abdominal assessment

• Abdomen


  • - Bordered superiorly by the costal margins
  • Inferiorly by symphysis pubis and inguinal canals
  • Laterally by the flanks

  
• Locating abdominal structures by quadrants


  • Determined by imaginary vertical line
  • Bisected perpendicular by the lateral line through umbilicus across the abdomen

  
• Left Upper Quadrant


  • - Left adrenal gland
  • Left kidney
  • Left ureter
  • Pancreas, spleen, stomach
  • Transverse descending colon
• Left Lower Quadrant


  • - Left kidney
  • Left ovary and tube
  • Left ureter
  • Left spermatic cord
  • Descending and sigmoid colon
• Right Upper Quadrant


  • - Ascending and transverse colon
  • Duodenum; gall bladder; hepatic flexure of colon; liver
  • Pancreatic head; pylorus; right adrenal gland
  • Right kidney; right ureter

  
• Right Lower Quadrant


  • - Appendix
  • Ascending colon; cecum
  • Right kidney
  • Right ovary and tube
  • Right ureter
  • Right spermatic cord

  
• Abdominal wall muscles


  • - 3 muscle layers from back, around flanks, to front: external and internal abdominus oblique, transverse abdominus
  • Protect internal organs; allow normal compression of internal organs during functional activities

  
• Peritoneum


  A thin, shiny serous membrane that lines the abdominal cavity and provides a protective covering for most of the internal abdominal organs
• Abdominal viscera


  • Solid Viscera:
  • liver
  • pancreas
  • spleen
  • adrenal glands
  • kidneys
  • ovaries
  • uterus

  Hollow Viscera:

  • stomach
  • gallbladder
  • small intestine
  • colon
  • bladder

  
• Viscera normally not palpable
• Visceral Pain


  Dull, aching, burning, cramping or colicky
• Parietal Pain


  Severe and steady pain
• Referred Pain


  Pain that travels
• Sources of Referred Abdominal Pain


  • - Epigastric pain from the stomach, duodenum or pancreas
  • Flank pain from the kidney and or radiating down the lower abdomen from the ureter
  • Periumbilical pain from the small bowel, appendix or proximal colon
  • Suprapubic pain from the rectum, colon, bladder or prostate
  • Right upper quadrant or epigastric pain from the gallbladder, biliary tree and liver
  • Referred pain from pancreas or spleen
  • Kidney pain
  • Ureter pain
  • Rectal pain
• Techniques of Assessing Abdomen


  • - Inspection
  • Auscultation
  • Percussion
  • Palpation
• Inspection


  • Observe the coloration of the skin
  • Note the vascularity of abdominal skin
  • Note any striae
  • Inspect for scars
  • Assess for lesions and rashes
• Abdominal skin may be paler than the general skin tone because this skin is so seldom exposed to the natural elements
• Grey Turner sign


  Purple discoloration at the flanks indicates bleeding within the abdominal wall, possibly from trauma to the kidneys, pancreas, or duodenum or from pancreatitis
• Jaundice


  The yellow hue may be more apparent on the abdomen
• Ascites


  Significant abdominal swelling indicating fluid accumulation in the abdominal cavity, resulting in pale, taut skin
• Striae


  • Old, silvery, white striae or stretch marks from past pregnancies or weight gain are normal
  • Dark bluish-pink striae are associated with Cushing's syndrome
  • Striae may also be caused by ascites, which stretches the skin
• Scars


  • Pale, smooth, minimally raised old scars are normal
  • Nonhealing scars, redness, inflammation are abnormal
  • Deep, irregular scars may result from burns
• Lesions and rashes


  Abdomen is free of lesions or rashes, but flat or raised brown moles are normal
• Umbilicus


  • Note the color of the umbilical area
  • Observe umbilical location and contour
• Normal umbilical skin tones


  Similar to surrounding abdominal skin tones or even pinkish
• Cullen's sign


  Bluish or purple discoloration around the umbilicus indicates intra-abdominal bleeding
• Umbilical contour


  • Recessed (inverted) or protruding no more than 0.5 cm; round or conical
  • An everted umbilicus is seen with abdominal distention
  • An enlarged, everted umbilicus suggests umbilical hernia
• Abdominal contour


  • Flat, rounded, or scaphoid (usually seen in thin adults)
  • Abdomen should be evenly rounded

  
• Generalized protuberant or distended abdomen


  May be due to air (gas) or fluid accumulation
• Distention below the umbilicus


  May be due to a full bladder, uterine enlargement, or an ovarian tumor or cyst
• Distention of the upper abdomen


  May be seen with masses of the pancreas or gastric dilation
• Abdominal asymmetry


  May be seen with organ enlargement, large masses or hernia, diastasis recti or bowel obstruction

  
• Diastasis recti


  Separation of the rectus abdominis muscles, resulting in abdominal asymmetry

  
• Hernia


  Protrusion of the bowel through the abdominal wall, seen as a bulging in the abdominal wall

  
• Abdomen does not bulge when client raises head
• Abdominal respiratory movement


  May be seen, especially in male clients

  Diminished abdominal respiration or change to thoracic breathing in male clients may reflect peritoneal irritation
• Aortic pulsations


  A slight pulsation of the abdominal aorta, which is visible in the epigastrium, extends full length in thin people

  Vigorous, wide, exaggerated pulsations may be seen with abdominal aortic aneurysm

  
• Peristaltic waves


  Normally, peristaltic waves are not seen, although they may be visible in very thin people as slight ripples on the abdominal wall
• Bowel sounds


  A series of intermittent, soft clicks and gurgles are heard at a rate of 5 to 30 per minute

  Hyperactive bowel sounds (loud, prolonged gurgles) are called "borborygmi"
• Hyperactive bowel sounds


  Indicate conditions like bowel obstruction, gastroenteritis, diarrhea, or use of laxative