Abdominal assessment: Inspection, Auscultation, Percussion, Palpation (IAPP)
Purpose of abdominal assessment
Determine if gastrointestinal symptoms affect the person’s activities of daily living (ADLs).
Assess for improvement or deterioration in gastrointestinal health over time.
Detect compromise of the GI system due to factors such as pain, diet, hydration, or mobility.
Follow textbook guidance for necessary equipment and preparation; ensure nails are short and perform hand hygiene.
Preparation, equipment, and safety considerations
Refer to the textbook for required equipment and preparation steps.
Personal hygiene: ensure nails are short and hands are clean.
Maintain privacy and consider draping as needed.
Lighting should be adequate for a clear view.
Assist the person to a supine position with one pillow if tolerated.
Check for privacy during the exam and provide comfort to the patient.
Positioning and initial inspection
Use anatomical landmarks to divide the abdomen into four quadrants:
landmarks include the costal margins, the pubic bone, the iliac crests, and the umbilicus.
The umbilicus should be midline and inverted with no sign of discoloration, inflammation, or bulging.
From the foot of the bed, assess symmetry by comparing the left and right sides with the umbilicus as the center point.
Observe the contour of the abdomen to classify as flat, concave, or convex.
If needed, assess for asymmetry or bulges by asking the patient to lift their head up and bring the chin to the chest (to tense the abdominal wall):
example cue used: "And lift your head up and pop your chin on your chest for me."
During the inspection, you may collect data beyond GI function, such as observations related to the skin, respiratory system, and cardiovascular system; refer to the text for details.
Auscultation (first, before palpation and percussion)
Rationale: auscultation is performed before palpation or percussion because touching the abdomen may stimulate bowel sounds and alter findings.
Method: hold the diaphragm of the stethoscope lightly against the skin.
Start in the right lower quadrant (RLQ) and move clockwise through each quadrant (
RUQ → LUQ → LLQ → RLQ) to assess bowel sounds.Listen for presence or absence and the quality of bowel sounds; there is no need to count individual sounds.
Note: bowel sounds are normally present in the RLQ.
Percussion
Purpose: assess for tympany (normal air-filled hollow sounds) and dullness (solid or filled tissues).
Method: percuss lightly in all four quadrants, starting in the RLQ and moving clockwise, percussing in each quadrant.
Palpation (surface and deeper palpation)
Indication: assess for tenderness, guarding, masses, and surface characteristics.
Technique described in the transcript:
Palpate using both surface and light palpation with the finger pads of the first four fingers, held close together, and depress the skin to about .
Then, for the next step, the transcript mentions a deeper palpation target: below the skin (the description labels this as light palpation in the dialogue, but it corresponds to deeper palpation in standard technique).
Patient feedback: ask the patient to report if any area hurts or is tender during palpation.
Observation during palpation: watch the patient’s facial expressions for signs of pain or distress.
After examination: help the patient redress and reposition.
Documentation of findings
Document the following:
Shape of the abdomen and any changes in contour
Condition of the skin and surface landmarks
Presence and characteristics of bowel sounds (auscultation)
Percussive tones (tympany vs dullness)
Any pain, tenderness, or guarding
Presence of any palpable mass or abnormal findings
Include any notable asymmetry, bulges, tenderness locations, or masses with precise location if identified.
During an abdominal assessment, you should complete your techniques in the order of inspection, followed by auscultation, then percussion, and finally palpation. Auscultation is performed first because touching the abdomen may stimulate bowel sounds and alter findings. You should start to auscultate in the right lower quadrant (RLQ) because bowel sounds are commonly present there. If a patient does not have any bowel sounds, it may indicate paralytic ileus, bowel obstruction, or peritonitis, and requires further medical evaluation.