Abdominal Assessment

• A family history of abdominal disease should be asked about.
• The usual bowel pattern and characteristics should be described.
• Problems with weight loss or gain, a change in appetite or taste, food intolerance, belching, nausea or vomiting, hematemesis, pain or indigestion with eating, difficulty swallowing, diarrhea or constipation, bowel incontinence, flatulence, changes in bowel habits or stool characteristics should be investigated.
• Abdominal assessment involves inquiring about a history of abdominal disease, asking the client to describe the usual bowel pattern and characteristics, and investigating problems with weight loss or gain, a change in appetite or taste, food intolerance, belching, nausea or vomiting, hematemesis, pain or indigestion with eating, difficulty swallowing, diarrhea or constipation, bowel incontinence, flatulence, changes in bowel habits or stool characteristics.
• The usual bowel pattern and characteristics should be described during abdominal assessment.
• Patient Behavior: Normal findings: A comfortable person is relaxed and quiet on the examining table, has a relaxed facial expressions and normal respirations.
• Abdominal contour: (measure abdominal girth) – describes the nutritional state, flat, rounded, protruberant or distended, scaphoid or concave, symmetry, symmetric, asymmetric, movement, respiratory movement, abdominal respiration, pulsations, slight pulsation, vigorous, exaggerated pulsations, peristaltic waves, not visible, visible.
• Auscultation: Normal findings: Bowel sounds (RLQ-RUQ-LUQ-LLQ) are normally present in the ileocecal valve area (RLQ), diaphragm of steth is high pitch, intermittent, soft clicks cascading and gurgles, “borborygmi” – stomach growling, absent or hypoactive, absent or hyperactive, absent or hypoactive, auscultate for 5 minutes before concluding.
• Percussion: Normal findings: Abdomen is non-tender, soft, guarding, rigid masses are not palpable, aorta is 2.5 – 3 cm wide with a moderately strong and regular pulse, liver, spleen, kidneys are not palpable, mild tenderness is normal, seldom palpable, not palpable, enlarged, tender, enlarged.
• Umbilicus’ color, location: Similar to surrounding abdominal skin tones, midline, inverted, round.
• Skin characteristic over abdomen: Pale, smooth, minimally raised scars, free of lesions or rashes, flat moles, surgical scars may be present but record the length in cm and location, good skin turgor.
• Abnormal findings: Restlessness and constant turning to find comfort, resisting any movements, knees flexed up, facial grimacing and rapid uneven respirations may indicate pain.
• Tests for appendicitis: Blumberg’s sign (Rebound tenderness) is a sharp, stabbing pain as the examiner releases pressure from the abdomen, Rovsing’s sign is pain in the RLQ during pressure in the LLQ, Psoas sign (Iliopsoas muscle test) is pain in the RLQ when raising the client’s right leg from the hip while applying pressure on the lower thigh, Obturator sign is pain in the RLQ when the hip and knee are flexed and when the legs are rotated internally.
• Defecation: bowel movements (BM)
• Constipation: passage of hard stool, no passage of stool for a period of time
• Ankle: Dorsiflexion, Plantar Flexion, Inversion, Eversion
• Hip: Rotation, Flexion, Extension, Abduction, Adduction
• Toes: Flexion, Extension, Abduction, Adduction
• Knee: Flexion, Extension
• Obstipation: collection of hardened feces in the colon
• Diarrhea: frequent passage of watery stools
• Flatulence: presence of excess gas (tympanites)
• Fecal impaction: collection of hardened feces in the folds of the rectum
• Pyrosis: heartburn
• Fecal incontinence: involuntary elimination of bowel movements (Encopresis)
• Feces: waste products of digestion in the colon
• Stool: waste products of digestion expelled into the external environment
• Acholic stool (clay-colored stool): absence of bile pigment stercobilin in biliary obstruction
• Hematochezia: passage of stool with bright red blood due to lower GI bleeding
• Melena: black, tarry stool due to Upper GI bleeding
• Right upper quadrant: Liver, Gallbladder, Duodenum, Head of pancreas, Right kidney and adrenal, Hepatic flexure of colon, Part of ascending and transverse colon
• Emesis: vomiting
• Oscopy: Visualization of an organ or body cavity with lighted instruments (e.g. esophagoscopy, gastroscopy, colonoscopy)
• Steatorrhea: greasy, fatty foul-smelling stool due to presence of undigested fats
• Enema: Administration of fluid or medication into the colon through a rectal tube
• Range of motion (ROM) exercises for various body parts
• Ostomy: Opening to the outside of the body (e.g. colostomy, ileostomy, gastrostomy)
• Ectomy: Removal of a body organ or glands (e.g. appendix, spleen, gallbladder, stomach)
• Centesis: Aspiration of fluid from a body organ or cavity (e.g. paracentesis - aspiration of fluid from the abdominal cavity)
• Murphy's sign: Pain occurs on palpation of the liver in a patient with inflammation of the gall bladder or cholecystitis