3. Physical Assessment: The Abdomen Purposes Identifies the anatomical boundaries of the abdomen. Identifies the functions of abdomen auscultation, palpation, and percussion. Performs complete physical examination of the abdomen, Documenting findings in an approved format.

4. The Abdomen The abdomen extends from the diaphragm inferiorly to the inlet of the true pelvis. Its contents are partially protected: Superiorly by the lower ribs. Posterior by the lumbar vertebra. Laterally by the iliac bones.

5. Abdomen Regions Divisions of the abdomen Four Quadrants. Nine regions.

6. Four Quadrants The four quadrants are formed by two imaginary perpendicular lines: One line laterally across the midline at the umbilicus. One line vertically fro xiphoid process to the symphysis pubis.

7. Nine Regions The nine regions are referred to as : Right hypochondriac. Epigastric. Left hypochondriac. Right lumbar. Umbilical. Left lumbar. Hypogastric Left inguinal.

8. Assessment Procedures Beginning the Examination Gather data. Prepare the Environment. Prepare client.

9. Inspection The first step, inspection, focuses on abdominal wall Contour. Appearance. Movement. Note for any : Bulging along the midline. Bulging above the inguinal ligament. Not for the position of the umbilicus.

10. Examination Look for scars, striae, hernias, vascular changes, lesions, or rashes. Look for movement associated with peristalsis or pulsations.

11. Auscultation Auscultation precedes percussion and palpation to improves the reliability of auscultation by preventing a disruption or distortion of bowel sounds.

12. Auscultation Place the diaphragm of the stethoscope lightly on the abdomen. Listen for bowel sounds. Are they normal, increased, decreased, or absent ? In all four quadrants. Listen for bruits over the renal arteries, iliac arteries, and aorta.

13. Bruits In addition to bowel sounds, abdominal bruits are sometimes heard. Listen over the aorta, renal, and iliac arteries. Bruits confined to systole do not necessarily indicate disease. Don't be fooled by a heart murmur transmitted to the abdomen.

14. Percussion This technique allow you to evaluate the size of some of the organs and to detect the presence of excess fluid or air. Remember to ask whether there are any sites that are tender of painful, This area should percussed last. Remember to warm your hands before beginning.

15. Percussion Percuss in all four quadrants using a clockwise sequence beginning with the right upper quadrant unless contraindicated by pain. Categorize what you hear as tympanitic or dull. Tympany is normally present over most of the abdomen in the supine position. Unusual dullness may be a clue to an underlying abdominal mass.

16. Liver Span Measure the liver span by percussing hepatic dullness from above (lung) and below (bowel). A normal liver span is 6 to 12 cm in the midclavicular line.

17. Liver Span Percuss downward from the chest in the right midclavicular line until you detect the top edge of liver dullness. Percuss upward from the abdomen in the same line until you detect the bottom edge of liver dullness.

18. Splenic Dullness Percuss the lowest costal interspace in the left anterior axillary line. This area is normally tympanitic. Ask the patient to take a deep breath and percuss this area again. Dullness in this area is a sign of splenic enlargement.

19. Palpation General Palpation Begin with light palpation At this point you are mostly looking for areas of tenderness. The most sensitive indicator of tenderness is the patients facial expression. Voluntary or involuntary guarding may also be present. Proceed to deep palpation After surveying the abdomen lightly. Try to identify abdominal masses or area of deep tenderness

20. Palpation of the Liver Standard Method Place your fingers just below the right costal margin and press firmly. Ask the patient to take deep breath. You may feel the edge of the liver press against your finger. Or it may slide under your hand as the patient exhales. A normal liver is not tender.

21. Alternate Method This method is useful when the patient is obese or when the examiner is small compared to the patient. Stand by the patients chest. “Hook’’ your fingers just below the coastal margin and press firmly. Ask the patient to take a deep breath. You may feel the edge of the liver press against your fingers.

22. Palpation of the Aorta Press down deeply in the midline above the umbilicus. The aortic pulsation is easily felt on most individuals. A well defined, pulsatile mass, greater than 3 cm across, suggests an aortic aneurysm.

23. Palpation of the Spleen Use your left hand to lift the lower rib cage and flank. Press down just below the left costal margin with your right hand. Ask the patient to take a deep breath. notThe spleen is not normally palpable on most individuals.

24. Special Testes Rebound Tenderness This is a test for peritoneal irritation: Warn the patient what you about to do Press deeply on the abdomen with your hand After a moment, quickly release pressure. If it hurts more when you release, the patient has rebound tenderness

25. Special Tests Costovertebral tenderness CVA tenderness is often associated with renal disease: Warn the patient what you are about to do. Have the patient sit up on the exam table. Use the heel of your closed fist to strike the patient firmly over the costovertebral angles. Compare the left and the right sides

26. Shifting Dullness This is a test for peritoneal fluid (ascites) : Percuss the patients abdomen to outline areas of dullness and tympany Have the patient roll away from you. Percuss and again outline areas of dullness and tympany. If the dullness has shifted to areas of prior tympany. The patient may have excess peritoneal fluid.

27. Psoas Sign This is a test for appendicitis: Place your hand above the patients right knee: Ask the patient to flex the right hip against resistance. Increased abdominal pain indicates a positive psoas sign

28. Obturator Sign This is a test for appendicitis: Raise the patients right leg with the knee flexed. Rotate the leg internally at the hip. Increased abdominal pain indicates a positive obturator sign.

29. Conclusion By Completion of the abdominal examination you: Compare findings with the patients baseline and expected findings. Identify Unexpected outcomes And nursing intervention’

30. Record and Report Assessment findings Description of abnormalities Abnormal findings (report to physician)