Anatomy of the Abdominal Organs

Study Notes

Abdominal Assessment

Inspection: Evaluate the abdomen's appearance, including symmetry, shape, contour, color, and any visible pulsations or movements.
- Assess skin color, checking for jaundice, bruising(Grey Turner's sign or Cullen's sign), or other abnormalities. Observe the umbilicus for inversion, protrusion, or masses. Note abdominal contour (flat, rounded, scaphoid, or protuberant).
- Check for symmetry, bulging, and any tenderness.
- Visible pulsations in the midline epigastrium may indicate the abdominal aorta.
- Also assess for presence of peristalsis (bowel movements). Assess and record abdominal contour.
- Look for visible hernias (protrusion of bowel through the abdominal wall).
Auscultation: Listen for bowel sounds and vascular sounds using a stethoscope.
- Bowel sounds should be present and have a rate of 5 to 30 clicks per minute.
- Hypoactive bowel sounds (decreased or absent) suggest decreased motility.
- Hyperactive bowel sounds (increased sounds) indicate increased motility.
- Auscultate for vascular sounds (bruits) over the abdominal aorta, renal, iliac, and femoral arteries. A swoosh sound is not normal.
Percussion: Tap the abdomen to assess the underlying structures.
- Percuss for tone, evaluating areas of tympany (air-filled), dullness (solid organ), and resonance (lung sound).
- Percuss the liver to assess its size and location and check for tenderness by palpation.
- Liver span is usually 6 to 12 cm at the mid-clavicular line (MCL)
- Percuss the spleen for consistency and tenderness, searching for a dullness (splenomegaly larger than 7 cm) near the 10th rib. Assess for tenderness along the costovertebral angle (CVA).
Palpation: Feel the abdomen to detect masses, tenderness, and rigidity.
- Begin with light palpation (gentle), progressing to deep palpation to check for masses.
- Note any presence ofguarding, tenderness (and if tender or painful note exact location) or rigidity.
- Note consistency, shape, size, any pulsating masses, or the presence of a fluid wave.
- Palpate for masses, and note their characteristics: consistency, mobility, size, shape, and location.
- Palpate the kidney; a normally placed kidney is not palpable.
- Palpate the bladder and check its location and consistency. A distended bladder is smooth and firm, and may extend to the umbilicus.
- Check for rebound tenderness
Special Abnormal Tests: Conduct tests to identify specific conditions.
- Perform tests to assess for shifting dullness or ascites (fluid buildup) in the abdomen.
- Check for rebound tenderness in suspected appendicitis.
- Perform the fluid wave test to identify the presence of ascites.