Physical Examination & Abdominal Findings

Inspection: Observe what you see, hear or smell using senses of

slight, hearing and smell
Look for any scars, rashes, stretch marks, obesity, ascites or
engorged veins (may indicate cirrohosis).
Shape: The contour of the abdomen should be described as flat,
protuberant, or scaphoid when viewing from the xiphoid process to
the symphysis pubis
Findings: Distended abdomen may indicate paralytic ileus, bowel
obstruction, abdominal ascites
Scaphoid abdomen or nonhealing wound may indicate malnutrition
Ascaphoid or concave may indicate loss of subcutaneous fat due to
energy deficit or malnutrition.
Round or protuberant abdomen maybe caused by obesity, gaseous
distention or ascites when w/ glistening skin & an everted umbilicus

Physical Examination & Abdominal Findings

Position: Bulging may indicate masses, fluid collections or hernias.
If pt is able have them raise their head and shoulder to help make the
hernias become more apparent. A hernia may cause an obstruction or
strangulation of the bowel as it protrudes through the abdominal wall
Movement: Respiration is usually seen in the abdomen with males
and in the costal margin with females. Limited respiratory movement
could suggest peritonitis.
A rippling movement across the abdomen can be cause by visible
peristalsis, which could indicate bowel obstruction.

Physical Examination & Abdominal Findings

Wounds: Next look for the presence of any wounds, dressing,
fistulas, tubes, drains or ostomies and assess their appearance and
condition.
A non healing wound may indicate inadequate nutrition. The
presence of a wound vaccum dressing likely indicates the need for
increased protein.
Describe color, amount, consistency and odor of any drainage from
fistulas, stomas, drains, decompression tubes to determine fluid and
nutrient losses from the bowel and to establish feeding routes.
Examine exit site of any feeding tubes and drains for redness or
leakage, which may indicate an infection or malfunction

Possible Causes of Abdominal Auscultation:

Listen, using a stethoscope or naked ear to sounds produced by
different parts of the body, to assess bowel motility
Normal bowel sounds have a high-pitched gurgle sound that occurs
5-35 times/min
Hyperactive bowel sounds are loud high-pitched, rushing, ticking
sounds and ( borborygmi); Can be increased motility (diarrhea),
fluid, or air pressure associated with intestinal obstruction. May
indicate paralytic illeus or indicate bowel obstruction
Hypoactive bowel sounds are quieter and occur less frequently
than normal bowel sounds (about every 15-20 seconds)- may be
indicative of paralytic ileus or peritonitis.

Physical Examination Techniques and Possible Causes of

Abdominal Findings
Percussion: Use finger tips to tap lightly against the body structures
to assess location and density of underlying body masses or organs
Findings: Dullness may indicate a solid organ or fluid; shifting
dullness may indicate abdominal ascites; distended tympanic
abdomen may indicate bowel obstruction

Physical Examination Techniques and Possible Causes of

Abdominal Findings
Palpation: Use touch to evaluate location, texture, size,
temperature, warmth, coolness, tenderness and mobility
Findings: Firmness may indicate paralytic ileus, bowel obstruction,
or abdominal ascites; rebound tenderness may indicate peritonitis;
guarding may indicate peritonitis or inflammation

Percussion

Tymphany
Predominant sound
heard
Drum like sound
Mostly heard in the
abdomen
Represents presents
of air

Dullness
Is a soft sound with
moderate to high
pitches, has a thud
like quality
Suggests the
presence of fluid
Example, percuss
your thigh

Resonant
A low pitch, hollowlike sound
Mostly heard from
the flank
Example, above the
breast on your chest

Palpation- involves using different parts of the hand to assess texture, distention, muscle
rigidity and tenderness
Light palpation
Ask pt to point out any areas of pain and palpate those last

 Watch pts face for signs of tenderness

Use palms and fingertip pads to gently press 1-2 cm
Palpate all four quadrants
Deep palpation
Use palmar surface of extended fingers and gently press about 4 cm deep.
Abdomen should be soft, smooth and non tender
*Firm abdomen may indicate presence gaseous distention or fluid
*If pt displays rebound tenderness, this could be a sign peritoneal inflammation
Exam Area
Muscle
Wasting

Tips

Scapula
(latissimus dorsi,
trapezious,
deltoids)

Have the patient

extend hands
strait out and push
against solid
object

Predominant
depressions
between
ribs/scapula,
shoulder/spine

Mild depression, or
bone may show
slightly

Bones not
prominent, no
significant
depressions

Interosseous
muscle

Thumb side of
hand; pads of
thumb/forefinger
touching
Have patient sit,
leg propped up,
bent at knee
Not as sensitive
as upper body
Observe side and
front view

Depressed area
between
thumb/forefinger

Slightly depressed

Muscle bulges,
could be flat in wellnourished person

Bones prominent,
scant knee muscle

Knee cap less bony,

more rounded

Depression/line
on thigh, very thin
Thin with
minimal/no
muscle definition
Hollowing,
scooping, indent

Mild depression on
inner thigh
Not well developed

Muscle protrudes,
bones are not
prominent
Well rounded,
developed
Well-developed bulb
of muscle

Knee (patella)
Thigh
(quadriceps)
Calf
(gastrocnemius)
Temple
(tempralis
muscle)
Clavicle
(pectoralis &
deltoids)
Shoulder (deltoid)

Subcutaneous
Fat
Below the eye
Muscle =
Orbicularis Oculi
Triceps/Biceps

Severe

Observe strait on,

have patient turn
head, side-to-side
Look for
prominent bone,
make sure patient
is not hunched
forward
Arms at side, note
shape

View patient strait

on, touch above
cheek bone
**fluid may mask
loss
Arm bent, roll
skin between

Level of Malnutrition
Mild-Moderate
Normal

Slight
depression/indentati
on
Visible in males,
some protrusion in
female

Can see/feel welldefined muscle

Looking strait on
with patients
arms at side
shoulder to arm
joint should look
square

Acromion process
may protrude
slightly

Rounded, curves at
arm/shoulder/neck

Hollow look,
depressions, dark
circles, loose skin

Slightly dark
circles, somewhat
hollow look

Slightly bulged fat

pads

Very little space

between folds,

Some depth to
pinch, but not ample

Ample fat tissue and

obvious folds of skin

Protruding
prominent bone

Not visible in male

but not prominent in
female

fingers, do not
include muscle in
pinch

fingers touch

How to interpret pitting edema:

1+: slight pitting/2 mm, disappears rapidly
2+: somewhat deeper pit/4 mm, disappears in 10-15 sec
3+: deep pit/6 mm, may last > 1 minute
4+: very deep pit/8 mm, lasts 2-5 min