Abdominal Assessment Overview

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Questions and Answers

What is the primary function of the four layers of large flat muscles in the abdominal wall?

To facilitate digestion

To assist in respiration

To compress the stomach

To protect and hold the organs in place (correct)

Which of the following organs is considered solid and maintains its shape?

Gallbladder

Stomach

Spleen (correct)

Colon

Where is the gallbladder located in relation to the liver?

Medial to the liver

Behind the liver

Below and lateral to the liver (correct)

Above the liver

What is a common gastrointestinal change associated with aging?

Gallstones formation Signup and view all the answers

Which technique is performed second during an abdominal assessment?

Auscultation Signup and view all the answers

What is one of the recommended preparations to enhance abdominal wall relaxation during assessment?

Empty the bladder Signup and view all the answers

What should be assessed last during an abdominal assessment to ensure patient comfort?

Palpation of painful areas Signup and view all the answers

Which measurement indicates the positions of the aorta during an abdominal assessment?

Just left of the midline, bifurcating 2cm below the umbilicus Signup and view all the answers

What is the normal range of bowel sounds per minute?

5-30 sounds Signup and view all the answers

Which of the following techniques is used for assessing costovertebral angle tenderness?

Indirect fist percussion Signup and view all the answers

What sign indicates peritoneal irritation during abdominal examination?

Rebound Tenderness Signup and view all the answers

When performing deep palpation, how deep should the examiner press into the abdomen?

5-8 cm Signup and view all the answers

Which condition is indicated by an enlarged spleen that feels firm with sharp edges?

Cirrhosis Signup and view all the answers

What is the typical width of a normal aortic area when palpating for pulsation?

2-3 cm Signup and view all the answers

What abnormal finding is indicated by diminished bowel sounds?

Obstruction Signup and view all the answers

Which technique is recommended for light palpation of the abdomen?

Using four fingers in circular motion Signup and view all the answers

A patient who is tense or ticklish may exhibit which type of guarding during palpation?

Voluntary guarding Signup and view all the answers

What characteristic does ascites have when palpated?

Dullness over fluid Signup and view all the answers

Which of the following indicates involuntary rigidity during a palpation assessment?

Pain with increased intra-abdominal pressure Signup and view all the answers

What physical sign might indicate the presence of an aortic aneurysm during palpation?

A pulsating mass greater than 5 cm Signup and view all the answers

What outcome signifies a positive Murphy’s Sign during an abdominal exam?

Pain when the patient takes a deep breath Signup and view all the answers

Which finding is most characteristic of ascites during physical examination?

Everted umbilicus and taut skin Signup and view all the answers

What is the appropriate technique for assessing costovertebral angle tenderness?

Indirect fist percussion on the back Signup and view all the answers

Which condition is likely indicated by the palpation of a rounded, soft enlarged spleen?

Mononucleosis Signup and view all the answers

During which part of the abdominal assessment is involuntary guarding likely observed?

In cases of peritoneal inflammation Signup and view all the answers

Which sound is characterized as borborygmus in abdominal auscultation?

Loud gurgling noises during digestion Signup and view all the answers

What is an expected finding when palpating the aorta in a healthy individual?

Pulsation measured at the midline Signup and view all the answers

Which statement is true regarding the technique of light palpation?

Involves depressions of about 1 cm with circular motion Signup and view all the answers

What is the location of the pancreas in relation to other abdominal organs?

Behind the stomach in the RUQ Signup and view all the answers

Which of the following structures is located laterally to the left midaxillary line?

Spleen Signup and view all the answers

Which change is NOT typically associated with aging in relation to abdominal assessment?

Increased salivation Signup and view all the answers

What is the proper order of techniques during an abdominal assessment?

Inspection, auscultation, percussion, palpation Signup and view all the answers

How should the abdominal wall be prepared to enhance relaxation before assessment?

Ensure the bladder is empty Signup and view all the answers

Which organ is responsible for maintaining its shape and is classified as solid?

Liver Signup and view all the answers

Which area in the abdomen is the abdominal aorta located?

On the left side of the midline Signup and view all the answers

What preparation technique helps in enhancing abdominal wall relaxation?

Having the patient supine with knees bent Signup and view all the answers

What sign might indicate the presence of an enlarged uterus upon inspection?

Obvious abdominal bulge in midline Signup and view all the answers

What might cause a patient to have a dry mouth during an abdominal assessment?

Decreased salivation Signup and view all the answers

Study Notes

Abdominal Assessment: Surface Landmarks

Diaphragm to the top of the pelvis
Vertebral column and paravertebral muscles (back)
Lower rib cage and abdominal muscles (side and front)
Four layers of large flat abdominal wall muscles
- Protect and hold organs in place

Abdominal Assessment: Structure & Function

Viscera
- Solid Organs: Liver, pancreas, spleen, adrenal glands, kidneys, ovaries
  - Maintain shape
- Hollow Organs: Stomach, gallbladder, small intestine, colon, bladder
  - Shape changes

Abdominal Assessment: Structures

Liver: Mostly right upper quadrant (RUQ)
Stomach: Between the liver and spleen, just below the diaphragm
Gallbladder: Below the liver, just lateral to the right midclavicular line
Small Intestine: All four quadrants
Spleen: Lateral to the left midaxillary line, 9th-11th rib
Aorta: Just left of midline, bifurcates 2 cm below the umbilicus
Pancreas: Behind the stomach, RUQ
Kidneys: Costovertebral angle

Abdominal Assessment: Structures & Function (Midline)

Aorta: Midline
Renal Artery: Midline
Uterus: Midline, if enlarged
Bladder: Midline, if distended

Abdominal Assessment: The Aging Adult

Fat deposits
Decreased salivation
Dry mouth
Decreased taste
Delayed esophageal emptying
Decreased gastric acid secretion
Gallstone formation
Decreased blood flow to the liver
Constipation

Abdominal Assessment: Subjective Data

Adult
- Appetite
- Dysphagia
- Food intolerances
- Pain
- Nausea/Vomiting
- Bowel habits
- GI history
- Medications
- Nutrition
Older Adult
- Groceries and meal preparation
- Eating alone
- Food diary
- Bowel movements

Abdominal Assessment: Objective Data - Preparation

Drape appropriately
Enhance abdominal wall relaxation:
- Empty bladder
- Keep room warm
- Supine position: head on pillow, knees bent or on pillow, arms at side
- Warm stethoscope and hands
- Assess painful areas last

Abdominal Assessment: Objective Data - Inspection

Contour: Shape of abdomen
Symmetry: Shine a light across the abdomen toward you; ask the patient to take a deep breath and assess again
Umbilicus: Normal location, contour, and any signs of hernia
Skin: Striae, nevi, scars, rashes, lesions
Peristalsis: Wavelike movements of the intestines usually not visible
Pulsations: Normal abdominal aorta pulsation may be visible

Abdominal Assessment: Objective Data - Auscultation

Bowel Sounds:
- Affected by time since last meal
- 5-30 sounds per minute (normoactive)
- Hypoactive: slowed or diminished
- Hyperactive: increased sounds
- Borborygmi: loud, gurgling sounds
- Absent bowel sounds: no sound after listening for 5 minutes
Vascular Sounds:
- Aorta, renal arteries, iliac arteries, femoral arteries
- Bruits: blowing, swooshing sound indicating turbulent blood flow through narrowed arteries

Abdominal Assessment: Objective Data - Percussion

Splenic Dullness: 9th-11th intercostal space just behind the left midaxillary line
Costovertebral Angle Tenderness:
- Patient sitting up
- Indirect fist percussion: Place non-dominant hand over the 12th rib at the costovertebral angle on the back, thump the hand with the ulnar edge of the other fist
- Pain may indicate kidney inflammation or infection

Abdominal Assessment: Objective Data - Palpation

Palpation Purpose: Helps judge size, location, and consistency of underlying organs, assess for masses and tenderness
Relaxation: Encourage relaxation for accurate assessment
Light Palpation: Use four fingers, depress about 1 cm, circular motions
Deep Palpation: Similar technique as light palpation, but push down 5-8 cm
Obese Abdomen: Use bimanual technique
Note: Location, size, consistency, and mobility of any palpable organs, any enlargement, tenderness, or masses

Abdominal Assessment: Palpation - Liver

Left hand under the patient's right back, parallel to the 11th and 12th ribs
Right hand on RUQ, fingers parallel to the midline
Push down and under the right costal margin
With the patient breathing slowly, move the right hand up 1-2 cm with each exhalation
The edge of the liver may be felt with the fingertips

Abdominal Assessment: Palpation - Aorta

Palpate on the upper abdomen slightly left of midline
Area of 2.5-3 cm
- Wider area may suggest an aneurysm
Use thumb and fingers to palpate the aortic pulsation

Abdominal Assessment: Palpation - Rebound Tenderness

Used when the patient complains of abdominal pain and/or tenderness with palpation
Hold your hand 90° to the abdomen (McBurney Point)
Push down slowly and deeply and lift up quickly
Pain indicates peritoneal irritation

Abdominal Assessment: Palpation - Inspiratory Arrest

Hold fingers under the liver border
Ask the patient to take a deep breath
Pain indicates cholecystitis (gall bladder inflammation)

Abdominal Assessment - Ascites

Everted umbilicus
Taut, glistening skin
Diminished bowel sounds over the fluid
Dullness over the fluid
Limited palpation

Abdominal Assessment - Aortic Aneurysm

Most are located below the renal arteries and extend to the umbilicus
Pulsating mass greater than 5 cm
Auscultate for a bruit
Femoral pulses present but decreased

Abdominal Assessment - Enlarged Spleen

Enlarges down and toward the midline
Mononucleosis: Enlarged, soft, and rounded edge
Chronic Cause (cirrhosis): Firm with sharp edges
Usually not tender unless the peritoneum is inflamed
The spleen needs to be three times its normal size to be palpable

Abdominal Assessment

Abdominal assessment is performed to assess the organs within the abdominal cavity
Abdominal cavity is located between the diaphragm and the top of the pelvis

Surface Landmarks

The abdominal wall is formed by four layers of large flat muscles that protect and hold the organs in place
The abdominal wall has the following landmarks:
- Vertebral column and paravertebral muscles (back)
- Lower rib cage and abdominal muscles (side and front)

Structures & Function

The abdominal cavity contains both solid and hollow viscera
Solid viscera maintain their shape and include: Liver, pancreas, spleen, adrenal glands, kidneys, and ovaries
Hollow viscera change in shape and include: Stomach, gallbladder, small intestine, colon, and bladder

Structures

Liver: Mostly located in the right upper quadrant (RUQ)
Stomach: Between the liver and spleen just below the diaphragm
Gallbladder: Located below the liver, just lateral to the right midclavicular line
Small intestine: Located in all four quadrants
Spleen: Located lateral to the left midaxillary line, between the 9th and 11th rib
Aorta: Located just left of midline, bifurcates 2 cm below the umbilicus
Pancreas: Located behind the stomach in the RUQ
Kidneys: Located at the costovertebral angle

Midline Structures

Aorta: Located along the midline, just left of the midline
Renal Artery: Located along the midline
Uterus: Located along the midline, if enlarged
Bladder: Located along the midline, if distended

The Aging Adult

Fat deposits are often present in the abdomen of the aging adult
Decreased salivation and a dry mouth are common in aging adults, which can lead to decreased sense of taste
The esophagus slows down in aging adults, making it take longer for food to empty from the stomach
Decreased gastric acid secretion in aging adults can impair digestion
Aging adults are at increased risk for gallstone formation
Blood flow to the liver is decreased with age
Constipation is a common problem in aging adults

Subjective Data

Obtain subjective data from the patient using specific questions
Questions to ask an adult:
- Appetite
- Dysphagia (difficulty swallowing)
- Food intolerance
- Pain
- Nausea/Vomiting
- Bowel habits
- GI history
- Medications
- Nutrition
Questions to ask an older adult:
- Groceries and meal preparation
- Eating alone
- Food diary
- Bowel movements

Objective Data

The abdominal assessment includes four components: Inspection, Auscultation, Percussion, and Palpation
Performing the abdominal assessment requires proper preparation:
- Drape the patient appropriately
- Ensure patient's bladder is empty
- Keep the room warm
- Position the patient supine with their head on a pillow, knees bent or on a pillow, and arms at their side
- Warm the stethoscope and hands
- Assess painful areas last

Inspection

Visual assessment of the abdomen
Assess the following:
- Contour
- Symmetry: Shine a light across abdomen toward you, lengthwise and ask the patient to take a deep breath and assess again
- Umbilicus
- Skin: Inspect for striae (linea albicantes), nevi, scars, rashes, and lesions
- Peristalsis -Pulsations

Auscultation

Auscultation is the second component of the abdominal assessment, and it is performed before percussion and palpation to minimize bowel sounds
Start auscultation in the right lower quadrant (RLQ) as this is a common location of bowel sounds
Assess bowel sounds:
- Normoactive: 5-30 sounds per minute
- Hypoactive: Decreased bowel sounds
- Hyperactive; Increased bowel sounds
- Borborygmi: Loud, gurgling bowel sounds
- Absent bowel sounds: No bowel sounds heard after 5 minutes
Bowel sounds can be affected by the time elapsed since eating
Vascular sounds (bruits) should be listened for in the following locations:
- Aorta
- Renal Arteries
- Iliac Arteries
- Femoral Arteries

Percussion

Percussion helps to assess the density of abdominal contents, detecting fluid, air, or solid masses
Specific percussion techniques:
- Splenic dullness: Percuss for dullness in the 9th-11th intercostal space just behind the left midaxillary line
- Costovertebral angle tenderness:
  - Patient should be sitting up
  - Perform indirect fist percussion over the costovertebral angle on the back
    - Place non-dominant hand over the 12th rib at the costovertebral angle
    - Thump that hand with the ulnar edge of your other fist
  - Pain is abnormal.

Palpation

Palpation helps to assess the size, location, and consistency of underlying organs
Palpation is also used to assess for masses and tenderness
Important to ensure patient relaxation during palpation
Never perform deep palpation of an enlarged or tender liver or spleen due to the risk of causing organ rupture

Light Palpation

Use four fingers
Depress about 1 cm
Perform circular motion
Palpate painful areas last
Assess for:
- Skin surface
- Superficial abdominal muscles

Voluntary Guarding

May occur when the patient is cold, tense, or ticklish
Bilateral guarding is usually relaxed slightly with exhalation
Voluntary guarding is not a sign of inflammation or peritoneal irritation

Involuntary Rigidity

Occurs from peritoneal inflammation
May be unilateral
Pain with increased intra-abdominal pressure

Deep Palpation

Same technique as light palpation except push down 5-8 cm
For obese patients, use a bimanual technique
Note:
- Location
- Size
- Consistency
- Mobility of any palpable organs
- Enlargement
- Tenderness
- Masses

Palpation of the Liver

Place your left hand under the patient’s right back, parallel to the 11th and 12th ribs
Place your right hand on the RUQ, fingers parallel to the midline
Push down and under the right costal margin
With the patient breathing slowly, move your right hand upward 1-2 cm with each exhalation
The edge of the liver may be felt with the fingertips

Palpation of the Aorta

Palpate just above the umbilicus slightly left of midline
The normal width of the aorta is 2.5-3 cm
If wider than 3 cm, suspect an aneurysm
Palpate the aortic pulsation between your thumb and fingers

Rebound Tenderness (Blumberg Sign)

Perform if the patient complains of abdominal pain and/or tenderness with palpation
Hold your hand 90° to the abdomen (McBurney Point)
Push down slowly and deeply and lift up quickly
Pain is a sign of peritoneal irritation and inflammation

Inspiratory Arrest (Murphy’s Sign)

Hold your fingers under the liver border
Ask the patient to take a deep breath
Pain is a sign of cholecystitis (gallbladder inflammation)

Ascites

Inspection of the abdomen may show the following signs of ascites:
- Everted umbilicus
- Taut glistening skin
Auscultation of the abdomen with ascites may show:
- Diminished bowel sounds over fluid
Percussion of the abdomen with ascites may show:
- Dullness over fluid
Palpation of the abdomen with ascites may show:
- Limited palpation

Aortic Aneurysm

Most aneurysms are located below the renal arteries and extend to the umbilicus
A pulsating mass greater than 5 cm may indicate an aneurysm
Auscultate for a bruit
Femoral pulses are present but decreased

Enlarged Spleen

An enlarged spleen will enlarge toward the midline
In mononucleosis, the spleen is enlarged, soft, and rounded
In chronic causes (cirrhosis), the spleen will be firm with sharp edges
An enlarged spleen is usually not tender unless the peritoneum is inflamed
The spleen needs to be 3 times its normal size to be palpable.

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Description

Explore the key surface landmarks, structures, and functions of the abdominal assessment. This quiz will cover the organization of solid and hollow organs, as well as their anatomical locations. Gain a deeper understanding of the abdominal cavity and its components.