ASSESSING THE QUADRANTS

OF THE ABDOMEN
BY: CHARRIL PABULAR – ARANETA MN, RN
Purpose: • To assess the abdomen for:
• Presence or Absence of bowel sounds
• Presence of Mass
• Asymmetry
• Ascites
• Enlargement
• Vascular Sounds
• Presence of Pain
 General Approach:

3. Full exposure of 5. Position in supine

1. Patient must be warm 4. Patient should not have
2. Good lighting. abdomen from xyphoid position with pillow under
and relaxed. full bladder.
process to groin. head and knees.

6. Arms should be held 10. Monitor your

7. Have warm hands and 8. Avoid quick, 9. Distract the patient
across chest or be at examination by watching
a warm stethoscope. unexpected movements. with questions.
sides. patient's face.
Four
Quadrants
of the
Abdomen
Which of the following is the correct way
of assessing the abdomen?

Inspection Palpation Inspection Auscultation

Percussion Auscultation Percussion Palpation

 • It is a visual examination.
• This examination must be systematic to assess color, body shape,
wounds, facial expression, motor behaviors and some area to be
INSPECTION examined.
• Nurses must use their clinical eye to further assess using
visualization or looking at different parts of the patient's body.
INSPECTION
• 1. Contour and Symmetry
• a. Flat
• b. Scaphoid - seen in school-aged children and wasting
diseases
• c. Round - pot belly; normal in infants and toddlers
• d. Protuberant
• e. Distended
• Auscultation is the technical term for listening to the internal
sounds of the body, usually using a stethoscope; based on the
Latin verb auscultate "to listen".
• Auscultation is a skill that requires substantial clinical experience, a AUSCULTATION
fine stethoscope and good listening skills.
• Nurse listens to the patient's heartbeat, lungs and blood vessels of
the neck and groin.
 BOWEL SOUNDS
Normal sounds consist of clicks and gurgles and occur 5 to 34 per
ABNORMAL BOWEL SOUNDS
minute.
• Frequency • Absence of bowel sound
• Intensity • Sluggish (hypoactive) bowel sounds
• Location • Hyperactive bowel sounds
• Pitch • High-pitched tinkling sounds and rushes
• Pattern • Borborygmi
• Vascular Sounds
 • The examiner places one hand on the patient and then taps a
finger on that hand, with the index finger of the other hand.
• It can determine the position, size, and consistency of an internal

PERCUSSION
organ.
• Since hollow and solid areas generate different vibrations, the
physician or other examiner uses this technique to determine if
various organs (heart, liver, etc.) are enlarged or not.
PERCUSSION
• Percussion of the abdomen helps assess for intestinal distention, free fluid, solid masses,
hepatomegaly, and splenomegaly.
• It is contraindicated in clients with AAA and organ transplants.
• Tympany - children's abdomens are usually more tympanic than adults (swallowed air)
• Dullness
• Assess for gastric tympany
• Assess for liver dullness
• Assess for suprapubic dullness
PALPATION
• It is an examination using the sense of touch.
• The pads of the fingers are used because the concentration of nerve endings
are highly sensitive to tactile discrimination.
• It is used as part of a physical examination in which an object is felt to
determine its size, shape, firmness, or location.
 Light Palpation - use a light, gently dipping motion to palpate for superficial organs, masses, areas of
tenderness, and increased resistance (1-2 cm)
• Normal consistency
• Guarding
• Tenderness

Deep Palpation - 2-handed technique - hand moves with expiration and rests with inspiration (4 cm)
PALPATION • a. Masses (neoplasms, cysts, aneurysms, feces in bowel)
• b. Tenderness
• c. Rigidity

1. Voluntary tightening - fear or nervousness

2. Involuntary rigidity - inflammation of the peritoneum

STEPS & RATIONALE
STEPS RATIONALE
INSPECTION
A. Observe the abdomen, check for symmetry, bumps, bulges or masses.
Note the patient’s abdominal shape and contour.
Begin mentally dividing the abdomen into four areas:
The Right Upper Quadrant (RUQ)
The Left Upper Quadrant (LUQ)
The Right Lower Quadrant (RLQ)
The Left Lower Quadrant (LLQ)
1. Assess the umbilicus, which should be inverted and located in the
abdominal midline.
STEPS & RATIONALE
STEPS RATIONALE

AUSCULTATION
2. Applying a light pressure, place the diaphragm of your stethoscope
in the RLQ slightly below the umbilicus.
Auscultate in a clockwise fashion in each of the four quadrants.
Note the character and quality of bowel sounds in each quadrant.

A. Auscultate abdomen for vascular sounds with the bell

of the stethoscope.
Using firm pressure, listen over the aorta, renal, iliac and
femoral arteries.
STEPS & RATIONALE
STEPS RATIONALE

PERCUSSION
A. Begin percussing the abdomen along the right midclavicular line, starting
below the level of the umbilicus.
B. Move upward until the percussion notes change from tympany to dullness, This indicates the lower border of the liver.
usually at or slightly below the costal margin.
Mark the point of change with a felt-tip pen.

C. Percuss downward along the right midclavicular line, starting above the This indicates the upper border of the liver.
nipple. Move downward until percussion notes change from normal lung
resonance to dullness, usually at 5th to 7th intercostal spaces.
Again, mark the point of change with a felt tip pen.
STEPS & RATIONALE
STEPS RATIONALE
D. Measure the distance between the two markings. Estimated size of the liver.
PALPATION
A. Put the fingers of one hand close together. Depress the skin about ½” To assess and localize pain and discomfort.
with your fingertips and make gentle, rotating movements.
Avoid short, quick jabs.
B. Push the abdomen down 2” to 3”; in an obese patient, put one hand on
top of the other and push.

C. Palpate the entire abdomen in a clockwise direction. Proper assessment for organ or peritoneal inflammation and pain.
Check for tenderness, pulsations, organ enlargement, and masses.
STEPS & RATIONALE
STEPS RATIONALE
NOTE: Organs, masses, areas of fluid accumulation and areas of tenderness or Caution: Don’t palpate a rigid abdomen.
increased resistance
NOTE: If resistance is due to patient’s cold, tense, or ticklish feeling or if its Peritoneal inflammation maybe present, in which case palpation cause pain or
due to involuntary guarding or rigidity from muscle spasms or peritoneal rupture of an inflamed organ.
inflammation.
SPECIAL ASSESSMENT TECHNIQUES:
1. Check for ascites. Have an assistant place the ulnar edge of her hand
firmly on the patient’s abdomen at its midline.

2. As you stand facing the patient’s head, place the palm of your left
hand against the patient’s right flank.
STEPS & RATIONALE
STEPS RATIONALE

3. Give the left abdomen a firm tap with your right hand. If ascites is present, you may see and feel a “fluid wave” ripple across the
abdomen.

4. If you detect ascites, use a tape measure to measure the fullest part of the To measure consistently for fluid removal or paracentesis.
abdomen.
Mark this point on the patient’s abdomen with a felt tip pen.

NOTE:
Measurement of the abdomen of the patient with ascites is done daily.