HA N106

• Anatomic Divisions


  • Abdominal quadrants
  • Abdominal wall muscles
  • Intestinal anatomy of the abdominal cavity
• Abdominal Quadrants


  • Right Upper Quadrant
  • Right Lower Quadrant
  • Left Lower Quadrant
  • Left Upper Quadrant
• LUQ contents


  • stomach
  • spleen
  • pancreas
  • left kidney and adrenal
• RLQ contents


  • cecum
  • appendix
  • right ovary and tube
• LLQ contents


  • sigmoid colon
  • left ovary and tube
• Abdominal Wall Muscles


  • External abdominal oblique - outermost
  • Internal abdominal oblique - middle
  • Transverse abdominis - innermost
• Parietal Peritoneum


  A thin shiny serous membrane that lines the abdominal cavity
• Visceral Peritoneum


  Provides a protective covering for most of the abdominal organs
• Abdominal organs


  • Solid viscera - kidneys, pancreas, ovaries and uterus, liver and adrenal glands
  • Hollow viscera - stomach, gallbladder, small intestine, colon and bladder
• The newborn's bladder is located above the symphysis pubis
• The liver proportionately takes up more space in the infant's abdomen and may extend 2 cm (3⁄4 inch) below the rib cage
• The infant's abdominal muscles are weak, so the abdomen normally protrudes
• The child's abdomen is proportionately larger than an adult's and has a slightly protuberant appearance because of the curvature of the back
• The protuberance is most obvious in toddlers and preschoolers and diminishes to adult proportions during adolescence
• The abdominal muscles are underdeveloped in children, so the organs are more easily palpated
• The abdominal muscles relax in pregnant women, allowing the uterus to protrude during a normal pregnancy
• For multiple pregnancies, the rectis abdominis muscles become separated (diastasis recti abdominis)
• As the fetus grows, it takes up even more room in the uterus, causing the stomach to rise up and impinge on the diaphragm
• Bowel sounds are diminished, there is decreased activity in the lower GI tract, prenatal vitamins cause constipation, and increased venous pressure in the lower abdomen can lead to hemorrhoids in pregnant women
• Pregnant women may develop linea nigra, a darkly pigmented line that appears on the anterior abdomen, and striae (stretch marks) from the increased tension of the expanding uterus
• As people age, many of their body systems slow down and become less efficient
• Elderly people have changes in dentition that may affect their chewing ability and digestion
• Poorly fitted dentures may result in painful mastication, which causes the patient to select foods that are easier to chew but not necessarily nutritionally balanced
• In the GI tract, there is a reduction of saliva, stomach acid, gastric motility, and peristalsis that causes problems with swallowing, absorption, and digestion
• These changes, along with a general reduction of muscle mass and tone, also contribute to constipation in the elderly
• Fat accumulates in the lower abdomen in women and around the waist in men, making physical assessment of the organs a little more challenging
• The liver becomes smaller and liver function declines in the elderly, making it harder to process medications
• Collecting Subjective Data


  • The nursing health history
  • History of present health concern
  • Past health history
  • Family history
  • Lifestyle and health history
• History of present health concern

  • Abdominal pain
  • Indigestion
  • Nausea and Vomiting
  • Appetite
  • Bowel Elimination
• Abdominal pain factors


  • Chemical / mechanical
  • Inflammation
  • Distention
  • Pressure
  • Trauma
  • Infection
  • Stretching
• COLDSPA


  • Character - How does it feel, look, sound or smell?
  • Onset - When did it begin?
  • Location - Where is it? Does it radiate?
  • Duration - How long does it last? Does it recur?
  • Severity - How bad is it?
  • Precipitating/Palliating factors - What makes it better? What makes it worse?
  • Associated symptoms - What other symptoms occur with it?
• Visceral pain


  Results from distension of the intestines or stretching of the solid organs. It is often described as burning, cramping, diffuse, and poorly localized.
• Parietal pain


  Results from inflammation of the parietal peritoneum. The pain is usually severe, localized, and aggravated by movement.
• Referred pain


  Pain felt at a site away from the site of origin. Impulses from the internal organs and structures that share nerve pathways inside the central nervous system explain the nature of referred pain.
• Purposes of abdominal examination

  • To explore gastrointestinal complaint
  • To assess abdominal pain, tenderness or masses
  • To monitor the client post-operatively
• Assessment procedures


  • Inspection
  • Auscultation
  • Percussion
  • Palpation
• Auscultate after you inspect as not to alter the client's pattern of bowel sounds
• Before touching the abdomen, ask the client about painful or tender areas. These areas should always be assessed at the end of the examination.
• Preparing the client


  • Perform the abdominal examination in a warm, private environment
  • Adequate lighting for better visualization
  • Draping to remove clothes and put on gown
  • Equipment - flat pillow for comfort, rolled blanket to help relax abdominal muscles, centimeter ruler, stethoscope and marking pen
  • Ask the client to empty the bladder to eliminate bladder distention and interference
  • Position the client supine with arms folded across chest or resting by sides (raising arms above head or folding behind head will tense abdominal muscles)
  • Instruct the client to breathe through the mouth and take slow, deep breaths to promote relaxation
• Inspection


  • Skin - color, vascularity, striae, scars, lesions and rashes
  • Umbilicus - color, location, contour, discharges
  • Symmetry / abdominal girth / considerations
  • Movement - aortic pulsation, and peristaltic waves