Abdomen

• Structures and functions of the digestive system

  • Mouth
  • Esophagus
  • Stomach
  • Small intestines
  • Large intestines
  • Rectum
  • Anus

  
• Associated organs of the digestive system

  • Liver
  • Gall bladder
  • Pancreas
• Process of digestion and elimination

  1. Ingestion (Taking In Food)

  2. Digestion (Breakdown of Food)

  3. Absorption (transfer of food products into the circulation)

  4. Elimination
• Regions of the abdomen

  • Epigastric: area between costal margins
  • Umbilical: area around umbilicus
  • Suprapubic or hypogastric: area above pubic bone

  
• Quadrants of the abdomen


  • RUQ
  • RLQ
  • LUQ
  • LLQ
• Assessment techniques for the abdomen

  • Inspection
  • Auscultation
  • Palpation
  • Percussion
• When assessing the abdomen, the nurse performs inspection first, followed by auscultation, percussion, and/or palpation
• Abdominal anatomy


  • Right upper quadrant (RUQ): Stomach, Left lobe of liver, Left kidney and adrenal, Part of transverse and descending colon
  • Left upper quadrant (LUQ): Spleen, Body of Pancreas, Splenic flexure of colon, Part of transverse and descending colon
  • Right lower quadrant (RLQ): Part of descending colon, Sigmoid colon, Right ovary and tube, Right spermatic cord
  • Left lower quadrant (LLQ): Part of descending colon, Sigmoid colon, Left ovary and tube, Left spermatic cord

  
• Sites of referred abdominal pain

  • Epigastric
  • Umbilical
  • Suprapubic or hypogastric
• Subjective data (health history questions)

  • Change in appetite
  • Usual weight; Changes in usual weight
  • Difficulty swallowing
  • Foods you have difficulty tolerating
  • Nausea
  • Vomiting
  • Indigestion
  • Heartburn (pyrosis) or Belching (eructation)
  • Use of antacids
  • Abdominal bloating after eating
  • Abdominal pain
  • Alcohol use
  • Medications
  • Bowel habits: Frequency, Usual color and consistency, Diarrhea/constipation/excessive flatulence, Recent change, Use of laxatives
• Past abdominal history


  • GI problems: ulcer, hepatitis, jaundice, appendicitis, colitis, hernia
  • Surgical history of abdomen
  • Abdominal x-rays, sonograms, CT results, colonoscopy results
• Abdominal assessment preparation


  1. Check doctor's order

  2. Perform hand hygiene, apply gloves, observe infection prevention

  3. Prepare equipment

  4. Introduce self, verify client identity, explain procedure

  5. Ask client to empty bladder, ensure warm room, instruct client to remove clothes and put on gown

  6. Help client lie supine with arms folded, pillow under head and knees

  7. Drape client, instruct slow deep breathing

  8. Provide privacy
• Abdominal assessment history questions

  • Incidence of abdominal pain, tender areas; location, onset, sequence, chronology; quality; frequency; associated symptoms; constipation or diarrhea; change in appetite, food intolerances, foods ingested in past 24 hours
• Inspection of the abdomen

  1. Inspect skin for integrity, coloration, vascularity, striae, scars, lesions, rashes

  2. Inspect contour for flatness, roundness, distension

  3. Inspect symmetry, observe for bulging, masses, asymmetry

  4. Inspect umbilicus for location, contour, symmetry

  5. Ask client to take deep breath to observe for liver/spleen enlargement

  6. Assess symmetry of contour while standing at foot of bed

  7. Measure abdominal girth if distension present

  8. Observe abdominal movement, peristalsis, aortic pulsations

  9. Observe vascular pattern
• Auscultation of the abdomen

  1. Auscultate for bowel sounds, vascular sounds, peritoneal friction rubs

  2. Use diaphragm of stethoscope for bowel sounds, bell for vascular sounds

  3. Listen for active bowel sounds, bruits, peritoneal friction rubs
• Borborygmi


  Intestinal sounds (gurgling noises) occurring frequently every 3 seconds
• Absence of bowel sounds


  Indicates cessation of intestinal motility
• Assessing bowel sounds


  1. Use flat-disk diaphragm

  2. Ask when client last ate

  3. Place diaphragm in each abdominal quadrant

  4. Listen for irregular gurgling noises every 5-20 seconds
• Assessing vascular sounds


  1. Use bell of stethoscope

  2. Listen for bruits over aorta, renal arteries, iliac arteries, femoral arteries
• Peritoneal friction rub


  Rough, grating sound like two pieces of leather rubbing together, caused by inflammation, infection, or abnormal growths
• Percussing the abdomen


  1. Percuss several areas in each quadrant

  2. Note tympany over stomach and gas-filled bowels, dullness over liver and spleen

  3. Percuss liver upward from RLQ

  4. Percuss spleen downward from posterior to left mid-axillary line

  5. Perform blunt percussion on liver

  
• Palpating the abdomen


  1. Instruct client to sit, perform blunt percussion on kidneys

  2. Place client supine, perform light palpation in each quadrant

  3. Palpate spleen by reaching over with left hand and pressing upward with right hand

  4. Palpate kidneys by supporting posterior flank and pressing inward during inspiration

  5. Palpate bladder by moving upward from symphysis pubis
• Testing for ascites


  1. Percuss flanks for shifting dullness

  2. Perform fluid wave test by tapping opposite side of abdomen
• Assessing for peritoneal irritation

  1. Assess for rebound tenderness by pressing deeply and suddenly releasing

  2. Test for referred rebound tenderness in LLQ

  3. Assess for psoas sign by hyperextending right leg

  4. Assess for obturator sign by flexing and rotating right leg
• Assessing for hypersensitivity


  1. Stroke abdomen with sharp object or pinch skin and release

  2. Note complaints of pain or exaggerated sensation
• Assessing for cholecystitis


  Press fingers under liver border at right costal margin and note increase in pain on deep inspiration
• Palpating the bladder


  Palpate area above pubic symphysis
• Inform client about end of assessment, show gratitude, ensure client is stable
• Perform hand hygiene
• Document findings, inform healthcare provider of any untoward findings
• The liver has two lobes - the left lobe and the right lobe
• The liver lies under the diaphragm on the right side of the abdominal cavity
• The liver is the largest glandular organ, weighing about 1500g
• The stomach secretes hydrochloric acid and enzymes to break down food into smaller molecules
• The spleen filters blood and removes old red blood cells
• Pancreatic cancer is a type of cancer that starts in the tissues of the pancreas.
• The gallbladder stores bile produced by the liver until it is needed to digest fatty foods.
• The gallbladder is located below the liver
• Bile flows from the gallbladder into the duodenum through the common hepatic duct (formed by the union of the cystic duct and the common bile duct).
• The spleen is located to the left of the stomach