ABDOMINAL ASSESSMENT

BARBARA REES, RN, DSN

SUBDIVISION OF ABDOMEN

RIGHT UPPER QUADRANT - RUQ

RIGHT LOWER QUADRANT - RLQ

LEFT UPPER QUADRANT - LUQ

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

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

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