ABDOMINAL ASSESSMENT

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.

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

Abdominal Assessment Always auscultate before percussing or palpating. These manipulations may alter your patient’s bowel motility and resulting bowel sounds.

Abdominal Assessment Inspect the skin of the abdomen and flank’s for: Scars Dilated veins Stretch marks Rashes Lesions Pigmentation changes

Abdominal Assessment Look for discoloration over the umbilicus: Cullen’s Sign: discoloration over the umbilicus Grey Turner’s Sign: discoloration over the flanks These are both late signs suggesting intra-abdominal bleeding

Abdominal Assessment Assess the size and shape of your patient’s abdomen to determine: Scaphoid (concave) Flat Round Distended Ask the patient if it is its usual size and shape

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.

Abdominal Assessment Look at your patient’s 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

Abdominal Assessment Next auscultate for bowel sounds and other sounds such as bruits throughout the abdomen. Gently place the diaphragm on your patient’s 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.

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

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

Abdominal Quadrants: Posterior

Abdominal Quadrants: Anterior

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

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

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

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

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 patient’s face for signs of discomfort

Abdominal Assessment Identify any masses and note: Size Location Contour Tenderness Pulsations Mobility

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)

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.

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.

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.

Ascites/Test 2 Test for fluid wave, ask an assistant to press the edge of his hand firmly down the midline of your patient’s abdomen With your fingertips, tap one flank and feel for the impulse’s transmission to the other flank through excess fluid If you detect the impulse easily, suspect ascites