NURS 209: TOPIC 9 - ABDOMEN

What are the four abdominal quadrants?

Right Upper Quadrant (RUQ), Right Lower Quadrant (RLQ), Left Upper Quadrant (LUQ), Left Lower Quadrant (LLQ)

What are alternative terms for the abdominal regions besides quadrants?

Epigastric, Umbilical, Hypogastric (or Suprapubic)

What is the patient’s appetite or any changes in appetite?

It indicates the patient’s usual desire for food and any recent changes in eating patterns.

Does the patient have dysphagia (trouble swallowing) or any muscle function abnormalities affecting swallowing?

It may indicate neurological or muscular issues affecting the ability to move food from mouth to stomach.

Does the patient have any food intolerances?

It involves adverse digestive responses to certain foods, such as bloating, gas, or diarrhea, often without an immune reaction.

Does the patient experience abdominal pain or distention?

It describes discomfort, cramping, or swelling of the abdomen, which may indicate gastrointestinal dysfunction or disease.

Does the patient have heartburn or indigestion?

It is a burning sensation in the chest caused by acid reflux; indigestion refers to discomfort or fullness after eating, sometimes associated with nausea or bloating.

Does the patient experience nausea or vomiting?

It may indicate infection, obstruction, or systemic illness.

What are the patient’s bowel habits or any recent changes? Include normal bowel habits and appearance of stool.

It includes frequency, consistency, and ease of passing stool. Normal stool is typically soft, brown, and formed. Changes may indicate dietary issues, infection, or gastrointestinal disease.

Does the patient have any past abdominal history, such as diagnoses like Crohn’s disease or IBS?

It includes chronic gastrointestinal conditions or previous diagnoses, which can affect current symptoms and risk for complications.

Has the patient had any abdominal surgeries or colonoscopies?

They may affect digestive function and provide information about past interventions or findings in the gastrointestinal tract.

What medications is the patient currently taking?

They may influence gastrointestinal function or interact with other conditions.

Is there any relevant family history of gastrointestinal or abdominal conditions?

It highlights hereditary risks or predispositions to gastrointestinal disorders, such as Crohn’s disease, ulcerative colitis, or colorectal cancer.

What is the Bristol Stool Scale used for?

It is used to classify the form and consistency of human stools to help assess bowel habits and digestive health.

What are the key steps in preparing a patient for an abdominal examination?

Adequate lighting, fully expose the abdomen while draping genitalia and female breasts, position the patient for comfort to enhance abdominal wall relaxation, ensure the bladder is empty (save specimen if needed), warm the stethoscope, examine painful areas last, and auscultate before palpation and percussion.

Why should the patient empty their bladder before an abdominal exam?

To increase comfort and prevent interference with examination; a specimen can be saved if needed.

Why is it important to warm the stethoscope before an abdominal exam?

To prevent patient discomfort and reduce abdominal muscle guarding.

In what order should auscultation, palpation, and percussion be performed during an abdominal exam?

Auscultation should be performed first, followed by palpation and percussion.

What equipment is typically needed for an abdominal examination? (3)

Stethoscope, small centimeter ruler, and skin-marking pen.

Why should areas identified as painful be examined last during an abdominal exam?

To prevent guarding and ensure a more accurate assessment.

Why is patient positioning important during an abdominal exam?

Proper positioning enhances comfort and promotes abdominal wall relaxation for accurate assessment.

What is the correct order of examination techniques for the abdomen?

Inspection, auscultation, percussion, palpation

What is the normal appearance of abdominal skin?

It include a smooth and even surface with homogeneous color.

What should you inspect the abdominal skin for?

Inspect for pigment changes and the presence of lesions or scars.

What are common pigment changes on the abdomen?

They include striae (linea albicantes) and pigmented nevi (moles).

What indicates jaundice on the abdomen?

A bronze or yellow coloration of the skin.

What do pink or purple striae on the abdomen suggest?

They may indicate conditions such as Cushing’s syndrome.

What does a taut or glistening abdomen indicate?

It can indicate ascites.

What is suggested by the presence of dilated veins on the abdomen?

They may indicate portal hypertension or other underlying vascular issues.

What should you inspect on the abdomen regarding the skin?

Inspect for scars, noting their size, shape, location, and character (fresh or healed).

What are striae?

They are silvery white, linear, jagged marks on the skin, typically 1–6 cm long.

What can cause striae to form?

Rapid or prolonged stretching of the skin due to tumors, pregnancy, obesity, ascites, or hormonal changes.

What color are recent striae?

Pink or blue.

What color are older striae?

White or silvery.

What abnormal color might striae appear in Cushing’s disease?

Purple or blue.

What is a normal finding when inspecting the abdomen for venous patterns on the skin?

Venous patterns are not normally seen.

What are abnormal findings when inspecting the abdomen for venous patterns on the skin?

Dilated or engorged veins, spider veins.

What conditions can cause dilated or engorged veins on the abdomen?

Vena cava obstruction, portal hypertension, cirrhosis.

What condition can cause spider veins on the abdomen?

Liver damage.

What should you observe when inspecting the symmetry of the abdomen?

It should be symmetric bilaterally with breathing movements. Shine tangential light across the abdomen to check for symmetry. There should be no bulges or masses.

How can you check for bulges or masses during an abdominal inspection?

By shining tangential light across the abdomen and observing carefully for any abnormal protrusions or masses.

What is normal for the umbilicus when inspecting the abdomen?

It is normally midline and inverted, with no signs of discoloration, inflammation, or hernia.

What abnormalities should you look for in the umbilicus during an inspection? (3)

Discoloration, inflammation, or hernias are abnormal findings.

What should you note when inspecting the abdomen for a mass, bulge, or nodule?

Location of the mass, bulge, or nodule and the condition of the overlying skin.

What should you assess when inspecting the abdomen for rashes?

The type and character of the rash.

What conditions might petechiae on the abdomen indicate? (3)

Vascular disease, fat emboli, or effects of blood thinners.

What abdominal pulsations are considered normal?

You may see pulsations from the aorta beneath the skin in the epigastric area, particularly in thin persons with relaxed abdominal muscles.

When are pulsations in the epigastric area abnormal?

Bounding, diffuse, or wide pulsations could indicate an abdominal aortic aneurysm.

Are pulsations in very thin individuals normal?

Yes, pulsations in the epigastric area are normal in very thin individuals as long as they are not bounding.

What is considered normal respiratory movement in the abdomen?

Abdominal respiratory movement is normal in men.

What could absent abdominal respirations in men indicate?

It could indicate peritonitis or another abdominal problem.

What is visible peristalsis?

Progressive, wavelike, involuntary movement of the intestines.

Is visible peristalsis normally seen?

Normally, it is not seen, but slight ripples may be visible in very thin individuals.

What abnormal abdominal pulsations or movements might be observed during inspection?

Strong contractions seen under the skin.

What can cause strong abdominal contractions?

Bowel obstruction.

What specific abnormal movement is seen in infants with pyloric stenosis?

Reverse peristalsis (food isn’t moving into the small intestines due to a restricted pyloric valve).

What can cause abnormal abdominal movement related to bowel positioning?

Malrotation of the bowel (bowel is twisted or kinked).

What position should the patient be in when inspecting the abdomen for contour?

Supine

Where should the examiner stand when inspecting the abdomen?

On the right side of the patient, viewing at eye level

What are the normal abdominal contour findings?

Flat, rounded, scaphoid (caves in), protuberant (distention)

What is an abnormal finding in abdominal contour inspection?

Distention – unusual stretching and enlargement of the abdomen; can be symmetrical or asymmetrical

What does abdominal distention imply?

Disease or underlying condition

What are the six Fs that can cause abdominal distention?

Fluid, Flatulence, Fat, Feces, Fibroid/fatal, Fetus

Give examples of how "Fluid" can cause abdominal distention.

Ascites, hemorrhage

How can "Flatulence" lead to abdominal distention?

Gas accumulation

How can "Fat" cause abdominal distention?

Obesity or excess adipose tissue

How does "Feces" contribute to abdominal distention?

Constipation

What does "Fibroid/fatal" refer to in abdominal distention causes?

Tumor or cancer

How does "Fetus" lead to abdominal distention?

Pregnancy

What is the normal pattern of pubic hair growth in adult males and females?

Adult males: diamond shape; adult females: inverted triangle shape.

What conditions can alter the normal pattern of pubic hair growth?

Endocrine or hormone abnormalities, or chronic liver disease.

What does a comfortable demeanor look like during an abdominal exam?

The person is relaxed, quietly on the examining table, has a benign facial expression, and slow, even respirations.

What does restlessness or constantly turning during an abdominal exam indicate? (2)

Pain or discomfort.

What type of stethoscope endpiece should be used to auscultate bowel sounds and why?

Use the diaphragm endpiece because bowel sounds are relatively high pitched.

How should you hold the stethoscope when auscultating the abdomen and why?

Hold it lightly against the skin; pushing too hard may stimulate more bowel sounds.

Where should you begin auscultating bowel sounds and why?

Begin in the right lower quadrant (RLQ) at the ileocecal valve area because bowel sounds are normally always present here.

In what direction should you move the stethoscope when auscultating the abdomen?

Move in a clockwise direction.

What should you hear when auscultating the abdomen for normal bowel sounds?

Normal bowel sounds are high-pitched, gurgling, and clicks.

How regular are normal bowel sounds in the abdomen?

They are very irregular.

How often do normal bowel sounds occur per minute?

They occur approximately 5–34 times per minute.

What does “absent bowel sounds” mean?

No sounds are heard in any abdominal quadrant after 5 minutes; this is extremely uncommon.

How long should you listen to confirm absent bowel sounds?

At least 5 minutes per quadrant.

What are “hypoactive bowel sounds”?

Bowel sounds that occur less than 5 times per minute.

What are “hyperactive bowel sounds”?

Bowel sounds that occur more than 30 times per minute and may be rushing or tinkling.

What is a common type of hyperactive bowel sound?

Borborygmi, which is loud, gurgling, splashing sounds (“stomach growling”).

What does borborygmi indicate?

It is usually a normal sound indicating movement of gas and fluid in the intestines.

What is vascular swooshing in the abdomen?

A sound of turbulent blood flow heard over blood vessels, which is abnormal.

Where is vascular swooshing typically heard?

Over major abdominal arteries, such as the aorta, renal, or iliac arteries.

What vascular sounds are considered abnormal when auscultating the abdomen?

Any vascular sound is usually abnormal.

What is a bruit and what conditions is it associated with?

A bruit is a pulsatile blowing sound that occurs with stenosis, partial occlusion, or aneurysm.

What is a peritoneal friction rub and how does it sound?

It is a grating sound, like leather rubbing together, soft in quality, associated with each breath.

What conditions can cause a peritoneal friction rub? (3)

It can result from an enlarged liver or spleen rubbing on organs or the peritoneum, or from other organs, an abscess, or a tumor.

What is a venous hum and how is it described?

A venous hum is a low-pitch, soft, continuous sound.

Where is a venous hum abnormal and what conditions can it indicate? (2)

It is abnormal over the liver or umbilicus and may indicate portal hypertension or splenic artery obstructions.

Can a venous hum ever be normal?

Yes, it may be normal in children due to increased blood velocity, or it may come from the hum of muscles.

What should you do when auscultating the abdomen?

Auscultate all four quadrants, noting the location, pitch, and timing of any vascular sounds.

What is the purpose of percussion of the abdomen?

Percussion is done to assess the relative density of abdominal contents, locate organs, and screen for abnormal fluid or masses.

How is abdominal percussion performed?

Lightly percuss all four quadrants in a clockwise manner to determine the prevailing amount of tympany and dullness.

What is the purpose of indirect fist percussion when assessing the abdomen?

Indirect fist percussion causes tissues to vibrate instead of producing a sound.

How do you assess for costovertebral angle (CVA) tenderness?

Place one hand over the 12th rib at the costovertebral angle on the back, then thump that hand with the ulnar edge of your other fist.