Clinical Skills: Abdominal Assessment

Hello! This video covers how to do an abdominal assessment. In a normal examination you’d do everything on this list, but to keep things concise this video will focus on the steps in blue and will also cover: special populations like infants, children, and the elderly; and include a summary.

Meet Fred. Before we go into inspecting his abdomen, let’s make sure that he’s comfortable. Fred’s already emptied his bladder and we’ve kicked up the heat a notch in the room. Let’s put a pillow under his knees, too. Fred, do you have any abdominal pain we should know about? Let’s leave those areas till last.

Fred’s abdomen is flat, but if it were a little rounded that would be ok too. It’s pretty symmetrical, as well. If we ask Fred to breathe in and hold his breath, there are no bumps or bulges, nor is there any muscle separation.

The umbilicus, navel, or belly button isn’t red or swollen, and the skin is nice and smooth. Overall, Fred looks well: he’s comfortable and breathing normally; but what if he didn’t?

His abdomen could be scaphoid, where it caves in, that usually indicates malnutrition. It could be also protuberant, where it sticks out, which may be caused by excess fat or ascites. There could be bulges, like a hernia. The skin could be a little yellow or green, suggesting jaundice, or there could be areas of discoloration following bruising. Veins might be sticking out due to malnutrition or cirrhosis, or you might see striae - stretch marks - which could be due to rapid growth, pregnancy, cirrhosis, or Cushing syndrome.

Now let’s auscultate Fred’s abdomen. Percussion and palpation stimulate peristalsis, so we always auscultate the abdomen first. With the diaphragm endpiece, gently hold the stethoscope against Fred’s skin.

Let’s start in the right lower quadrant. Bowel sounds are most common here, and sound like high-pitched gurgling, every few seconds. You don’t have to hear sounds in each quadrant. As long as there are some sounds somewhere with pauses, that’s okay. Stomach growling, or borborygmus, is normal if you’re hungry. Constant, continuous bowel sounds is not - that’s associated with increased motility and might indicate gastroenteritis or the early stages of abdominal obstruction. Absent bowel sounds are defined as 5 minutes with no bowel sounds at all - they’re a late sign of abdominal obstruction. Listening with the bell of a stethoscope, you might also hear some quiet vascular sounds, or bruits, which are normal in the abdomen.