any redness, rashes, bruises, etc
- Striae - stretch marks
- normal finding if consistent with rapid or
prolonged skin stretching, otherwise
abnormal
- normal finding if consistent with rapid or
- Lesions - not usually present
- Presence of veins - not usually present
- Turgor - good skin elasticity reflects healthy nutrition, hydration
- Temperature - should be warm
Skin is normally warm, dry and intact with colour consistent with ethinicity, and no presence of lesions, masses, rashes, or bruising
Auscultation Points
a. Bowel Sounds
b. Vascular Sounds
Auscultation of Bowel Sounds
start in the LRQ and continue clockwise unless pain or tenderness is expressed –> then start in the next quadrant and do painful one last
- uses the diaphragm of the stethoscpe
Types of Bowel Sounds (4)
a. Normal - 5-30 sounds per minute
b. Hyperactive - increased motility (30+)
- often occurs when digesting food, or in early
bowel obstruction (when consistent with
other signs)
c. Hypoactive - decreased motility (<5)
- often occurs following abdominal surgery,
when the patient has not eaten for a while
d. Absent - listen for 5 minutes to distinguish hypoactive and absent sounds
Auscultation of Vascular Sounds
assess the presence of vascular sounds in the abdomen prior to palpation
- Normal: no sounds
- use the bell end of the stethoscope to listen
over the aorta, left and right renal artery, iliac
a artery and femoral artery
Types of Vascular Sounds (2)
- Systolic Bruit - pulsing, blowing sound
- causes: abdominal aortic aneurysm, partial
occlusion of the femoral arteries, renal artery
stenosis –> anything causing partial occlusion of
blood flow
- causes: abdominal aortic aneurysm, partial
- Venous Hum - soft, continuous humming sound
- causes: portal hypertension, liver cirrhosis
- heard between the xiphoid process and
umbilicus
Documenting the Presence of Vascular Sounds (3)
- Location
- Pitch
- Timing - during the cardio cycle
Percussion of the Abdomen
used to:
a. assess the relative density of abdominal
contents
b. to locate organs
c. screen for abdominal fluid or masses
perform while the patient is supine, starting in the RLQ (skip to next if patient expresses pain/tenderness in RLQ) –> move clockwise
