Assessing the Abdomen

posted Oct 13, 2009, 12:54 AM by Kitty McKay   [ updated Oct 2, 2010, 12:52 AM ]
  1. Assess patient for abdominal pain, nausea, vomiting, and other GI signs and symptoms.
  2. Assess patient's history for normal bowel habits, abdominal surgery or trauma, GI tests, use of drugs that cause GI upset or bleeding, pregnancy, and risk of exposure to HBV. Also assess for family history of cancer, kidney disease, alcoholism, hypertension, and heart disease.
  3. Inspect supine patient's abdomen, noting color, scars, venous patterns, rashes, lesions, striae, bruises, and artificial openings. Note any lesion's characteristics.
  4. Inspect the abdomens contour, symmetry, and surface motion. Note any masses, bulges, or generalized or localized distention.
  5. If distention is suspected, measure abdominal girth by placing tape measure around abdomen at level of umbilicus. With a pen, mark where tape measure was applied.
  6. Auscultate bowel sounds with diaphragm of stethoscope in each quadrant. Listen until gurgling or bubbling is heard in each quadrant (at least once in 5 to 20 seconds). Describe sounds as normal, hyperactive, hypoactive, or absent. Listen for five minutes over each quadrant before deciding that bowel sounds are absent.
  7. Auscultate for vascular (whooshing) sounds with bell of stethoscope over the epigastric region and each quadrant.
  8. Gently percuss each quadrant systematically. Note areas of tympany and dullness.
  9. To determine if distention is caused by fluid or air, percuss for a fluid wave.
  10. Have an assistant gently and firmly press at midline of abdomen.
  11. Place your fingertips along both sides of the lower abdomen. Thrust quickly into the patients side with your dominant hand, while feeling for a fluid wave with the nondominant hand.
  12. Ask patient if abdomen feels unusually tight, and determine if this is recent.
  13. With patient seated, gently but firmly percuss over each costovertebral angle with ulnar surface of fist. Note if patient experiences pain.
  14. With patient supine again, lightly palpate over each abdominal quadrant, using the pads of the fingertips to depress skin about 1 cm (1/2 inch) in a gentle dipping motion.
  15. Note muscular resistance, distention, tenderness, and superficial masses or organs; observe patients face for signs of discomfort.
  16. Note if abdomen feels firm or soft.
  17. Just below umbilicus and above symphysis pubis, palpate for a smooth, rounded mass. While applying light pressure, ask if patient feels the need to void.
  18. If a mass is palpated, note its size, location, shape, consistency, tenderness, mobility, and texture.
  19. If tenderness is present, press one hand slowly and deeply into the involved area and then let go quickly. Note if pain is exacerbated.
  20. Perform deep palpation, being sure the patient is relaxed. Depress the palm and fingers approximately 2.5 to 7.5 cm (1 to 3 inches) into the abdomen. 
How to assess abdominal pain diagram below