Abdomen Assessment Protocol

Abdomen Assessment Protocol

General Overview

  • The abdomen assessment is conducted:
    • After cardiovascular and peripheral vascular assessments.
    • Before the musculoskeletal exam.

1. Preparation of the Patient

  • Patient Positioning:
    • Patient should be supine with knees slightly bent or with a pillow underneath.
  • Draping:
    • Drape the chest and legs, exposing only the abdomen.
  • Temperature Control:
    • Warm your hands and stethoscope to ensure patient comfort.
  • Communication:
    • Stand at the patient's right side and inform them: "I am going to examine your abdomen now."

2. Inspection

  • Standing Position:
    • Begin the inspection from the foot of the bed, then move to the right side of the patient.
  • Observation Parameters:
    • Contour:
    • Types:
      • Flat
      • Round
      • Scaphoid
      • Protruding
    • Symmetry of Abdomen: Check for evenness on both sides.
    • Skin Examination:
    • Look for:
      • Scars
      • Striae (stretch marks)
      • Lesions
      • Rashes
    • Umbilicus Condition:
    • Should be midline, typically inverted.
    • Signs of Hernia: Inspect for any abnormalities.
    • Pulsations:
    • Observe for:
      • Aortic peristalsis
      • Venous patterns
    • Distension or Visible Masses: Check for swelling or masses that are observable.
  • Normal Findings:
    • Abdomen is flat or rounded and symmetric.
    • No scars or lesions present.
    • Umbilicus is midline and inverted.
    • No visible pulsations or masses.

3. Auscultation

  • Importance: Always perform auscultation before palpation.
  • Stethoscope Usage:
    • Use the diaphragm for bowel sounds and the bell for vascular sounds.
  • Assessment Areas:
    • Bowel sounds in all four quadrants:
    • Right Lower Quadrant
    • Right Upper Quadrant
    • Left Lower Quadrant
    • Left Upper Quadrant
  • Bowel Sound Characteristics:
    • Active Bowel Sounds: Present every 5 to 15 seconds.
    • Hyperactive Bowel Sounds: Characterized by consonant rushing, tickling, or tinkling sounds.
    • Hypoactive Bowel Sounds: Fewer than 5 sounds per minute.
    • Absent Bowel Sounds: No sounds for a full 5 minutes.
  • Recording Findings:
    • Example: "Bowel sounds present and normal. Active in all four quadrants."
  • Further Auscultation Areas:
    • Use the bell of the stethoscope to auscultate:
    • Aorta: Midline above the umbilicus.
    • Renal Arteries: Lower left and right above the umbilicus.
    • Lateral Iliac Arteries: Left and right below the umbilicus.
    • Femoral Artery: Left and right groin (may be skipped in class).
  • Normal Findings: Indicate the absence of bruits.
    • Record: "No aortic, renal, or iliac bruits appreciated."

4. Percussion

  • Technique: Percuss the entire abdomen to assess for tympany and dullness.
  • Normal Findings:
    • Tympany: Normal over the intestines indicating gas presence.
    • Dullness: Can suggest presence of organs or masses.
  • Areas to Percuss:
    • All four quadrants.
    • Over the liver span.
    • Over the spleen (to check for splenomegaly).
  • Expected Findings:
    • Tympany should dominate without significant areas of dullness.
  • Recording Findings:
    • Example: "Percussion reveals tympany throughout with expected dullness over the liver."

5. Palpation

  • Light Palpation:

    • Technique:
    • Use four fingers in a gentle motion across all four quadrants.
    • Abnormal Findings to look for:
    • Tenderness
    • Guarding
    • Rigidity
    • Masses
    • Only perform rebound tenderness if indicated.
    • Normal Findings: Show no tenderness or guarding.

  • Recording Findings:

    • Example: "Light palpation reveals a soft abdomen with no guarding or tenderness."

  • Deep Palpation:

    • Technique: Use the same pattern with deeper pressure to assess for masses or organ enlargement.
    • Normal Findings: Indicate no masses or deep tenderness.

  • Recording Findings:

    • Example: "Deep palpation reveals no masses or tenderness."

  • Palpation of Specific Organs:

    • Liver:

    • Method: Place your left hand under the patient's back, and right hand on the right upper quadrant at the costal margin. Ask the patient to take a deep breath to feel for liver edges.

    • Normal Findings: Liver edges not felt or are 1-2 cm below costal margin on inspiration.

    • Recording Findings:

    • Example: "Liver edge not enlarged, non-tender."

    • Spleen:

    • Method: Support the left lower rib cage with your left hand and palpate under the left costal margin with your right hand while asking the patient to inhale.

    • Normal Findings: Spleen should not be palpable.

    • Recording Findings:

    • Example: "Spleen non-palpable."

    • Kidneys:

    • Note: The right kidney may be palpable in thin individuals, while the left kidney is usually not.

    • Recording Findings:

    • Example: "Kidneys non-palpable without masses."

6. Assessing Costovertebral Angle (CVA) Tenderness

  • Position: Patient can be seated or prone for this part of the assessment.
  • Technique: Use the back of your fists to gently tap over the costovertebral angle.
  • Focus: Look for pain, which may indicate conditions such as pyelonephritis or renal inflammation.
  • Normal Findings: Show no tenderness.
  • Recording Findings:
    • Example: "No CVA tenderness noted."

Final Assessment Summary

  • Inspection Outcomes:
    • Abdomen is flat, symmetric, umbilicus is midline, and absence of lesions or visible pulsations.
  • Bowel Sounds:
    • Normal and active in all four quadrants with no bruits detected.
  • Percussion Findings:
    • Tympany throughout the abdomen.
  • Palpation Results:
    • Both light and deep palpation reveal a soft abdomen with no guarding, masses, or tenderness.
  • Organ Findings:
    • Liver, spleen, and kidneys are all non-palpable.
  • CVA Tenderness:
    • No tenderness observed.