Objective:
To perform a systematic abdominal examination to assess the health of abdominal organs and detect abnormalities.
Equipment Required:
- Stethoscope
- Measuring tape
- Gloves
- Penlight (for transillumination if needed)
- Draping sheet
- Marker pen (for marking borders)
Steps of Abdominal Examination
1. Preparation
- Informed Consent: Explain the procedure to the patient.
- Positioning: Supine position with arms at sides, knees slightly flexed.
- Exposure: Expose the abdomen fully but maintain dignity.
- Warm Hands & Quiet Environment: Ensure comfort and relaxation.
2. Inspection
- General Observation: Distension, scars, striae, visible peristalsis, pulsations.
- Umbilicus: Position, shape, discoloration, hernia.
- Skin: Color, lesions, dilated veins, bruising.
- Contour: Flat, scaphoid, rounded, distended.
- Movement with Respiration: Symmetry.
3. Auscultation (Before palpation to avoid altering bowel sounds)
- Bowel Sounds:
- Normal (5-35/min), hyperactive (obstruction), hypoactive (paralytic ileus), absent (peritonitis).
- Bruits: Over aorta, renal, iliac, and femoral arteries (indicates stenosis).
- Friction Rubs: Over liver/spleen (rare, suggests inflammation).
4. Percussion
- General Tympani vs. Dullness:
- Tympani (gas-filled intestines).
- Dullness (solid organs or fluid).
- Liver Span: Normally 6-12 cm in midclavicular line.
- Spleen & Kidneys: Check for enlargement.
- Fluid Wave & Shifting Dullness: For ascites.
5. Palpation
A. Light Palpation (1-2 cm depth)
- Check for tenderness, guarding, rigidity, superficial masses.
- Rebound Tenderness (Blumberg’s Sign): Peritonitis.
B. Deep Palpation (5-6 cm depth)
- Liver: Start in RLQ, move upwards during inspiration.
- Spleen: Right hand in LUQ, left hand under rib cage.
- Kidneys: Ballottement technique.
- Aorta: Width (<3 cm normal).
- Masses: Note size, shape, mobility, tenderness.
6. Special Tests (If Indicated)
- Murphy’s Sign: Cholecystitis.
- McBurney’s Point Tenderness: Appendicitis.
- Psoas & Obturator Signs: Appendicitis.
- Fluid Thrill & Shifting Dullness: Ascites.
Documentation & Reporting
- Record findings systematically (inspection, auscultation, percussion, palpation).
- Note any abnormalities (e.g., tenderness, organomegaly, ascites).
- Report to the physician if pathological signs are detected.
Nursing Considerations
- Ensure patient comfort and privacy.
- Use gentle pressure to avoid pain.
- Compare findings with history (e.g., pain, nausea, vomiting).
- Follow infection control protocols.
Conclusion: A thorough abdominal examination helps in diagnosing conditions like appendicitis, liver disease, bowel obstruction, and more. Proper technique ensures accurate assessment.
Would you like a demonstration video or a checklist for practice? 😊