Physical Exam: Abdomen

I. History

• Pain, bowel habits, dietary problems, weight change, difficulty swallowing, flatulence, belching, heartburn, nausea, vomiting, cramping
• Changes in micturition including: change in amount and color of urine, irritation of lower urinary tract, urinary incontinence, urinary tract pain

II. Inspection

• Landmarks: 

1. Xiphoid process - marks upper boundary of abdomen 
2. Symphysis pubis - marks lower boundary 
3. Abdomen divided into four quadrants - RUQ, RLQ, LUQ, LLQ

• Normal findings: 

1. skin texture and color should be consistent with rest of body
2. striae may be present
3. umbilicus is normally flat or concave midway between xiphoid and symphysis pubis
4. abdomen may be flat, concave or convex; all three are normal if there is symmetry
5. you may not peristalsis movement or aortic pulse
6. voiding - steady, straight stream with no pain or post void dribble

III. Percussion

• Normal findings: Tympany over stomach and intestines; dullness over liver, spleen, pancreas, kidneys and distended (>150 cc) bladder
• Liver border:

1. usually noted in the 5th, 6th or 7th intercostal space
2. distance between upper and lower borders should range between 6 to 12 cm at right midclavicular line

• Spleen:

1. Left posterior midaxillary line - dullness at 6th to 10th rib
2. Left intercostal space in anterior axillary line - tympany

IV. Palpation

• Normal findings: soft with no palpable masses, no tenderness or rigidity
• Bladder noted as a bulge in abdomen when filled with more than 500cc of urine
• Deep palpation may produce tenderness - liver, kidneys, spleen inguinal nodes generally not palpable

V. Auscultation

• Bowel motility: normal findings - audible in all quadrants
• Vascular sounds: normal findings

1. no vascular sounds over aorta or femoral arteries
2. renal artery bruits can be heard

VI. Alterations

• Distention
• Ascites
• Paralytic ileus
• Borborygmus
• Guarding (muscle contract)
• Tenderness
• Pain

VII. Geriatric Alterations

• Increased fat deposits over abdominal area
• Muscle tone more lax

POINTS TO REMEMBER:

• Auscultation should be performed before palpation to prevent distortion of bowel sounds
• Tightening of abdominal muscles hinders accuracy of palpation and auscultation
• Warm hands before touching client's abdomen
• Men breathe abdominally; women breathe costally
• Auscultate all four quadrants for bowel sounds
• Auscultate abdomen between meals