This content is based upon The Correctional Nurse Educator class entitled Abdominal Assessment: Basic Assessment for the Correctional Nurse.
The physical examination of the patient begins with inspection. Unique to the sequence of the abdomen, the abdomen is then auscultated, percussed and finally, palpated. Auscultating before the percussion and palpation of the abdomen ensures that the examiner is listening to undisturbed bowel sounds. In addition, if the patient is complaining of pain, leaving the palpation until last allows the examiner to gather other data before potentially causing the patient more discomfort. When completing the physical examination, it is helpful to divide the abdomen into regions in order to consider which organs are involved. A four-quadrant system – left upper quadrant, left lower quadrant, right upper quadrant and right lower quadrant provides a more general overview, and is acceptable in situations when there is no abdominal complaint. The nine-region system provides more specific information if the patient is complaining of discomfort or problems in a certain area. The nine regions include the following: right hypochondriac (upper) region, right lumbar (middle) region, right iliac (lower) region, left hypochondriac (upper) region, left lumbar (middle) region, left iliac (lower) region, epigastric region, umbilical region, and hypogastric (suprapubic) region.
The inspection of the abdomen includes looking for scars, striae, venous pattern, rashes, contour, symmetry, masses, peristalsis, and pulsations. Inspection is optimum with the patient lying flat on the examination table, breathing normally. As this is being done, note the comfort level of the patient. A patient that is shifting his/her position on the table, or moving frequently may be experiencing discomfort. A patient with a distended abdomen may have difficulty breathing when lying flat, as the abdominal contents may be pressing on the diaphragm. Normally, peristaltic movements are not visible. Some patients do have visible aortic pulsations, especially those with a thin body habitus. Ask the patient to raise his/her head and shoulders while the rest of the body remains supine to check for an umbilical and incisional hernia; if present, it will protrude during this maneuver.
Abnormal findings that may be present on Inspection
Scars – indicate past surgery or trauma
Striae – may indicate obesity, ascites, pregnancy, tumor, Cushing’s disease and steroid use
Venous pattern – may be prominent in fair-skinned individuals or due to congested portal circulation
Discoloration – may be due to jaundice, Addison’s disease, von Reckling-hausen’s disease, trauma, rashes or lesions
Visible peristalsis – in an older adult, consider bowel obstruction. [PEARL: In newborns, upper abdominal peristalsis is diagnostic for pyloric stenosis.]
Pulsations – visible aortic pulsations may be normal in thin individuals, but in others may indicate an aortic aneurysm
Distention – for changes in contour or symmetry, consider the “Fs” of abdominal distention – fat, fluid, feces, fetus, flatus, fibroid, full bladder, fatal tumor, and false pregnancy.
Be sure to return to the site next week, when we will add Auscultation to this continuing series on Abdominal Assessment.