KAMPALA INTERNATIONAL UNIVERSITY-

WESTERN CAMPUS

PRESENTER:TAYEBWA NOBERT
PROGRAMME:MASTERS IN NURSING SCIENCE,1.1
REGIST.NUMBER:2024-08-26782
COURSE UNIT:ADVANCED HEALTH AND PHYSICAL ASSESSMENT
LECTURER:DR.MUBARAK ALHASSAN SAED
 Assignment
Assessment of the following systems;

1. ABDOMINAL AND RENAL SYSTEM

2.RECTUM AND ANUS
3.MALE REPRODUCTIVE
ORGANS( prostate,genitalia and hernias)
4.Skin,hair and nails
 NOTE
The nurse locates and describes abdominal
findings using two common methods of
subdividing the abdomen that is;
i) Quadrants
ii) Regions
 Quadrants of the abdomen
• Specific organs or parts of organs lie in each
abdominal quadrant/region
Organs found in the four abdominal
quadrants
Right upper quadrant
Liver,duodenum,right adrenal gland
Gall bladder,head of pancreas,upper lobe of right
kidney,section of transverse colon, section of
ascending colon
 Cont.
Right lower quadrant
Lower lobe of right kidney
Caecum,appendix,
right ovary
right ureter
Right spermatic cord
part of the uterus
Section of ascending colon
 cont….
Left upper quadrant
Left lobe of the liver
Stomach
Spleen
Upper lobe of left kidney
Pancreas
Left adrenal gland
splenic flexure of the colon
Section of transverse and descending colon
 Left lower quadrant
• Lower lobe of left kidney
• Sigmoid colon
• Left ovary
• Left spermatic cord
• Left ureter
• Part of the uterus
• Section of descending colon
Abdominopelvic regions
 Abdominal assessment
Has 4 Elements ;
• Inspection
• Auscultation
• Percussion,
• Palpation
 Tips for abdominal examination
• Check if the patient has an empty bladder
• Make patient comfortable in supine position,with a pillow
under the head and perhaps another one under the knees
• Ask the patient to keep arms at the sides
• Before palpation,ask the patient to point at the areas of
pain so that the same are examined last
• Warm your hands/stethoscope
• Calm approach,avoid quick and unexpected
movements.watch patient’s face for any signs of
pain/discomfort
• Distract the patient if necessary with
questions/conversation.
 Inspection cont..

• Stand at the right side of the bed and inspect the

abdomen
• Watch for peristalsis
• Its helpful to sit or bend down so that you can view the
abdomen tangentially
The skin;
Look for scars and their location
Striae:old striae or strecth marks are normal
Dilated veins:A few small veins may be visible normallly
Rashes or ecchymoses
 Cont…
The umblicus
Observe its contour and location plus bulges that
may suggest a ventral hernia
contour of the abdmen
Is it flat,rounded,protuberant, or scaphoid
Do the flanks bulge,or are there any local
bulges ?.Also survey the inguinal and femoral areas
Is the abdomen symetrical
Look for visible masses, i.e enlarged spleen,liver
 Cont.
Peristalsis:
Observe for several minutes if you suspect
intestinal obstruction.Normally,peristalsis may
be visible in very thin people
Pulsations:the normal aortic pulsation is
frequently visible in the epigastrium
 Auscultation
• Provides important information about bowel
motility
• Listen for bowel sounds before doing
percussion or palpation because these
maneuvers may alter frequency of bowel
sounds
• May also reveal bruits or vascular sounds
resembling heart murmurs ovver the aorta or
other arteries in the abdomen
 Auscultation Cont..
• Occasionally you may hear prolonged gurgles
of hyperperistalsis familiar to stomach
growling.
• Because bowel sounds are widely transmitted
through the abdomen,listening in one spot
such as the right upper quadrant is usually
sufficient.
 Abdominal bruits and friction rub
• If the patient has high blood pressure,listen to
sounds in the epigastrium and each upper
quadrant for bruits,later in the examination
• Epigastric bruits confined to systole are
normal
 Percussion
• Helps you to assess the amount and distribution
of gas in the abdomen, size of the liver and
spleen.
• Percuss the abdomen lightly in the 4 quadrants
• Assess the distribution of tympany and dullness
• Tympany usually predominates because of gas in
the GI tract,but scattered areas of dullness from
fluid and feaces are also typical
 Percussion cont..
• Note any large dull areas suggesting an
underlying mass or enlarged organ.This
observation will guide your examination
• On each side of the protuberant abdomen ,note
where the abdominal tympany changes to
dullness of solid posterior structures.
 percussion
• Dull sounds:solid or fluid-filled structures
• Resonant:structures containing air or gas
• Shifting dullness
 Normal percussion findings
• The anterior gas-filled abdomen normally has a
tympanitic sound to percussion ,which is
replaced by dullness where solid viscera, fluid,
or stool predominate.
• The flanks are duller as posterior solid
structures predominate
• Right upper quadrant is somewhat duller over
the liver.
 For an abdominal mass
Take note of the following;
• Location
• Size
• Shape
• Consistency
• Surface
• Tenderness
• Movable or fixed
• Moving with respiration
 Palpation
• Identify any superficial organs or massess and
any area of tenderness or increased resistance
to your hand
• If resistance is present,try to distinguish
voluntary guarding from involuntary muscle
spasms
 Some terms used
• Tenderness:discomfort and resistance to
palpation
• Involuntary guarding :reflex contraction of
abdominal muscles
• Rebound tenderness :patient feels pain when
the hand is released
• Tenderness + rigidity:perforated viscous
• Palpable mass:enlarged organ,faeces,tumor
 Murphy’s sign
Description
• Murphy's sign is elicited in patients with acute
cholecystitis by asking the patient to take in and
hold a deep breath while palpating the right
subcostal area.
• If pain occurs on inspiration, when the inflamed
gallbladder comes into contact with the
examiner's hand, Murphy's sign is positive
 Mc burney’s point
• It is a point midway between the umbilicus and
the right anterior-superior iliac spine used as a
guide to locate the position of the appendix.
• The McBurney point is the most common site of
maximum tenderness in acute appendicitis,
which is typically determined by the pressure of
one finger.
 Fluid thrill test
• The fluid wave/fluid thrill test is a
test for ascites (free fluid in the
peritoneal cavity).
• It is performed by having the patient
(or a colleague) push their hands
down on the midline of the abdomen.
• The examiner then taps one flank,
while feeling on the other flank for
the tap.
• If a ripple is felt upon flicking,we call
it a fluid thrill=ascites
 Palpation of the liver
• Flex the knee joint
• Ask the patient to take a deep breath
• Start palpating in the right iliac fossa
• Move the hand progresively up the abdomen
• Try to feel the liver edge
• Check for the liver span
 Palpation of the spleen
• Roll the patient towards you
• Start from the right iliac fossa
• Palpate with the right hand while using the
left hand to press forward on the patient’s
lower ribs from behind
• Feel along the costal margin
Some causes of pain in anatomic regions of
the abdomen
RIGHT UPPER QUADRANT RIGHT LOWER QUADRANT
Duodenal ulcer Appendicitis, strangulated
Hepatitis hernia
Hepatomegaly Salpingitis, perforated
caecum
Lower lobe pneumonia
Ovarian cyst
Cholecystitis
Tubo-ovarian abscess
Ruptured ectopic pregnancy
renal/urethral stones
 Cont..
PERIUMBLICAL(around LEFT UPPER QUADRANT
the umblicus) Ruptured spleen
Intestinal obstruction Gastric ulcers
Acute pancreatitis Aortic aneurysm
Mesenteric thrombosis Perforated colon
Aortic aneurism Lower lobe pneumonia
Diverticulitis
 Cont..
LEFT LOWER QUADRANT
Sigmoid diverticulitis
Salpingitis
Ovarian cyst
Ruptured ectopic pregnancy
Tubo-ovarian abscess
Renal/urethral stones
Strangulated hernia
Perforated colon
Ulcerative colitis