Assessment of Abdomen

An assessment of the abdomen should be completed during a comprehensive assessment or as part of a focused assessment if your patient is experiencing issues with their abdomen or GI system. Methods of abdominal assessment include inspection, auscultation, percussion, and palpation, as well as special tests. Unlike other body system assessments, you should always auscultate first when performing an abdominal assessment, so you can avoid stimulating bowel sounds or inflicting pain during percussion or palpation.

Beginning with inspection, look between the costal margins and the symphysis pubis, and note the abdomen’s normal contour, which will be either flat; slightly convex, which is a curved outward appearance; or slightly concave, which is a curved inward appearance. An abdomen that’s profoundly concave could indicate malnourishment and a profoundly convex abdomen is associated with ascites, poor muscle tone, or an accumulation of subcutaneous fat.

The skin of the abdomen should be free from lesions, including open wounds or ecchymosis. However, as a normal finding, you may note striae, or stretch marks, as well as hair, moles, or freckles. Also note any bodily modifications like tattoos, piercings, or surgical scars.

Now, if you are inspecting the abdomen of a very thin patient, you might be able to see pulsations in the region of the abdominal aorta. This can be normal, however, if pulsations are prominent, it may represent an abdominal aortic aneurysm. Also, inspect for any obvious bulging or protrusions, which can represent herniation.

Next up is auscultation. Start with the diaphragm of your stethoscope and begin in the lower right quadrant, moving in a clockwise fashion, listening for bowel sounds, which sound like high-pitched clicks and gurgles. It’s normal to hear bowel sounds in each quadrant at a frequency of 5 to 35 sounds per minute.

If bowel sounds are not heard, you should auscultate up to a full 5 minutes in each quadrant. Bowel sounds are hypoactive if they occur at a rate of less than 5 per minute and can be associated with constipation; while more than 35 bowel sounds per minute are considered hyperactive and might be caused by gastroenteritis or an early sign of bowel obstruction. On the other hand, borborygmi is a prolonged gurgle, which typically occurs as a normal part of the digestive process.

Next, using the bell of the stethoscope, listen for bruits, or low-pitched blowing sounds caused by turbulent blood flow through arteries. You should auscultate the abdominal aorta by placing the bell of the stethoscope in the epigastric region. Then move on to the renal arteries, auscultated approximately 3 centimeters above the umbilicus laterally on both the left and right sides of the aorta; and the iliac arteries which can be auscultated about 3 centimeters below the umbilicus and laterally on both the right and left sides. Normally, you should not hear any vascular sounds. If a bruit can be heard, it might indicate an aneurysm or atherosclerotic arterial disease.