abdominal examination

Jonathan Downham 2010

Abdominal ExaminationJonathan Downham Advanced Nurse Practitioner 2008


Abdominal Examination

•Gastrointestinal•Weight loss•Nausea, vomiting•Dysphagia• Regurgitation, flatulance, heartburn• Abdominal pain• Stool frequency


Clinical History Taking- Review of systems.

• Gastrointestinal– Weight loss– Nausea, vomiting– Dysphagia– Regurgitation,

flatulance, heartburn– Abdominal pain– Stool frequency– Surgery

– Medications– Last Period– Family History– Alcohol– Diet– Stress


Abdominal ExaminationPatient Position• Good lighting• Undressed nipple to knees• Modesty blanket• Flat on couch with single pillow for head• Arms by their sides• If unable to fully relax abdomen than flex

hips to 45 degrees and knees to 90 degrees.


Abdominal ExaminationGeneral Inspection• Pain, distress, cachexia, pallor or jaundice.• Hands• Metabolic flap- hepatic encephalopathy,

carbon dioxide retention or ureamia• Aneamia

• Eyes• Face• Abnormal pigmentation around lips• Angular stomatitis

• Oral cavity• Lymph glands



Inspection.• Symmetry• Abdominal pulsation• Shape• The five F’s• Scars• Sinuses• Fistulas e.g. crohns• Visible peristalsis due to intestinal

obstruction• Distended veins



Auscultation• May be best to do this before palpating.• Listen specifically for bowel sounds• Place stethoscope to right of umbilicus and do

not move it. • Normal sounds occur every 5-10 seconds• Listen above umbilicus over aorta for bruits• Place stethoscope 2-3cm above and lateral to

umbilicus and listen for renal artery bruits.



Percussion• Percuss over whole abdomen• Pay attention to any masses you may have

detected.• If ascites is suspected test for shifting

dullness• Orientate your hands correctly



PalpationAsk the patient where the pain is.

Warn the patient you are about to put your hand on them.

Light palpationDeep palpation

Specific palpation of the intra-abdominal

organs


Abdominal ExaminationLight Palpation• Commence palpation at a site remote from any

area of discomfort.• All areas must be palpated systematically• Use the nine quadrants as a guide.• Is performed to elicit

any tenderness or guarding• Lie hands and fingers flat• Press very gently.

Deep Palpation


Abdominal ExaminationPalpation of intra abdominal organs.Liver• Start with hand at right iliac fossa, fingers

pointing to head• Palpate deeply whilst patient breathes in and

out deeply• If nothing is felt repeat the process moving

the hand up slightly.• If edge is palpable describe:• Size• Contour• Texture• Tenderness


Abdominal ExaminationPercuss out liver edges


Abdominal ExaminationPalpation of the spleen


Abdominal ExaminationPalpate the Kidney



Abdominal Aorta



Hernias• Examine groin with patient standing upright• Inspect inguinal and femoral canals and scrotum

for any lumps and bumps• Ask patient to cough; look for any impulses• Ask the patient to lie down and establish if the

hernia reduces.• Press two fingers over the internal inguinal ring at

the mid inguinal point and ask patient to cough• If it reappears it is a direct hernia, if not it is

indirect.


Abdominal ExaminationRectal Examination• Explain• Position- left lateral, knees drawn up• Examine peri-anal area• Lubricate• Pulp of finger at 6 0’clock an anal margin• Anal spasm- stop, try again, local suppository

may be required.• Ask patient to squeeze your finger• Identify cervix/prostate• Withdraw finger and examine for colour/blood



Common abdominal conditions•Dysphagia/odynophagia•Questions• Trouble swallowing both solids and liquids?• Where does blockage seem to be?• Intermittent or persistent• Has it been getting worse?• Coughing or choking when starting to swallow• Heartburn or acid indigestion• Weight loss



Common abdominal conditions• Pain• SOCRATES• Site• Onset• Character• Radiation• Associated symptoms• Timing• Exacerbating or relieving factors• Severity


Abdominal ExaminationCommon abdominal conditions• Diarrhoea• Secretory• Osmotic• Abnormal intestinal motility• Exudative• Malabsorption


Abdominal ExaminationCommon abdominal conditions• Diarrhoea- questions• How many stools per day• What do they look like• ?urgency• Woken at night?• Blood mucus or pus?• Pale, greasy, smelly?• Lost weight?• Recent travel?• Antibiotics?• Family history• Recent fevers?



Nausea and vomiting• Questions• Acute or chronic?• Vomiting with or without nausea?• How long after meal?• What does it look

like..blood/bile/faeculent• Abdo pain• Weight loss?• Medications?

abdominal examination

Health & Medicine

abdominal examinationpalpate

abdominal examinationnausea

kidney jonathan downham

spleen jonathan downham

colourbloodjonathan

liver edges jonathan

deep palpationjonathan

bumpsask patient