Assessment of Abdomen

An assessment of the abdomen should be completed during a comprehensive assessment or as part of a focused assessment if your patient is experiencing issues with their abdomen or GI system. Methods of abdominal assessment include inspection, auscultation, percussion, and palpation, as well as special tests. Unlike other body system assessments, you should always auscultate first when performing an abdominal assessment, so you can avoid stimulating bowel sounds or inflicting pain during percussion or palpation.

Beginning with inspection, look between the costal margins and the symphysis pubis, and note the abdomen's normal contour, which will be either flat; slightly convex, which is a curved outward appearance; or slightly concave, which is a curved inward appearance. An abdomen that's profoundly concave could indicate malnourishment and a profoundly convex abdomen is associated with ascites, poor muscle tone, or an accumulation of subcutaneous fat.

The skin of the abdomen should be free from lesions, including open wounds or ecchymosis. However, as a normal finding, you may note striae, or stretch marks, as well as hair, moles, or freckles. Also note any bodily modifications like tattoos, piercings, or surgical scars.

Now, if you are inspecting the abdomen of a very thin patient, you might be able to see pulsations in the region of the abdominal aorta. This can be normal, however, if pulsations are prominent, it may represent an abdominal aortic aneurysm. Also, inspect for any obvious bulging or protrusions, which can represent herniation.

Next up is auscultation. Start with the diaphragm of your stethoscope and begin in the lower right quadrant, moving in a clockwise fashion, listening for bowel sounds, which sound like high-pitched clicks and gurgles. It's normal to hear bowel sounds in each quadrant at a frequency of 5 to 35 sounds per minute.

If bowel sounds are not heard, you should auscultate up to a full 5 minutes in each quadrant. Bowel sounds are hypoactive if they occur at a rate of less than 5 per minute and can be associated with constipation; while more than 35 bowel sounds per minute are considered hyperactive and might be caused by gastroenteritis or an early sign of bowel obstruction. On the other hand, borborygmi is a prolonged gurgle, which typically occurs as a normal part of the digestive process.

Next, using the bell of the stethoscope, listen for bruits, or low-pitched blowing sounds caused by turbulent blood flow through arteries. You should auscultate the abdominal aorta by placing the bell of the stethoscope in the epigastric region. Then move on to the renal arteries, auscultated approximately 3 centimeters above the umbilicus laterally on both the left and right sides of the aorta; and the iliac arteries which can be auscultated about 3 centimeters below the umbilicus and laterally on both the right and left sides. Normally, you should not hear any vascular sounds. If a bruit can be heard, it might indicate an aneurysm or atherosclerotic arterial disease.

Okay, let's move on to percussion, which is used to determine the density and size of organs and assess areas of air and fluid. Percuss in each of the four quadrants. Sounds you can expect to percuss in the abdomen include tympany over either air-filled or hollow organs, like the stomach, and dullness over bone or solid organs, like the liver. If there's dullness in an area where it is not expected, it might mean there is a mass in the underlying tissue.

You can also assess the kidneys using percussion. Assist your patient in a seated position and, standing behind them, locate the costovertebral angle, or CVA, which is formed by the curve of the 12th rib and the spine. Place your palm on your patient's back at the level of the CVA, make a fist with your other hand, and strike your hand with a single, swift thump. A normal response is an absence of pain. If your patient appears uncomfortable, this is a positive finding that might indicate renal inflammation or infection.

Lastly, let's look at palpation. Beginning with light palpation, depress the abdomen in each quadrant approximately 1 centimeter in depth using a gentle, circular motion. If the patient is experiencing any kind of abdominal pain, you should palpate that area last. Otherwise, begin in the right lower quadrant and move clockwise. During light palpation, you are assessing for any abnormalities close to the abdominal surface like hernias, as well as the qualities of the underlying structures. Then, proceed with deep palpation by compressing the abdomen about 4 to 5 centimeters using the same circular hand motion. A potential abnormal finding is an abdominal mass which can indicate constipation or even malignancy.

Now, there are a couple of tests that are used in certain circumstances. First, there's Murphy sign, also known as inspiratory arrest, which evaluates for gallbladder inflammation. To perform this test, position your hands as if you were going to assess the subcostal border, but this time, apply upward pressure and then instruct your patient to take a deep breath. If they're unable to inhale or suddenly halt their inspiratory effort, this is a positive finding and likely indicates gallbladder inflammation.

The next test is Blumberg sign, which is useful in identifying appendicitis or peritonitis. For this exam, assist your patient to lie supine. Then, using the fingertips of your dominant hand, compress the right lower quadrant of the abdomen to about 4 to 5 centimeters. Then, quickly release pressure. If your patient experiences more pain with release than with compression, also known as rebound tenderness, this is a positive finding.

Alright, as a quick recap…An assessment of the abdomen should be completed during a comprehensive assessment or as part of a focused assessment if your patient is experiencing issues with their abdomen or GI system. Methods of abdominal assessment include inspection, auscultation, percussion, and palpation, as well as special tests. You should always auscultate first when performing an abdominal assessment, so you can avoid stimulating bowel sounds or inflicting pain during percussion or palpation.