Assessment of the

Abdomen
Anatomical landmarks

◦ Xiphoid process
◦ Umbilicus
◦ Costal margins
◦ Symphysis pubis
◦ Iliac crest
◦ Anterior superior iliac spine
 Four Quadrants of Abdomen

 Right Upper Quadrant

◦ Liver
◦ Portions of ascending and transverse colon
◦ Pylorus valve of stomach
◦ Hepatic flexure of colon
◦ Duodenum
◦ Right kidney and adrenal gland
 Right Lower Quadrant
◦ Appendix and cecum
◦ Right ureter
◦ Ascending colon
◦ Right spermatic cord
◦ Bladder if distended
◦ Uterus if enlarged
◦ Ovary
 Four Quadrants of Abdomen

 Left Upper Quadrant

◦Tip of medial lobe of liver
◦Portions of transverse and descending colon
◦Spleen
◦Splenic flexure of colon
◦Stomach
◦Left kidney and adrenal gland
◦Pancreas
 Left Lower Quadrant

◦Sigmoid colon
◦Left ureter
◦Descending colon
◦Left spermatic cord
◦Bladder if distended
◦Uterus if enlarged
◦Ovary
Collecting SUBJECTIVE DATA
 Chief complaint / present illness
◦ Abdominal pain
◦ Constipation
◦ Indigestion
◦ Diarrhea
◦ Nausea
◦ Vomiting
Collecting SUBJECTIVE DATA
 Chief complaint / present illness
◦ Fecal incontinence
◦ Jaundice
◦ Dysuria
◦ Urinary frequency
◦ Urinary incontinence
◦ Hematuria, blood in stool
◦ Weight loss, weight gain 
Collecting SUBJECTIVE DATA

 Symptom characteristics
◦ Onset and duration
◦ Prior evaluation or treatment
◦ Getting better or worse
◦ Home or prescribed treatment
◦ Character or quality
◦ Others in family with similar symptoms
◦ Associated symptoms
◦ Alterations in activities of daily living
◦ Location, radiation
◦ Factors that relieve or exacerbate
symptoms
Nursing history to determine

Past Medical History (have you had,

have you ever had)
 Perinatal history

◦ Pregnancies, abortions, miscarriages

◦ Birth defects
◦ Infant feeding problems
◦ Prematurity
◦ Short bowel syndrome
 Nursing history to determine

 Illnesses / infectious disease

 Acute GI infections
 Irritable bowel
 Hepatitis
 GERD
 PID, STI’s
 Constipation
 HIV
 Food allergies / intolerance
 UTI’s
 Cystic fibrosis
 Diverticulitis
 Colitis
 Ulcers

 Nursing history to determine

Immunizations
 Hepatitis B
 Cholera
 Hepatitis A
 Typhoid
 Rota virus

Other
 Laboratory test
 Stool cultures
 Organ biopsy
 Abdominal x-ray, sonograms, ultrasounds
 Sigmoid or colonoscopy
 Urinalysis
 Ova and parasites
 H. pylori tests
 Nursing history to determine

Operations / hospitalizations / ER visits

 Abdominal surgery

 Recurrent abdominal pain

 Appendicitis

 Organ inflammation (liver, pancreas, gallbladder)

 Trauma to abdomen

 Acute gastroenteritis (AGE)

 Births

 Blood transfusions

Accidents (unintentional injury)

 Car

 Falls

 Bike

 Skateboard
 Nursing history to determine

Medication use (What prescriptions)

 Antibiotics
 Folk remedies
 Laxatives
 Birth control
 Suppositories, enemas
 Iron and vitamins
 Antacids
 Chronic steroid or ASA use
 Ulcer medications
 Folk remedies
 Chronic steroid or ASA use
 Birth control
 Iron and vitamins
Nursing history to determine

Family History (is there a hx of any of the ff)

 Infectious conditions (hepatitis, AGE)
 Constipation, irritable bowel
 Ulcers, diverticulitis, inflammatory bowel
 Gallbladder disease
 Symptoms similar to CC
 Colon cancer, ovarian cancer
 Ova and parasites
Nursing history to determine

Personal and Social History (what types, do

you, how much)
 Nutrition
 Last menstrual period
 Sexual practices and protection
 Substance use, including caffeine, alcohol,

tobacco
 Recent stress
 Weight gain or loss
 Anorexia, bulimia, dieting
 Travel outside of country
 Collecting OBJECTIVE DATA

Preparing the Client:

 Have child empty bladder
 Have child lie supine with hips and knees flexed
 Drape for privacy
 Tell child what you will do before you do it
 Have warm room and warm hands
 Have good light source
 Examine identified painful areas last 

Equipment :
 Small pillow or rolled blanket
 Tape measure
 Stethoscope
 Marking pin
 Collecting OBJECTIVE DATA

Inspection
Skin
 Scars
 Lesions
 Striae – old silver striae or stretch marks
 Rashes
 Dilated veins, vein pattern (hepatic cirrhosis or inferior vena

cava obstruction)
Umbilicus
 Location
 Contour , Signs of inflammation or bulging, hernia

Contour
 Symmetrical / asymmetrical
 Scaphoid (concave or hollowed)
 Flat
 Protuberant

 Rounded 
Collecting OBJECTIVE DATA

Causes of Abdominal Distention

 Obesity

 Neoplasms

 Pregnancy

 Feces

 Tympanitis

 Ascites
 (Six “F’s”: Fat, Fluid, Flatus, Fetus, Fecus, Fatal

growths)
Location of Distention
 Xiphoid - Diastasis recti
 Umbilicus - Pregnancy, distended bladder
 Pubis - Umbilical hernia
 Midline - Diaphragmatic hernia
Collecting OBJECTIVE DATA

Normal Variations of Contour with Age

 Infant-toddler

◦ Protuberant
 Preschool age child

◦ Rounded, lumbar lordosis

 School age child

◦ Scaphoid
 Adolescent / adult

◦ Varied
 Collecting OBJECTIVE DATA

 Inspection
◦ Peristalsis
 May be seen in thin individuals or with obstructive
conditions (intestinal obstruction)
◦ Pulsation
 Pulsations of descending aorta may be seen in thin
individuals in the epigastrium
◦ Respirations
 Abdominal breathing normal until school age
 Intercostal breathing occurs with
 Respiratory distress
 Abdominal inflammation
 Pneumonia or pleural effusion may cause
 Abdominal pain
 Altered respirations
 Collecting OBJECTIVE DATA
 Auscultation
◦ To assess Bowel sounds – (normal sounds
consist of clicks & gurgles)
◦ Vascular sounds (bruits sounds)
◦ Organ size, location
 Warm stethoscope before use

◦ Increased bowel sounds

 Diarrhea
 Diverticulitis
 Colic
 Intussusception
 Malrotation

◦ Decreased bowel sounds

Collecting OBJECTIVE DATA

Total obstruction
Peritonitis
Paralytic ileus
Severe ascites
Absence of bowel sounds established

after 5 minutes of listening

◦Scratch test for liver size
Intensity of sound increases as you
approach liver edge  
Collecting OBJECTIVE DATA

Techniques for Relaxation of Children for

Percussion and Palpation
 Pacifier to encourage relaxation with
sucking
 Flex knees and hips
 Use of puppets or toys
 Distraction, support of caregiver
 Involve them in procedure
 Reassure procedure will not hurt 
Collecting OBJECTIVE DATA
Percussion
◦ Percussion is excellent for assessing organ
size, presence of masses, fluid or gas.
◦ Tympany  stomach, bowel
◦ Resonance  bowel
◦ Dullness  liver
◦ Flat  thigh
 Tympany

◦ High pitch note elicited over air filled

structures, such as viscera and stomach.
 Collecting OBJECTIVE DATA

 Dull
◦ Short high-pitched sound with little
resonance. Found in solid or fluid filled
organs adjacent to air containing organs, i.e.,
liver, spleen, distended bladder.
 Flat

◦ Very short, high-pitched sound produced

over tissue which contains no air, i.e.,
muscle, large solid mass.
Collecting OBJECTIVE DATA

 Percuss
◦ 4 quadrants for gas or masses (Solid or fluid
filled)
◦ Liver span
◦ Spleen size
◦ Costovertebral angle (CVA) tenderness
 Liver percussion

◦ At right mid-clavicular line, start below

umbilicus and percuss upward until dullness
of sound heard
◦ Liver usually @ right costal margin +/- 2 cm
◦ Size and shape of liver vary
 Collecting OBJECTIVE DATA

 Spleen Percussion
◦ Splenic dullness may be heard near left 10th rib
posterior to the mid-axillary line
 Usually not found unless enlarged
 Obscured by air in the colon
◦ Percuss at 10th intercostal space to determine
dullness with deep breath
◦ For spleenomegaly
 Percuss the lowest interspace in the left anterior
axillary line – usually tympanitic
 Percussion for tenderness of liver or kidneys
◦ Place palm of one hand over organ. Strike hand
with ulnar surface of other hand. If organ is
inflamed, this will result in pain.
 Collecting OBJECTIVE DATA

Palpation
 Light palpation

◦ Assessment of skin turgor

◦ Muscle tone/resistance
◦ Superficial lesions or masses
◦ Areas of tenderness
 Deep palpation
 Assess for masses or enlarged organs
 Mass descriptors
◦ Location
◦ Mobility
◦ Size
◦ Pulsation
◦ Shape
◦ Tenderness
◦ Consistency
Collecting objective data

◦ Liver
 Normally palpable near right costal margin,
mid-clavicular line.
 Palpate with right hand starting below umbilicus

and moving upward until liver palpable.

 Remember the liver is a superficial organ.

◦ Spleen
 Difficult to palpate unless enlarged
 Deep palpation under L costal margin at the

anterior axillary line

 Will descend with deep inspiration
 Can roll person to R side to move spleen

towards midline
Collecting objective data

Kidneys
 Difficult to palpate unless enlarged
 With hands perpendicular to midline between rib

cage and iliac crest, press hands gently but firmly

together.
 Have person take deep breath.
 May feel kidney slide between hands. Right kidney

normally lower than left kidney.

Stool
 Firm, movable, mildly tender, elongated mass often
palpable in sigmoid colon
Bladder
 If distended, bladder is palpable midline above
symphysis pubis
 Smooth round mass, not moveable
 Collecting objective data

Special maneuvers
 Rebound tenderness

 Psoas maneuver

 Obturator sign

 Murphy’s sign

Rebound Tenderness at McBurney Point

 Sharp pain when pressure released in RLQ suggest appendicitis

Obturator Muscle Test

 Flex R leg at hip & knee. Rotate leg laterally & medially.

 Pain in hypogastric region may indicate ruptured appendix

Iliopsoas Muscle Test

 Ask to raise the R leg flexing at the hip while pressing

 down on lower thigh. Lower quadrant pain may indicate appendicitis.

Murphy’s Sign
 Client complains of sharp pain when trying to take a deep breath

while examiner performs deep palpation in URQ.

 Inflamed gallbladder descends during inspiration resulting in pain 
Common Abnormal Abdominal Findings

Hernias
 Protrusions of the peritoneum or intestine

through a weakened spot in musculature of

abdominal wall. Umbilical hernias rarely
need intervention. Inguinal and femoral
hernias are usually surgically corrected.
◦ Inspection - Assess for bulges with crying or
bearing down.
◦ Auscultation - Assess for hums or bruits - should
not be present. May hear bowel sounds.
◦ Percussion - Can not percuss hernia.
◦ Palpation- Mass soft, nontender and retractable.
Measure opening in musculature with finger tips.
Common Abnormal Abdominal Findings

Pyloric Stenosis
 Hypertrophy of the pyloric valve prevents feed from

leaving the stomach. Infant initially feeds well but then

develops persistent vomiting.
Inspection
 Peristalic wave over stomach area - Projectile
vomiting
Auscultation
 Hyperactive sounds over stomach area
 Hyperactive sounds over intestines

Percussion
 Resonant stomach sounds. Contents expelled.

Palpation
 An enlarged, firm, “olive shape” mass may be palpable in

RUQ. Needs to be referred to MD for ultrasound testing

and then surgery.
 Common Abnormal Abdominal Findings

Appendicitis
 Appendicitis is the most common cause of acute surgical abdomen in

childhood.
◦ Rare in early childhood, becoming more frequent after age 10.
◦ History includes dull aching, steady peri-umbilical pain that localizes to RLQ
after 4-6 hours.
◦ Nausea and vomiting frequently occur but there is no change in bowel habits.
Low grade fever may be present.
Inspection
◦ Note guarding or pain with walking or coughing. Abdominal distention may be
present. Prefer supine position with knees flexed.
Auscultation
◦ Bowel sounds may be decreased or hyperactive. Need to auscultate RLL of
lungs carefully to rule out lobar pneumonia with referred pain.
Percussion
◦ Increased tenderness may make percussion too uncomfortable to perform.
Palpation
◦ Tenderness over area of inflamed appendix, usually RLQ (McBurney point).
◦ Rebound tenderness localized to same area.
 Unable to palpate inflamed appendix. Rectal exam usually finds right-sided
tenderness.
 Common Abnormal Abdominal Findings

Abdominal pain
Inspection
◦ Limitation of movement or alterations in breathing pattern (shallow or
chest breathing) are important assessment criteria. Watch client climb on
or off the exam table
◦ Periumbilical pain less likely to be serious than other locations
◦ Evaluate for weight loss or gain
Auscultation
◦ Bowel sounds may be increased or decreased
◦ Friction rub may be heard with pleural inflammation or peritoneal
inflammation
Percussion
◦ Percussion over areas of inflammation may result in pain
◦ Watch facial expressions as you attempt to distract individual. Those
who watch you have more pain.
Palpation
◦ Palpation may identify localized or generalized pain.
◦ Watch facial expressions as you attempt to distract during palpation.
◦ Firm but gentle palpation is best.
Common Abnormal Abdominal Findings

Pregnancy
Inspection
◦ Enlargement of lower abdomen, midline
◦ Enlargement of breast
◦ Linea nigra, increase facial pigmentation, striae
Auscultation
◦ Fetal heart sounds
Percussion
◦ Dull mass in lower abdomen
◦ Displaced tympany of bowel and stomach
Palpation
◦ Fetal outline
◦ Fundus of uterus