Physical Assessment: Abdomen Inspection

Physical Assessment: Abdomen

• Blunt percussion on the liver and kidneys can indicate tenderness or sharp pain, suggesting kidney infection, renal calculi, or hydronephrosis
• Light palpation of the four quadrants of the abdomen can detect involuntary reflex guarding, which may indicate peritoneal irritation
• Right-sided guarding may be due to cholecystitis
• Deep palpation of all quadrants can help delineate abdominal organs and detect subtle masses
• Severe tenderness or pain may be related to trauma, peritonitis, infection, tumors, or enlarged or diseased organs

Palpation of Abdominal Organs

• A wide, bounding pulse may be felt with an abdominal aortic aneurysm
• A hard, firm liver may indicate cancer
• Enlargement of the liver may be due to hepatitis, liver tumors, or cirrhosis
• An enlarged kidney may be due to a cyst, tumor, or hydronephrosis
• A palpable spleen suggests enlargement, which may result from trauma, chronic blood disorders, or cancers
• A distended bladder is palpated as a smooth, round, and somewhat firm mass extending as far as the umbilicus

General Inspection

• Nasal flaring and pursed lip breathing may indicate labored respirations or hypoxia
• Ruddy to purple complexion may be seen in COPD or CHF due to polycythemia
• Cyanosis may be seen in clients who are cold or hypoxic, appearing blue-tinged in the perioral, nailbed, and conjunctival areas
• Pale or cyanotic nails may be seen with hypoxia, leading to early or late clubbing

Posterior Thorax

• Scoliosis may have respiratory implications due to spinal configurations

Abdominal Inspection

• Dilated veins may be seen with cirrhosis of the liver, obstruction of the inferior vena cava, portal hypertension, or ascites
• Spider angioma may be seen with liver disease or portal hypertension
• Dark bluish-pink striae are associated with Cushing's syndrome or ascites, which stretches the skin
• Keloids result from trauma or surgery

Abdominal Contour

• Generalized protuberant or distended abdomen may be due to obesity, air or gas accumulation, or fluid accumulation
• Distention below the umbilicus may be due to a full bladder
• Distention of the upper abdomen may be seen with masses of the pancreas or gastric dilation
• Major causes of abdominal distention are referred to as the "6 Fs": Fat, feces, fetus, fibroids, flatulence, and fluid