An abdominal assessment is a physical examination conducted by a physician or nurse to interrogate the abdomen of a patient for signs of disease. The assessment is done after a thorough medical history is taken and is composed of three steps –visual inspection, auscultation, and palpation (Walker, Hall, & Hurst, 1990). Visual inspection is usually done to check for signs of distention. When carrying out a visual inspection, a note is made to the shape of the abdomen, abnormalities in the abdominal skin, and the way the abdominal wall moves with respiration. A visual inspection gives clues to intra-abdominal pathologies, which are further examined with auscultation and palpation.
The abdomen should then be auscultated to detect bowel sounds, rubs, or vascular bruits (Walker, Hall, & Hurst, 1990). Auscultation is done over all the four quadrants. This step precedes palpation because palpation may stimulate bowel activity, and thus falsely increase bowel sounds. The third step which is palpation is done to evaluate the internal organs in order to identify any source of pain. Gentle palpation is done to help identify pain and compromise in the abdominal wall while deep palpation is done to identify other abnormalities like the presence of fluid, masses, organ displacement, and organomegaly.
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Identifying the location of the pain is the most important step in diagnosing abdominal pain (see figure 1).
Once the location is identified, the differential diagnosis can be narrowed by determining (I) the time course of the pain, (II) peritoneal finding on the exam, (III) unexplained hypertension, and (IV) abdominal distention (Stern, Cifu, & Altkorn, 2013). For instance, when narrowed down by time, some disease such as Irritable Bowel Syndrome (IBS) present chronically over weeks to months or year while others such as appendicitis present acutely within hours to days of onset.
References
Stern, S., Cifu, A., & Altkorn, D. (2013). Symptom to diagnosis. New York, McGraw-Hill Company.
Walker, H., Hall, W., & Hurst, J. (1990). Clinical methods: The history, physical, and laboratory examination. Third Edition. Boston, MA: Butterworths.
