Physical Assessment of Abdomen - Ibrahim Rawhi Ayasreh

7/30/2019 Physical Assessment of Abdomen - Ibrahim Rawhi Ayasreh

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Physical Assessment

Abdomen

Ibrahim R. Ayasreh

ACNS, MSN


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Collecting Subjective Data

Are you experiencing abdominal pain?

Do you experience indigestion? Describe

Abdominal pain occurs when specific digestive organs or structures are affected

by chemical or mechanical factors such as inflammation, infection, distention,

stretching, pressure, obstruction, or trauma

Indigestion (pyrosis), often described as heartburn, may be an indication of

acute or chronic gastric disorders including hyperacidity, gastroesophageal reflux

disease (GERD), peptic ulcer disease, and stomach cancer.


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Do you experience nausea? Describe.

Have you been vomiting? Describe the vomitus

Nausea may reflect gastric dysfunction and is also associated with many

digestive disorders and diseases of the accessory organs, such as the liver and

pancreas, as well as with renal failure and drug intolerance. Nausea may also be

precipitated by dietary intolerance, psychological triggers, or menstruation.

Vomiting is associated with impaired gastric motility or reflex mechanisms.

Description of vomitus (emesis) is a clue to the source. For example, brighthematemesis is seen with bleeding esophageal varices and ulcers of the

stomach or duodenum


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Have you noticed a change in your appetite.

Do you have constipation? Describe. Do you have any accompanying symptoms?

Have you experienced diarrhea? Describe

Loss of appetite (anorexia) is a general complaint often associated with digestive

disorders, chronic syndromes, cancers, and psychological disorders

Constipation is usually defined as a decrease in the frequency of bowel

movements or the passage of hard and possibly painful stools

Diarrhea is defined as frequency of bowel movements producing unformed or

liquid stools


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Preparing the Client

Ask the client to empty the bladder before beginning the examination to eliminate

bladder distention and interference with an accurate examination.

Instruct the client to remove clothes and to put on a gown.

Help the client to lie supine with the arms folded across the chest or resting by

the sides.

Drape the client with sheets so the abdomen is visible from the lower rib cage to

the pubic area.

Instruct the client to breathe through the mouth and to take slow, deep breaths;

this promotes relaxation.

Before touching the abdomen, ask the client about painful or tender areas. Theseareas should always be assessed at the end of the examination.


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Collecting Objective Data

Observe the coloration of the skin.

Note any striae

Purple discoloration at the flanks indicates bleeding within the abdominal wall,

possibly from trauma to the kidneys, pancreas, or duodenum or from pancreatitis

Pale, taut skin may be seen with ascites

Redness may indicate inflammation

- Dark bluish-pink striae are associated with Cushings syndrome.

- Striae may also be caused by ascites, which stretches the skin


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Dark bluish-pink striae


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Note the vascularity of the abdominal skin.

Inspect for scars

Dilated veins may be seen with cirrhosis of the liver, obstruction of the inferior

vena cava, portal hypertension, or ascites.

Dilated surface arterioles and capillaries with a central star (spider angioma) may

be seen with liver disease or portal hypertension

Nonhealing scars, redness, inflammation. Deep, irregular scars may result

from burns


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Dilated veins in abdomen


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Spider angioma


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Inspect the umbilicus.

Inspect abdominal contour.

- Bluish or purple discoloration around the umbilicus (Cullens sign) indicates

intra-abdominal bleeding.

- A deviated umbilicus may be caused by pressure from a mass, enlarged organs,

hernia, fluid, or scar tissue.- An everted umbilicus is seen with abdominal distention.

- An enlarged, everted umbilicus suggests umbilical hernia.

- A generalized protuberant or distended abdomen may be due to obesity, air

(gas), or fluid accumulation.

- A scaphoid (sunken) abdomen may be seen with severe weight loss or cachexia

related to starvation or terminal illness.


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Abnormal Findings


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Abnormal Findings


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Abnormal Findings


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Abnormal Findings


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Observe aortic pulsations.

Auscultate for bowel sounds.

- A series of intermittent, soft clicks and gurgles are heard at a rate of 5 to 30 per

minute

Vigorous, wide, exaggerated pulsations may be seen with abdominal aortic aneurysm

Hypoactive bowel sounds indicate diminished bowel motility. Common causes includeabdominal surgery or late bowel obstruction.

Hyperactive bowel sounds indicate increased bowel motility. Common causes include

diarrhea, gastroenteritis, or early bowel obstruction.


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Auscultate for vascular sounds.

A bruit with both systolic and

diastolic components occurs whenblood flow in an artery is turbulent or

obstructed. This usually indicates

aneurysm or arterial stenosis


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Percuss for tone.

- Generalized tympany predominates over the abdomen because of air in the

stomach and intestines. Normal dullness is heard over the liver and spleen.

Accentuated tympany or

hyperresonance is heard over a

gaseous distended abdomen.

An enlarged area of dullness is

heard over an enlarged liver or

spleen.

Abnormal dullness is heard over a

distended bladder, large masses,

or ascites


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Percuss the span or height of the liver.

Hepatomegaly, a liver span that

exceeds normal limits (enlarged),

is characteristic of liver tumors,

cirrhosis, abscess, and vascular

engorgement.

Atrophy of the liver is indicated by

a decreased span.


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Perform blunt percussion on the liver and the kidneys.

Tenderness elicited over the liver

may be associated withinflammation or infection

(e.g., hepatitis or cholecystitis).

Tenderness or sharp pain elicited

over the CVA suggests kidney

infection (pyelonephritis), renalcalculi, or hydronephrosis


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Perform light palpation.

- Light palpation is used to identify areas of tenderness and muscular

resistance.

- Abdomen is nontender and soft. There is no guarding.


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Deeply palpate all quadrants to delineate abdominal organs and detect

subtle masses.

- Normal (mild) tenderness is possible over the xiphoid, aorta, cecum, sigmoid

colon, and ovaries with deep palpation.

Severe tenderness or pain may

be related to trauma, peritonitis,

infection, tumors, or enlarged or

diseased organs.

A mass detected in any quadrant

may be due to a tumor, cyst,

abscess, enlarged organ,

aneurysm, or adhesions


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Palpate the aorta.

- The normal aorta is approximately 2.5 to 3.0 cm wide with a moderately strong

and regular pulse.

A wide, bounding pulse may be

felt with an abdominal aortic

aneurysm.

A prominent, laterally pulsating

mass above the umbilicus withan accompanying audible bruit

strongly suggests an aortic

aneurysm.


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Tests for Ascites

Test for shifting dullness.


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Tests for Ascites

Perform the fluid wave test.


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Tests for Appendicitis

Assess for rebound tenderness and Rovsings Sign


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Assess for Psoas sign


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Assess for Obturator sign.


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Test for Cholecystitis

Murphys sign.

- Press your fingertips under the liver border at the right costal

margin and ask the client to inhale deeply.

- Accentuated sharp pain that causes the client to hold his or

her breath (inspiratory arrest) is a positive Murphys sign.

Physical Assessment of Abdomen - Ibrahim Rawhi Ayasreh

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