RETDEM CHECKLIST: ABDOMEN

LOPEZ, MARJORIE JOY C.

Gather equipment (pillow/towel, This allows you to work efficiently by eliminating the need to go
centimeter ruler, stethoscope, to the supply room for items you have overlooked. Also, it
marking pen). prevents the stress to your patient that occurs when you
interrupt a procedure to go get a needed item.
Explain procedure to client. Explanation helps to alleviate anxiety, promotes cooperation,
and facilitates the examination
Ask client to put on a gown. They can be easily identified as a “patient” and remain safe in
the hospital.
Inspect the skin, noting color, Abdominal skin may be paler than the general skin tone
vascularity, striae, scars and lesions because this skin is seldom exposed to the natural elements,
(wear gloves to inspect lesions). scattered fine veins may be visile.

Inspect the umbilicus, noting color, The umbilicus should be centrally located and may be flat,
location, and contour. rounded, or concave. The abdomen should be evenly rounded
or symmetric, without visible peristalsis. In thin people, an
upper midline pulsation may normally be visible
Inspect the contour of the The normal contour of the abdomen is typically flat or rounded.
abdomen. A concave contour (inward curve of the abdomen that looks
sunken in) is concerning because it can be associated with
dehydration and malnutrition, and sometimes with anorexia
nervosa and cancer.
Inspect the symmetry of the The abdomen should be symmetrical and the umbilicus should
abdomen be midline. Note the location of any asymmetry. If you suspect
asymmetry, you can ask the client to take a deep breath in and
out; this can accentuate any asymmetry or potential bulges.
Inspect abdominal movement,
noting respiratory movement, REFER TO PICTURE IN PPT
aortic pulsations, and/or peristaltic
waves.
Auscultate for bowel sounds, Performing auscultation before percussion or palpation
noting intensity, pitch and prevents percussion and palpation techniques from interfering
frequency. with findings.

Auscultation detects the presence of bowel sounds, which

indicate peristalsis
Auscultate for vascular sounds and Auscultation of the abdomen is performed for detection of
friction rubs. altered bowel sounds, rubs, or vascular bruits. Normal
peristalsis creates bowel sounds that may be altered or absent
by disease. Irritation of serosal surfaces may produce a sound
(rub) as an organ moves against the serosal surface.

A bruit on auscultation suggests an aneurysm or arterial

stenosis
Percuss the abdomen for tone. Percussion assesses for the density of the abdominal contents,
organs, or possible masses. Tympany over more air-filled
regions and dullness over a solid organ are the predominant
tones elicited. Percussion on the right side helps to evaluate the
RETDEM CHECKLIST: ABDOMEN
LOPEZ, MARJORIE JOY C.

spleen; percussion over the symphysis pubis helps to evaluate

the bladder for fullness
Percuss the liver. To measure the liver size. Starting in the midclavicular line at
about the 3rd intercostal space, lightly percuss and move down.
Percuss inferiorly until dullness denotes the liver's upper border
(usually at 5th intercostal space in MCL).
Perform the scratch test. The test usually consists of placing the stethoscope below the
xiphoid and lightly but briskly stroking the skin in a direction
parallel to the expected liver edge, starting at the right lower
quadrant and working slowly up to the right costal margin along
the mid clavicular line.
Percuss the spleen. The spleen is enlarged in a number of important clinical
diagnoses. Palpation and percussion of the spleen are
important techniques for identifying an enlarged spleen..
Perform percussion on the liver Percussion is performed to detect pain in the area of a kidney
and blunt percussion of the or to determine excess accumulation of air, fluid, or solids
kidneys. around the kidneys. Percussion of the kidneys also provides
information about kidney location, size, and possible problems.
Perform light palpation, noting
tenderness or guarding in all
quadrants.
Perform deep palpation, noting
tenderness or masses in all
quadrants.
Palpate the umbilicus. A two-handed technique is preferred, with the left and right
hands placed along the lower borders of the left and right costal
margins, respectively, and the fingers pointing toward the
umbilicus. A generous amount of skin should be left between
the two index fingers
Palpate the aorta. The aortic pulse can be palpated just above and to the left of
the umbilicus. The width of the aorta can then be measured by
placing both hands palms down on the patient's abdomen, with
one index finger on either side of the aorta. Each systole should
move the fingers apart.
Palpate the liver, noting Place your right hand on the patient's abdomen in the right
consistency and tenderness. lower quadrant. Gently move up to the right upper quadrant
lateral to the rectus muscle. Gently pressing in and up, ask the
patient to take a deep breath. If the liver is enlarged, it will
come downward to meet your fingertips and will be
recognizable.
Palpate the spleen, noting Palpation for splenic enlargement should begin with the patient
consistency and tenderness. supine and with knees flexed. Using the right hand, the
examiner should begin well below the left costal margin and
feel gently but firmly for the splenic edge by pushing down,
then cephalad, then release.
Palpate the kidneys. Place your left hand behind the patient between the rib cage
and iliac crest and place your right hand below the right costal
RETDEM CHECKLIST: ABDOMEN
LOPEZ, MARJORIE JOY C.

margin. While pressing your hands firmly together, ask the

patient to take a deep breath. Attempt to feel the lower pole of
the right kidney. Repeat the same maneuver for the left kidney.
Palpate the urinary bladder. Use deep palpation to locate the base of the bladder. This is
below the umbilicus in the lower abdomen. Once you have
found the bladder, continue to palpate outlining the bladder.
You are noting the shape and contour of the bladder.
Perform the test for shifting 1. This maneuver is performed with the patient supine.
dullness. 2. Percuss across the abdomen as for flank dullness, with
the point of transition from tympany to dullness noted.
3. The patient then is rolled on his/her side away from the
examiner, and percussion from the umbilicus to flank
area is repeated.
4. Positive test: When ascites is present, the area of
dullness will shift to the dependent site. The area of
tympany will shift toward the top.

Note: The shift in zone of tympany with position change will

usually be at least 3 cm when ascites is
Perform the fluid wave test. Have the patient lying supine.
The patient or an assistant places one or both hands (ulnar
surface of hand downward) in a wedge-like position into the
patient's mid abdomen, applying with slight pressure.
The examiner places the fingertips of one hand along one flank,
and with the other hand firmly gives a sharp tap along the
opposite flank.
Positive test: The examiner is able to detect "a shock wave" of
fluid moving against the fingertips pressed along the flank, as
the fluid is pushed from one side of the abdomen to the other
by the force of the tap along the opposite flank.
Perform the ballottement test. The examiner places 3~4 fingers together on the surface of
suspected abdominal area and push quickly and shortly for
several times with the motion from the wrist
The fingertips might feel the abdominal organs are floating,
because it produce ascitic waves
Employed in palpating the enlarged liver, spleen or masses
It may also elicit uncomfortable of the patient
It is suggested do not push too hard
Perform tests for a appendicitis: To check for rebound tenderness, a doctor applies pressure to
Rebound tenderness an area of your abdomen using their hands. They quickly
remove their hands and ask if you feel any pain when the skin
and tissue that was pushed down moves back into place. If you
do feel pain or discomfort, you have rebound tenderness.
Perform tests for a appendicitis: A clinician will press slowly and gently into the left lower
Rovsing's sign quadrant of the individual's abdomen, and then gradually
release pressure. If the individual feels sudden pain in the right
RETDEM CHECKLIST: ABDOMEN
LOPEZ, MARJORIE JOY C.

lower quadrant of the abdomen, it is indicative of a positive

Rovsing's sign.
Perform tests for a appendicitis:
Referred rebound tenderness
Perform tests for a appendicitis: The patient lie supine and placing your hand just above the
Psoas sign knee. Ask the patient to lift the right leg against resistance of
your hand. This motion causes friction of the psoas muscle over
the inflamed appendix, causing pain.
Perform tests for a appendicitis: Position the patient supine with their right knee bent and leg
Obturator sign bent at the hip. Rotate the leg internally at the hip, causing the
internal obturator muscle to stretch providing indirect pressure
over the appendix
Perform tests for a appendicitis: Pinch-an-inch test is essentially a form of rebound tenderness,
Hypersensitivity test only in reverse. To perform the test, a fold of abdominal skin
over McBurney's point is grasped and elevated away from the
peritoneum (see Fig. 1). The skin is then allowed to recoil back
briskly against the peritoneum.
Perform test for cholecystitis: Murphy's sign is elicited in patients with acute cholecystitis
Murphy's sign by asking the patient to take in and hold a deep breath while
palpating the right subcostal area. If pain occurs when the
inflamed gallbladder comes into contact with the examiner's
hand, Murphy's sign is positive.
Formulate nursing diagnoses
(wellness, risk, actual).
Formulate collaborative problems.
Make necessary referrals.

Deep palpation is CONTRAINDICATED for patients with suspected abdominal aortic aneurysm,
appendicitis, a tender spleen, a kidney transplant.

A normal liver, spleen, and kidneys are often not palpable. Palpation helps detect enlarged organs.