Physical assessment - Abdomen: Nursing

An assessment of the abdomen should be completed as part of a comprehensive assessment, like during a routine physical exam, during an admission to the hospital, or as part of a focused exam if a client is experiencing abdominal issues like pain, nausea, or changes to bowel patterns. Let’s review the process of completing an abdominal assessment.

Supplies needed for the abdominal assessment include drapes, a stethoscope with a diaphragm and bell, gloves, a measuring tape, a washable skin marker, and a good source of light.

Before beginning, ask your client to empty their bladder. Then prepare for the abdominal assessment by properly draping your client. Remember to keep your client covered and only expose areas of their body as needed to perform your assessment.

Also, ensure privacy by closing any curtains or closing the door. Ensure your client is comfortable in the supine position, meaning they are lying flat on their back. You may also place a pillow under their knees to help relax their abdominal muscles. Also warm your hands and stethoscope and ensure your client is comfortable with the temperature of the room, since cold temperatures can cause rigidity of the abdominal muscles, making it more difficult to perform some assessment techniques.

Before getting started, explain the procedure to your client and be sure to answer any questions they might have before obtaining verbal consent. Then, perform hand hygiene and collect your supplies.

Locating the anatomical landmarks of the abdomen will help guide the appropriate placement of your equipment and hands throughout your assessment. Commonly used landmarks include the xiphoid process, costal margin, umbilicus, iliac crest, and the pubic crest. The abdomen can also be separated into four quadrants, to help you locate the abdominal organs.

First is the right upper quadrant, called the RUQ for short, which contains the liver, gallbladder, and right colic flexure.
Next, the left upper quadrant, also called the LUQ, which includes the stomach, pancreas, and left colic flexure. Then there’s the right lower quadrant, or RLQ, which contains part of the ascending colon, the cecum, and the appendix. Finally, there’s the left lower quadrant, which is called the LLQ, that contains the descending and sigmoid colon. If your client is experiencing any abdominal symptoms, like pain, it can be helpful to identify which quadrant or quadrants are involved to determine which internal structure might be responsible.

The abdomen can also be divided into nine regions including the right hypochondriac, left hypochondriac, the epigastric, the right lumbar, left lumbar, the umbilical, right inguinal, and left inguinal and the suprapubic or hypogastric regions.

Using this method of description allows you to be more precise in the description of abnormal findings, since structures located in the midline of the body have named regions. For example, the bladder is located in the suprapubic region using this system, whereas it is located in both the right and left quadrant.

Now, methods of abdominal assessment include inspection, auscultation, percussion, and palpation, as well as some special techniques used in certain circumstances. Unlike other body system assessments, you should always auscultate first when performing an abdominal assessment, percussing or palpating, so you can avoid stimulating the bowel sounds or inflicting pain which could cause your client to tense their abdominal muscles.

You’ll also want to ask your client about any acute symptoms of pain or distress. And be sure to watch your client closely for indications of discomfort during your assessment, including facial expressions or other nonverbal cues, such as guarding, which is when the client tenses their abdominal muscles and uses their arms to protect their abdomen.

Okay, begin your assessment with inspection. As you look between the costal margins and the symphysis pubis, the abdomen’s normal contour will be either flat; slightly convex, which is a curved outward appearance; or slightly concave, which is curved inward appearance. If the abdomen is profoundly concave or convex, it may indicate an underlying issue.

For example, a protruding, convex abdomen is associated with obesity, or it might indicate ascites. A profoundly concave abdomen might indicate malnourishment.

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, or hair distributed on the abdomen, as well as moles or freckles. Also make note of any body modifications like tattoos, piercings, or surgical scars.

Now, if you are inspecting the abdomen of a slender client, 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 and should be reported immediately.

Also, inspect for symmetry to make sure both sides of the abdomen appear equal with no obvious bulging or protrusions, since this can represent herniation. If needed you could use a light source like a floor lamp to cross illuminate the abdominal surface to make slight irregularities more prominent.

Next up is auscultation. When auscultating, remember to use the diaphragm of the stethoscope. Begin in the right lower quadrant and auscultate in a clockwise fashion, listening for bowel sounds, which sound like high-pitched clicks and gurgles. It is normal to hear bowel sounds in each quadrant at a frequency of 5 to 35 sounds per minute.