Abdominal System
Assessment – Abdominal System
Optimal assessment occurs with the patient lying flat on a semi-firm surface with the abdomen fully visible. All four assessment domains (inspection, auscultation, percussion, and palpation) are required.
Inspection
The patient lies flat with arms placed at the sides. The abdomen is visually assessed for:
- Symmetry – does each quadrant appear similar?
- Contour – is the abdomen flat, protuberant, or scaphoid (concave)?
- Skin – observe for any scars, striae, rashes, lesions, dilated veins
- Umbilicus – look for inflammation, bulges
- Peristalsis – are there any visible waves of motion over the intestines?
- Aortic Pulsations – are there any visible pulsations on the abdomen?
Auscultation
Auscultation must be performed before palpation. The following characteristics are assessed through auscultation:
- Bowel sounds are auscultated in all four quadrants noting frequency and character (Listen along the midclavicular lines in the four quadrants, pausing between locations).
- Auscultate for bruits (vascular sounds) over the aorta, renal, iliac, and femoral arteries
- Aorta: slightly below the xiphoid process midline with the umbilicus
- Renal arteries: go slightly down to the right and left at the aortic site
- Iliac arteries: go a few inches down from the belly button at the right and left sides to listen
- Femoral arteries: found in the right and left groin.
- Listen for venous hums or friction rubs over the liver and spleen.
Percussion
Technique
Middle finger is hyperextended, and the distal interphalangeal joint [DIP] is pressed on the skin surface. The middle finger of the striking hand briskly strikes the DIP joint.
- Percuss generally for distribution of tympany and dullness (Percuss in all nine areas and try to distinguish between dullness over the liver and tympany over the splenic flexure).
- Measure the span of liver dullness at the right midclavicular line (Percuss downward starting just under the breast along the midclavicular line until dullness is heard, then percuss from the level of the umbilicus upward until dullness is heard and measure the span of dullness).
- Assess for splenomegaly (Splenic percussion sign: Percuss at the anterior axillary line at the lowest interspace and ask the patient to take a deep breath while continuing to percuss).
Palpation
Position the patient appropriately with the knees bent, head supported, and arms at the side.
- Use light palpation for tenderness, guarding, or superficial masses (This should be very superficial; use the hand in a horizontal plane and slide the hand or barely lift the hand to the next location to palpate, moving slowly in four or nine areas.)
- Use deep palpation for tenderness and masses (Palpate much deeper; depress skin ~2–3”.)
- Palpate for rebound tenderness to assess for peritoneal inflammation (Press down slowly in the area of tenderness, then release quickly.)
- Describe palpable masses in terms of their location, size, shape,