Assessment of the Abdomen (FINALS)

• ABDOMEN IS THE AREA OF THE BODY BETWEEN THE DIAPHRAGM AND THE SYMPHYSIS PUBIS
• Four quadrants of the abdomen


  • Right upper quadrant
  • Left upper quadrant
  • Right lower quadrant
  • Left lower quadrant
• Contents of the right upper quadrant


  • Liver
  • Gallbladder
  • Duodenum
  • Head of the pancreas
  • Portion of the right kidney and adrenal gland
  • Hepatic flexure of the colon
  • Section of ascending and transverse colon
• Contents of the left upper quadrant


  • Left lobe of the liver
  • Stomach
  • Spleen
  • Body of the pancreas
  • Portion of the left kidney and adrenal gland
  • Splenic flexure of the colon
  • Sections of transverse and descending colon
• Contents of the right lower quadrant


  • Appendix
  • Cecum
  • Lower pole of the kidney
  • Right ureter
  • Right ovary (female)
  • Right spermatic cord (male)
• Contents of the left lower quadrant


  • Sigmoid colon
  • Section of the descending colon
  • Lower pole of left kidney
  • Left ureter
  • Left ovary (female)
  • Left spermatic cord (male)
• Abdominal regions


  • Right hypochondriac
  • Epigastric
  • Left hypochondriac
  • Right lumbar
  • Umbilical
  • Left lumbar
  • Right iliac
  • Hypogastric
  • Left iliac
• General considerations for abdominal assessment


  • Greet the patient
  • Ensure warm, comfortable temperature
  • Use a quiet room free from interruptions
  • Utilize adequate light source
  • Ask patient to urinate before exam
  • Drape patient from xiphoid to symphysis pubis
  • Position patient supine with knees flexed
  • Stand on right side of patient
  • Have patient point to tender area and assess last
  • Watch patient's face for signs of discomfort
  • Help patient relax with unhurried approach
  • Ensure hands and stethoscope are warm
• Purposes of abdominal assessment


  • As part of comprehensive health exam
  • To explore gastrointestinal complaints
  • To assess abdominal pain, tenderness or masses
  • To monitor the client post-operatively
• Subjective data to collect


  • Character
  • Onset
  • Location
  • Duration
  • Severity
  • Pattern
  • Associated factors
  • Alleviating factors
• Abnormal findings on abdominal inspection


  • Flatus
  • Fetus
  • Fats
  • Fluids
  • Feces
  • Fatal growth
  • Fibroid tumors
  • Food
  • Abdominal hernia
  • Umbilical hernia
• Diastasis rectus abdominis


  Abnormal finding on inspection of rectus abdominis
• Abnormal findings on abdominal inspection


  • Cullen's sign
  • Jaundice abdomen
  • Caput medusae
• Sister Mary Joseph's nodule is an abnormal finding on inspection of the umbilicus
• Aortic aneurysm causes widened pulse pressure and strong epigastric pulsations
• Borborygmi


  Normal hyperactive bowel sounds - loud, audible, and gurgling
• Venous hum is not present in adults
• No friction rubs should be present on auscultation
• Tympany


  High pitched sound with long duration, predominant sound heard on percussion due to fluid in stomach and intestines
• Normal liver span


  • Distance between lower border and upper border dullness is 6-12 cm in midclavicular line, 10.5 cm in males, 7 cm in females
• Normal liver descent


  • Lower border dullness descends 2-3 cm on inspiration
• Normal spleen


  • Upper border of dullness is found 6 cm from left costal margin, splenic dullness may be heard from 6th to 10th rib
• Gastric bubble


  Tympany of lower pitch than intestinal tympany, heard on percussion in LUQ
• No tenderness should be elicited on percussion of the kidneys or liver
• Bladder percussion


  Urine filled bladder is dull to percussion, recently emptied bladder should not be percussable above symphysis pubis
• Palpate kidneys and liver for tenderness


  1. Place patient in sitting position

  2. Strike costovertebral angle with closed fist (direct) or place palmar surface of hand on costovertebral angle and strike with ulnar surface of fist (indirect)

  3. Ask patient what was felt

  4. Repeat on other side
• Normal: No tenderness should be elicited
• Palpate liver


  1. Place patient in supine position

  2. Place palmar surface of hand over lower rib cage

  3. Strike hand with ulnar surface of fist

  4. Ask patient what was felt and observe reaction
• Percuss bladder


  1. Percuss upward from symphysis pubis to umbilicus

  2. Note where sound changes from dullness to tympany
• Normal: Urine filled bladder is dull to percussion. Recently emptied bladder should not be percussable above symphysis pubis
• It is abnormal to percuss a bladder that has been emptied. The urine that remains is called residual urine
• Inability to empty bladder occurs in elderly, postoperative, bedridden, acutely ill patients and those with neurogenic bladder dysfunction
• Light palpation of abdomen


  1. Depress abdominal wall 1 cm with pads of fingers

  2. Lightly palpate all four quadrants systematically
• Normal: Abdomen should feel smooth with consistent softness
• Deep palpation of abdomen


  1. Depress skin approximately 5-8 cm starting in RLQ

  2. Use one-handed or two-handed method
• Normal: No organ enlargement, bulges or swelling should be palpable. Only aorta and liver edge are palpable
• Palpate liver


  1. Bimanual method: Stand on right side, place left hand under right flank, press upward, place right hand parallel to midline below right costal margin, instruct patient to take deep breath

  2. Hook method: Stand on right side, place both hands on right costal margin, hook fingers in and up, ask patient to take deep breath
• Normal: Liver edges should be firm, sharp, regular ridge with smooth surface. Normally not palpable, may be felt in thin adults
• Palpate spleen


  Stand on right side, reach across with left hand to left costovertebral angle and press upward, with right hand press inward along left costal margin as patient takes deep breath
• Normal: Spleen should not be palpable. It is palpable only when enlarged to 3 times normal size, which could be very tender