Abdominal
Assessme
nt
Anatomy Review
First things
first…
Health History/Chief Concern/History
of Present Illness
Anorexia Pain (referred)
Dysphagia Nausea/Vomiting
Food intolerance Bowel habits/changes
Pyrosis Urinary problems
Eructation
How Can I Find Out More About the Chief
Concern/HPI in relation to abdominal concerns?
Timing Setting
Onset Aggravating Factors
Duration Alleviating or Relieving Factors
Frequency Associated Symptoms
Location & Radiation
Quality aka “character”
Quantity
History
Past abdominal history
Ulcers, gallbladder disease, hepatitis/jaundice,
appendicitis, colitis, hernia
Past abdominal surgeries
Cholecystectomy, appendectomy
Medications
NSAIDs, laxatives
History
Smoking, Drugs, Alcohol
Nutritional assessment
24 hour ________ recall
Family History
Gallbladder disease
Kidney disease
Celiac Disease
Colon cancer
Lactose Intolerant
Order of abdominal assessment
Inspection/Connection -I
Auscultation - Am
Percussion - Perfect
Palpation - Pal
Inspection of anterior and posterior
Umbilicus
Should be midline and
__________
Hernias
Umbilical, inguinal, epigastric,
incisional
Pulsations/movement
___________ in epigastric region
Inspection of contour
Inspection
Skin color
Appropriate for
____________
Jaundice
Skin lesions
General term that
describes pathologic
skin change or new
occurrence
Inspection
Incisions
Dressing clean, _______, intact or ______________
If open to air, how is the incision closed?
Sutures, staples, glue
Steri-strips
What location is the incision/dressing? How many?
Midline/vertical, transverse
Use _________________ to describe location
Scars
Connection
Drains
Jackson-Pratt (JP) drain
Hemovac drain
Wound Vac
Connection
Nasogastric (NG) tubes
Suction or feeding?
Continuous or intermittent?
Gastrostomy feeding tubes
Percutaneous Endoscopic
Gastrostomy (PEG)/
Percutaneous Endoscopic
Jejunostomy (PEJ) tube
Mic-key button
Connection
Stoma
Opening outside of the body
Red, moist, painless
Ostomy pouch
Ileostomy (small intestine)
Colostomy (colon/large intestine)
Urostomy (bladder)
Rectal Tube
Auscultation of bowel sounds
Listen in each quadrant
Divide at ______________
Use ___________________
Clicks and gurgles that occur
irregularly
Absent
Hypoactive/Diminished
Normal
Hyperactive/Borborygmi If you do not hear any bowel sounds, you must
listen for ___________before saying they are
Auscultation of vascular sounds
Listen over arteries
Aorta – ______________; halfway between
xyphoid and umbilicus
Renal – bilateral; ___________________, top of
upper quadrants (2 inches above umbilicus)
Iliac – bilateral; midclavicular, center of
___________ quadrants (1 inch below umbilicus)
Femoral – bilateral; groin
Use ____________
Hearing nothing is the goal
__________ – turbulent blood flow that sounds
like harsh, musical intermittent sound;
indicate aneurysm, vascular stenosis
Percussion of abdomen
Tapping to produce sounds Examples of normal sounds:
Indirect/Mediate Technique: Tympanic – _______________ over
Place non-dominant hand flat and stomach aka gastric bubble
firmly against area to be percussed
Dull – ____________ over liver
Use middle finger of dominant hand
Flat – very dull over muscle or
to tap the middle finger of the hand
lying flat bone
Tap the finger midway between the
nail and the knuckle (distal
interphalangeal joint)
All four quadrants
Blunt percussion
Fist Technique:
Place non-dominant hand flat and
firmly against area to be percussed
Make a fist with dominant hand
and strike non-dominant hand with
pinky finger side of fist
Examples of use:
_________ percussion for kidney
infection/pyelonephritis
(Costovertebral angle (_______)
tenderness)
Palpation of the abdomen
Light Palpation Edge of liver
1 cm deep Right kidney
____ hand Full bladder
Rotary movement; lift fingers
moving to the next quadrant
Tender? Pain?
Deep Palpation
4-5 cm
_______ hands/bimanual
Masses
Abdominal Signs
Blumberg Sign
McBurney Point Tenderness
Murphy Sign
Iliopsoas muscle test
Obturator test
Assessment of bowel movement
Never assume it’s normal just because they say it’s normal…
ask questions!
Date/time of last BM?
Characteristics – Color? Formed?
Normal – Brown and soft
Abnormal - Steatorrhea, ___________, bloody, diarrhea, constipation
Pattern – How often?
Continent/incontinent?
Wears adult briefs?
Documentation
Fecal Incontinence
___________ to control bowel movements leading
to leakage of stool
Associated with three major causes:
Fecal __________________
Underlying disease
Neurogenic disorders
Assessment of urination
Never assume it’s normal just because they say it’s normal…ask
questions!
Voiding method
Color
Clarity
Odor
Dysuria, urgency, ______________, nocturia
Continence/incontinence
I&Os – 30 ml/hr
Documentation
Urinary Incontinence
Stress
Urge
Overflow
Functional
Older Adults
Risk for nutritional deficit
Decreased salivation (_______________)
Decreased taste sensitivity
Delayed esophageal emptying
Decreased gastric acid secretion
Impaired ________ metabolism by liver
_________________ (non-physiologic)
Visible peristalsis
_________________ sense of abdominal pain
Abnormal Findings
Hepatitis Appendicitis
GERD Kidney Stones
Cholecystitis Pyelonephritis
Pancreatitis Gastroenteritis
Duodenal Ulcer Bowel/intestinal obstruction
Gastric Ulcer IBS
Peritonitis Obesity vs. Ascites
References
Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S. & Stewart, R.W. (2019).
Seidel’s Guide to Physical Examination, 9th ed. St. Louis, MO:
Elsevier.
Jarvis, C. (2020). Physical Examination and Health Assessment, 8th ed.
Elsevier.
