Health Assessment Abdomen

Borders of the Abdomen

Superiorly: Costal margins; Inferiorly: Symphysis pubis and inguinal canals; Laterally: Flanks.

Divisions of the Abdomen

Quadrants and regions.

Components of the Abdomen

Includes abdominal wall muscles, internal anatomy, and landmarks from thoracic diaphragm to pelvic brim.

Right Upper Quadrant (RUQ) Components

Ascending & transverse colon, Duodenum, Gallbladder, Hepatic flexure of colon, Liver, Pancreatic head, Pylorus, Right adrenal gland, Right kidney, Right ureter.

Right Lower Quadrant (RLQ) Components

Appendix, Ascending colon, Cecum, Right kidney, Right ovary & tube, Right ureter, Right spermatic cord.

Left Upper Quadrant (LUQ) Components

Left adrenal gland, Left kidney, Left ureter, Pancreas, Spleen, Stomach, Transverse & descending colon.

Left Lower Quadrant (LLQ) Components

Bladder, Uterus, Prostate gland.

Dividing Lines of Abdomen

Vertical/midline: Xiphoid to Umbilicus to Symphysis pubis; Horizontal/lateral: Separates upper & lower quadrants.

Abdominal Regions

Epigastric, Umbilical, Hypogastric, Right & left hypochondriac, Right & left lumbar, Right & left iliac (inguinal).

Three layers of Abdominal Wall Muscles

External abdominal oblique, Internal abdominal oblique, Transverse abdominis.

Function of Abdominal Wall Muscles

Protects internal organs and allows normal compression of organs.

Peritoneum

Parietal peritoneum lines abdominal cavity; Visceral peritoneum covers most internal organs.

Solid Viscera

Liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus.

Hollow Viscera

Stomach, gallbladder, small intestine, colon, bladder.

Gastric Cancer Risk

40-50% higher in non-Hispanic Black, Hispanic, Asian/Pacific Islander populations.

H. pylori Infection

Linked to stomach cancer; highest rates in Asia, Latin America, Caribbean.

Gallbladder Disease & Cancer

Higher in Native Americans & Mexican Americans; more common in women than men.

Keloids

More common in African Americans & Asians.

Older Adult Considerations in Abdominal Health

Reduced pain sensitivity, decreased appetite, higher fat-to-lean muscle ratio, increased UTI risk, and dilated superficial capillaries.

Abdominal Aortic Aneurysm Screening Recommendations

Men 65-75 years (smokers): one-time screening recommended; non-smokers: selective screening; not recommended for women.

COLDSPA

Character, Onset, Location, Duration, Severity, Pattern, Associated Factors.

Character of Abdominal Pain

Describes pain quality such as dull, aching, burning.

Onset of Abdominal Pain

Identifies when the pain began; sudden vs. gradual.

Location of Abdominal Pain

Area where pain is felt; may radiate.

Duration of Abdominal Pain

Length of time pain lasts; intermittent vs. prolonged.

Severity of Abdominal Pain

Pain rating on a scale from 1-10.

Pattern of Abdominal Pain

When pain occurs; relation to meals or activities.

Associated Factors of Abdominal Pain

Other symptoms like nausea, vomiting, diarrhea.

Indigestion Assessment

Key question about experiencing indigestion; assess character, onset, location, etc.

Nausea and Vomiting Assessment

Key questions; triggers, timing, associated factors.

Appetite Assessment

Changes in appetite; impact on food intake and weight.

Bowel Elimination Assessment

Frequency, consistency, color of stools; constipation vs. diarrhea.

Jaundice Assessment

Notice yellowing of skin, eyes; refer for liver disease evaluation.

Personal Health History in Abdominal Health

Past gastrointestinal disorders like ulcers, GERD, inflammatory diseases.

Types of Abdominal Pain

Visceral pain, Parietal pain, Referred pain.

Peptic Ulcer Disease (PUD) Causes

H. pylori infection, NSAID use, excess stomach acid, lifestyle factors.

Peptic Ulcer Disease Symptoms

Burning abdominal pain, black or tarry stools, vomiting, weight loss.

Gastroesophageal Reflux Disease (GERD) Causes

Weak esophageal sphincter, obesity, dietary triggers.

GERD Symptoms

Frequent acid reflux, hoarseness, chronic cough, asthma-like symptoms.

GERD Prevention and Education

Avoid trigger foods; eat smaller meals; weight loss.

Client Position for Examination

Supine with arms at sides; avoid raising arms to reduce muscle tension.

Pre-examination Considerations

Ask client to empty bladder; ensure comfort.

Common Abnormal Findings in Abdomen

Edema, masses, unusual pulsations, pain.

Routine vs. Focused Assessment

General screening vs. specialty assessments.

Skin Color Observations

Normal: pale; abnormal: discoloration.

Vascularity of Abdominal Skin

Normal: fine veins; abnormal: dilated veins indicate issues.

Striae (Stretch Marks) Observations

Normal: pink or bluish; abnormal: dark bluish-pink.

Scars Observations

Normal: pale and smooth; abnormal: non-healing wounds.

Lesions and Rashes Observations

Normal: no lesions; abnormal: changes in moles.

Umbilicus Observations

Normal: midline; abnormal: discoloration, deviation.

Abdominal Contour Observations

Normal: flat, rounded, symmetric; abnormal: distention.

Abdominal Symmetry Observations

Normal: symmetric; abnormal: bulges or asymmetry.

Abdominal Respiratory Movements

Normal: abdominal movement may be visible; abnormal: diminished.

Aortic Pulsations Observations

Normal: slight pulsation; abnormal: exaggerated.

Peristaltic Waves Observations

Normal: not visible; abnormal: increased waves.

Auscultation for Bowel Sounds Procedure

Listen for sounds in all quadrants; normal: soft clicks.

Hyperactive Bowel Sounds

Loud, prolonged gurgles indicating rapid motility.

Hypoactive Bowel Sounds

Diminished motility indicating possible illness.

Clinical Tips for Bowel Sounds

Bowel sounds are typically more active over the ileocecal valve.

Auscultate for Vascular Sounds Procedure

Listen for bruits over abdominal arteries.

Normal Findings for Vascular Sounds

Bruits are not normally heard.

Abnormal Findings for Vascular Sounds

Bruit with systolic and diastolic components suggest problems.

Auscultate for Venous Hum Procedure

Listen for hums using the stethoscope.

Auscultate for Friction Rubs Procedure

Listen for rubs over the liver and spleen.

Percussion Tone Procedure

Percuss all abdominal quadrants for normal tone.

Blunt Percussion of the Liver

Assess for tenderness in the liver.

Blunt Percussion of the Kidneys

Assess for tenderness at costovertebral angles.

Light Palpation Purpose

Identify areas of tenderness and muscular resistance.

Deep Palpation Purpose

Assess deeper structures and detect subtle masses.

Palpation for Masses Procedure

Assess for abnormal masses in the abdomen.

Palpation of Umbilicus Normal Findings

No swellings, bulges, or masses.

Palpation of Aorta Purpose

Assess abdominal aorta for width and pulsation.

Tests for Ascites

Shifting Dullness Test and Fluid Wave Test.

Rebound Tenderness (Blumberg Sign) Purpose

Detects peritoneal irritation, often from appendicitis.

Referred Rebound Tenderness (Rovsing Sign) Purpose

Tests for appendicitis via referred pain.

Psoas Sign Purpose

Identifies irritation of the iliopsoas muscle, often from appendicitis.

Obturator Sign Purpose

Identifies irritation of the obturator muscle, seen in appendicitis.

Tests for Cholecystitis (Murphy’s Sign) Purpose

Identifies acute cholecystitis (inflammation of the gallbladder).

Normal Findings for Cholecystitis

No increase in pain upon inhalation.

Enlarged Liver (Hepatomegaly) Definition

Normal size: 12 cm at midclavicular line; 8 cm at midsternal line.

Enlarged Spleen (Splenomegaly) Definition

Area of dullness >7 cm.

Aortic Aneurysm Key Finding

Prominent, laterally pulsating mass above the umbilicus.

Enlarged Gallbladder Key Finding

Extremely tender and enlarged; associated with positive Murphy sign.

Types of Abdominal Distention

Pregnancy, fat, feces, fibroids, flatus, ascitic fluid.

Umbilical Hernia

Bowel protrudes through a weakness in the umbilical ring.

EPigastric Hernia

Bowel protrudes through a weakness in the linea alba.

Diastasis Recti Definition

Separation between the two rectus abdominis muscles.

Incisional Hernia

Bowel protrudes through a defect at the site of a surgical incision.