1. Dr. K. Shaarawy
Abdomen Assessment
Dr. K. Shaarawy Dr. K. Shaarawy

2. Anatomy of the Abdomen 4 Quadrants 4 Quadrants:
The word "abdomen" has a curious story behind it. It comes from the Latin "abdodere", to hide. The idea was that whatever was eaten was hidden in the abdomen.
4 Quadrants:
RUQ: Rt Upper Quadrant.
RLQ: Rt Lower Quadrant.
LUQ: Lt Upper Quadrant.
LLQ: Lt Lower Quadrant.
4 Quadrants
Dr.Karim Shaarawy,MD

3. 9 Regions
Dr. K. Shaarawy
Dr.Karim Shaarawy,MD

4. Dr.Karim Shaarawy,MD

5. Location RUQ Liver (Rt Lobe) Gall Bladder Duodenum Pancreas (Head)
Rt Kidney
Adrenal Galnd
Dr.Karim Shaarawy,MD

6. Location RLQ Cecum Appendix Rt Ovary Rt Fallopian Tube Ascending Colon
Dr.Karim Shaarawy,MD

7. Location LLQ Sigmoid Colon Lt. ovary Lt Fallopian Tube LUQ Stomach
Spleen
Pancreas (Body,Tail)
Lt Kidney
Lt Adrenal Gland
Dr.Karim Shaarawy,MD

8. GI Variations Due to Age
Aging- should not affect GI function unless associated with a disease process
Decreased: salivation, sense of taste, gastric acid secretion, esophageal emptying, liver size, bacterial flora
Increased: constipation!امساك
Dr.Karim Shaarawy,MD

9. GI Variations with pregnancy
Decrease in gastric motility
High incidence of GERD (pregnancy hormones cause “heartburn” or acid reflux)
Bowel sounds diminished because enlarged uterus displacing intestines
Linea Nigra- increased pigmentation of abd midline
Striae Gravidarum (stretch marks)
Dr.Karim Shaarawy,MD

10. Health History - Abdomen
Ask about:
Appetite
Weight gain or loss
Dysphagiaصعوبة فى البلع
Intolerance to certain foods
Any Abdominal Pain, Nausea and Vomiting
Bowel movements
Any past abdominal problems
Dr.Karim Shaarawy,MD

11. Health History Infants and Children –
Ask: bottle or breast fed, any table foods, how often & how well & how much the baby eat, any problems with constipation, c/o of any abdominal pain
Older Adults
Ask: Do you have any trouble swallowing?
How often do your bowels move?
How often do you take anything for constipation?
What medications do you take?
Dr.Karim Shaarawy,MD

12. Focused Health History
Nutrition
Allergies
Medications
Cigarette/tobacco
Alcohol intake
Drug use
Stool characteristics
Urine characteristics
Exposure to infectious diseases.
Recent stressful life events
Possibility of Pregnancy
Dr.Karim Shaarawy,MD

13. Physical Assessment Auscultation Percussion Palpation (always last)
General Observation
Inspection
Auscultation
Percussion
Palpation (always last)
Dr.Karim Shaarawy,MD

14. Examination Techniques
Provide privacy
Good lighting/appropriate temp in room
Expose the abdomen
Empty bladder
Position pt supine, arms by side & head on pillow with knees slightly bent or on a pillow
Warm stethoscope & hands
Painful areas last
Distraction techniques
Dr.Karim Shaarawy,MD

15. Inspection Overall observation
Abdominal contour- flat, scaphoid, round, protuberant
Abdominal symmetry and skin color –
Note any masses, striae, scars, veins, pigmentation
Pulsations
Dr.Karim Shaarawy,MD

16. Abnormal Abdominal Appearance
Dilated veins: hepatic cirrhosis or inferior vena cava obstruction
Umbilical bulge: hernia
Asymmetric abdomen: mass or enlarged organ
Protuberant abdomen: fat, tumors, gas, ascites, or pregnancy
Convex abdominal contour: pregnancy, obesity, ascites, urinary retention, gas (presenting with acute distention from bloating)
Visible Peristalsis: Obstruction
Dr.Karim Shaarawy,MD

17. Auscultation
Always done before percussion & palpation as they may disrupt the noises produced by the bowel sounds.
Use diaphragm of stethoscope
Listen lightly
Start with RLQ (follow route of Large intestine)
Listen to each quadrant for 15 seconds each.
Dr.Karim Shaarawy,MD

18. Auscultation
Should be approximately 5-35/min clicks and gurgles in each quadrant. Note character & frequency of bowel sounds.
Listen for 5 minutes before documenting absent bowel sounds
Hyper- gastroenteritis, obstruction, hunger
Hypo- pregnancy, peritonitis
Absent - Ileus
Dr.Karim Shaarawy,MD

19. Abnormal Auscultation
Hyperactive bowel sounds- “borborygmi”
Listen for bruits- aortic, renal, iliac, femoral
Peritoneal Friction Rub- rough, grating heard over liver & spleen- inflammation of peritoneal surface from tumor, infection, etc.
Dr.Karim Shaarawy,MD

20. Percussion Gently tapping on the skin to create a vibration
Detect fluid, gaseous distention and masses
Tympany- gas (dominant sound because of air in small intestine)
Dullness- solid masses, distended bladder
Percuss liver, spleen ,kidneys
Dr.Karim Shaarawy,MD

21. Percussion Abnormal Findings
Enlarged organs,
Palpable masses,
Distention,
Ascites
Marked tenderness
Dr.Karim Shaarawy,MD

22. Palpation of Abdomen
Light palpation- depress about 1 cm. Assess skin pulsations. Always done first- clockwise
Deep palpation- depress skin about 5-8 cm.
Always assess tender areas last.
Watch patients expression during palpation
Dr.Karim Shaarawy,MD

23. Palpation Abnormal Findings
Tenderness- rebound- done away from painful area- done at end of exam
Masses- document location, size, shape, mobile, pulsating, smooth, nodular, firm
Firmness or muscle guarding/rigidity- intraabdominal bleeding- DO NOT CONTINUE TO PALPATE!!!!!!
Dr.Karim Shaarawy,MD

24. Special Procedures
Fluid Wave - need 3 hands- feel for impulse of the wave of fluid across the abdomen= ascites
Rebound Tenderness - Blumberg’s Sign
Iliopsoas Muscle Test - thigh muscle lift R leg and push down on R thigh= appendicitis
Obturator Test - lift R leg and rotate at 90 degrees= muscle is irritated by appendicitis
Murphy’s Sign - “inspiratory arrest” palpate the liver should be painless= cholecystitis
Dr.Karim Shaarawy,MD

25. Special Procedures McBurney’s Point - RLQ midclavicular= appendicitis
Referred pain - location of pain is not where the involved organ is! May be felt where the organ was located in fetal development ex: spleen= L shoulder pain/ kidney= groin pain
Cullen’s Sign- bluish discoloration
around the umbilicus(Pancreatitis)
Kehr’s Sign- abd pain radiating
to Lt shoulder= spleen or pancreatitis
Dr.Karim Shaarawy,MD

26. Sample Documentation Normal Exam-
Abdomen soft, rounded and symmetric without distention; no lesions or scars, or visible peristalsis. Aorta midline without bruit or visible pulsation; umbilicus inverted and midline without herniation; bowel sounds present in all 4 quadrants. Liver, kidney and spleen non-palpable; no tenderness on palpation. Reports good appetite; no constipation, nausea or diarrhea. Voiding well and denies laxative use.
Dr.Karim Shaarawy,MD