Assessing the Abdomen

Liver diagnostics

Aspirate aminotrasferase (AST), alanine aminotransferase (ALT), ammonia level, bilirubin level, liver biopsy

Gallbladder diagnostics

Ultrasound, heptobiliary iminodiacetic acid scan

Pancreas diagnostics

Amylase and lipase, glucose

Stomach diagnostics

Esophagogastroduodenoscopy, capsule endoscopy

Spleen diagnostics

Complete blood count (CBC)

Veriform appendix diagnostics

Stool analysis, fecal occult blood test (FOBT), stool for culture, barium enema, sigmoidoscopy, colonoscopy

Kidneys and bladder diagnostics

Blood urea nitrogen (BUN), creatinine, glomerular filtration rate (GFR), bladder scan

Weight health history

Weight loss or gain, intentional or nonintentional

Appetite health history

Changes in appetite, factors affecting appetite or ability to eat, good intolerances, cultural considerations

Dysphagia 

Difficulty swallowing

Nausea/vomiting health history

When did it start, pattern, color of emesis, hematemesis, projectile vomiting

Hematemesis

Vomiting of blood, can indicate medical conditions like GI bleeding or ulcers

Indigestion or heartburn health history

Timing, duration, medications, pattern

Gastroesophageal reflux disease (GERD)

Chronic digestive disorder where stomach acid flows back into the esophagus, causing symptoms like heartburn and regurgitation

Pyrosis

Burning sensation in the chest or throat, commonly known as heartburn, often associated with gastroesophageal reflux disease (GERD)

Dyspepsia

Difficult digestion; indigestion

Diarrhea/constipation health history

Normal bowel habits, color, consistency, blood in stool, laxative use, perceived constipation

Flatulence health history

Problems associated with gas, bloating, belching, or burping, can be influenced by diet, how much air is swallowed with eating, and sometimes intestinal disorders

Aerophagia

Swallowing air, can lead to bloating and discomfort

Urination health history

Frequency, incontinence, back pain, difficulty starting the stream, dysuria, renal or colic pain

Dysuria

Painful or difficult urination, often associated with urinary tract infections or other bladder issues

Abdominal sequence of assessment

Inspection, auscultation, indirect percussion, palpation

Abdominal mapping

Process of dividing the abdomen into four quadrants; four- and nine-region

Inspecting the abdomen normal findings

Contour (flat or round), bilaterally symmetrical, umbilicus midline, skin smooth and intact without pulsations or visible peristalsis

Inspecting the abdomen abnormal findings

Scaphoid, distended, or protuberant, increased peristaltic waves, pulsations, ascites, diastasis recti, hernia, Cullen’s sign

Scaphoid

Abdominal contour that appears sunken or concave, often indicating issues like malnutrition or dehydration

Distended

Abdomen appears swollen or enlarged due to excess gas, fluid, or other substances.

Protuberant

Abdomen is bulging or swollen outward, often indicating underlying issues such as obesity or fluid accumulation

Distention

Condition of being stretched, inflated, or larger than normal

Ascites

Abnormal accumulation of fluid in the abdomen

Diastasis recti

Separation of abdominal longitudinal muscles (rectus abdominis) during pregnancy

Hernia

Protrusion of an organ through the wall of the cavity that normally contains it

Cullen’s sign

Bruising in the skin around the umbilicus, indicates internal bleeding

Auscultating bowel sounds normal findings

5-34 clicks or gurgles per minutes

Auscultating bowel sounds abnormal findings

Hyper or hypoactive, no bowel sounds

Types of bowel sounds

Borborygmes, hyperactive, hypoactive, absent

Borborygmes

Loud, gurgling sounds made by movement of gas through intestines

Hyperactive

Loud, high-pitched sounds

Hypoactive

Slow, decreased sounds

Absent

No sounds heard

Auscultating vascular sounds normal findings

No bruit sounds are heard over arteries

Auscultating vascular sounds abnormal findings

Bruits, venous hum, friction rub

Venous hum

Soft, low-pitched sound heard over veins, indicating increased blood flow

Bruit

Swooshing sound, indicating turbulent blood flow

Percussing the abdomen normal findings

Tympany in all four quadrants and dullness over organs

Percussing the abdomen abnormal findings

Excessive high pitched tympanic sounds, dullness, pain

Palpating the abdomen normal findings

No tenderness, smooth surface characteristics

Palpating the abdomen abnormal findings

Tenderness is present, mass is felt

Deep palpation normal findings

No masses, enlarged organs, or tenderness

Deep palpation abnormal findings

Masses are palpated, enlarged organs, tenderness or pain is present

Palpating the bladder normal findings

Empty bladder is nonpalpable, partially filled bladder is firm and smooth

Palpating the bladder abnormal findings

Distended bladder is palpated as a smooth, round, and firm mass extending as far up as the umbilicus

Distended bladder

Bladder is overly filled with urine, making it easily palpable and enlarged

Percussing for costovertebral (CVA) tenderness normal findings

Elicits no pain

Percussing for costovertebral tenderness abnormal findings

Tenderness or pain is felt

Pyelonephritis

Kidney infection resulting from bacteria, leading to inflammation of the renal pelvis and renal tissue

American Cancer Society recommended age for colon cancer screening

45

Visceral pain

Poorly localized, dull, or diffuse pain that arises from the abdominal organs, or viscera

Gastric lavage

Medical procedure used to wash out the stomach contents, often performed to treat poisoning or overdose

Splenomegaly

Enlargement of the spleen, often indicating an underlying health issue or condition

Right upper quadrant organs

Liver, gallbladder, right portion of the diaphragm, duodenum, pancreas head, right kidney, parts of the colon

Left upper quadrant organs

Stomach, spleen, pancreas tail, left lobe of the liver, left kidney, parts of the colon

Right lower quadrant organs

Appendix, cecum, ascending colon, right ureter, parts of the small intestine, part of the bladder; right ovary and fallopian tube in females

Left lower quadrant organs

Descending and sigmoid colon, left ureter, part of the bladder, parts of the small intestine; left ovary and fallopian tube in females

Auscultating bowel sounds

Begin at the ileocecal valve

Vascular auscultation sites

Right and left femoral arteries, right and left iliac arteries, right and left renal arteries, aorta