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Abdomen Extra Notes

Here’s a clearer, better-explained version of your notes — rewritten in a clean, logical order and with short explanations for each concept 👇

🩺 Abdominal Assessment – Key Points

Preparation

  • ✅ Ask the client to empty their bladder before the exam.

    • → A full bladder can interfere with palpation and make it uncomfortable.

  • ⚖️ Position: Patient should lie supine (flat) with knees slightly bent to relax the abdominal muscles.
  • 🕵️ Drape properly for privacy; expose only the abdomen.

General Sequence (Order of Steps)

Always perform the abdominal exam in this order:

  1. Inspection 👀
  2. Auscultation 🎧
  3. Palpation ✋
  4. Percussion 🔔

➡️ Auscultate before palpation because touching the abdomen can change bowel sounds.

Inspection

  • Look from the side and from above the patient’s abdomen.
  • Check for:
    • Contour: flat, rounded, or distended
    • Lesions, scars, discoloration
    • Visible pulsations → mild pulsation from the aorta (below the xiphoid process) is normal
    • Peristalsis: visible wave-like movement can be normal in thin people

Auscultation

  • Use the diaphragm of the stethoscope lightly (don’t press hard).
  • Listen clockwise starting in the right lower quadrant (RLQ) → RUQ → LUQ → LLQ.
  • Note:
    • Normal bowel sounds: gurgling every 5–30 sec
    • Hypoactive or hyperactive sounds suggest GI issues

Palpation

  • Use light palpation only (about 1 cm deep).
  • Use a rotary motion with fingertips.
  • Start in the RLQ, move up → across → down (clockwise).
  • Purpose:
    • Detect tenderness, masses, or muscle rigidity
    • Note that palpation may increase bowel or gas movement
  • Do not palpate deeply if an aortic aneurysm is suspected.

Palpating the Aorta

  • Use both hands — index and thumb — just above the umbilicus.
  • You might feel a light pulsation, which is normal.

Percussion

  • Produces different sounds depending on what’s underneath:
    • Tympany (drum-like): normal over most of the abdomen (air in intestines)
    • Dullness: over solid organs (liver, spleen) or fluid/mass

Kidney (Costovertebral Angle) Assessment

  • To check for kidney tenderness, place one hand on the patient’s back over the costovertebral angle and gently thump it with your other fist.
  • Pain indicates possible kidney inflammation or infection.

Bladder Assessment

  • The bladder is located in the suprapubic (hypogastric) region — just above the pubic bone.
  • If it’s distended, it can be palpable like a firm, smooth mound.
  • A full bladder can indicate urinary retention.

Bowel Function and Constipation

  • Encourage the patient to move and walk to prevent constipation.
  • Ask about bowel movements — frequency, consistency, and difficulty.

Diet Recall

  • Ask the patient to describe what they’ve eaten recently.
  • This helps identify dietary causes of digestive problems (e.g., bloating, constipation, diarrhea).