Abdominal Assessment Lecture Notes

Assessment Order

• Pain noted in the right upper quadrant; to be assessed last.
• Order of assessment:
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation

Inspection

• Patient position:
  • Pillow support
  • Knees flexed
  • Arms at side
• Observation:
  • Contour: Flat (can be flat, protuberant, round, or scaphoid)
  • Symmetry: Abdomen is symmetrical
  • Umbilicus: Midline, inverted, no redness or dryness
  • Skin: Uniform color, no redness, lesions, or striae
  • Hair Growth: Uniform
  • Facial Expression: Calm, relaxed
  • Respirations: Even and silent
  • Pulsations: Slight pulsation in epigastric area associated with aortic pulse
  • No abnormal movements: No peristalsis, abdominal breathing

Auscultation

• Technique:
  • Diaphragm for bowel sounds
  • Bell for vascular sounds
• Bowel Sounds:
  • Landmark approximately one inch outside the umbilicus
  • Start at the right lower quadrant
  • Listen for approximately 10 seconds per quadrant (normal/hyperactive)
  • Listen for a full minute if hypoactive (< 5 sounds)
  • Listen for 5 minutes if absent
  • Normal sounds: 5 to 30 per minute, irregular, high-pitched, cascading, gurgling
• Vascular Sounds:
  • Areas: Epigastric (aorta), renal, iliac, femoral
  • No bruit present

Percussion

• Technique: Three areas per quadrant, starting in the right lower quadrant
• Findings:
  • General tympany throughout
  • Liver dullness in the right upper quadrant
  • Possible splenic dullness in the left upper quadrant
  • Potential bladder dullness in lower quadrants

Scratch Test

• Procedure:
  • Place stethoscope over liver
  • Scratch from right lower quadrant to identify lower liver border

Costovertebral Angle Tenderness

• Procedure:
  • Landmark at the twelfth vertebrae
  • Assess bilaterally
  • No pain or tenderness present

Palpation

• Procedure:
  • Start in right lower quadrant; right upper last due to pain
  • Use gentle pressure, about 1 cm deep
  • Circular motion with three fingers, hand parallel
• Findings:
  • No pain or tenderness
  • No masses, guarding, or rigidity

Conclusion

• Assessment completed with no pain or tenderness reported.
• No further questions from the patient.