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27.1 Structure and Function

The external structure of the abdomen has dual functions: to assist the body in movement and to protect internal organs. The layers consist of skin, muscle, fat, and fascia. The abdomen is divided into four quadrants to provide a reference to the anatomic location of organs when signs and symptoms arise in the abdomen. Internal structures of the abdomen include vital organs and blood vessels that aid in digestion, metabolism, and overall body function.

The abdomen functions as a cavity to house vital organs of the digestive, endocrine, urinary, reproductive, and circulatory system. It also aids in functions such as maintaining intra-abdominal pressure (IAP), forced expiration, bladder emptying, vomiting, excretion, pregnancy, and childbirth.

Dysfunction of organs of the abdomen manifest in different ways. The patient may feel pain, experience bloating, have a change in bowel habits, or have abdominal distention. Reasons organs of the abdomen may not function correctly vary and include poor diet, lack of exercise, stress, reflux, and certain medications, among other issues. Impaired function of the abdomen can include abdominal pain, bloating, nausea, diarrhea, and constipation. Multiple organs and structures are contained within the abdomen, and abdominal issues can be caused by any of these.

27.2 Physical Assessment

A thorough assessment of the abdomen provides valuable information regarding the function of a patient’s GI and GU systems. A focused GI and GU subjective assessment collects data about the signs and symptoms of GI and GU diseases, including any digestive or nutritional issues, relevant medical or family history of GI and GU diseases, and any current treatment for related issues. Information gained from the interview process is used to tailor the subsequent physical assessment and create a plan for patient care and education. Physical examination of the abdomen includes inspection, auscultation, palpation, and percussion. When assessing the abdomen, consider the organs located in the quadrant you are examining.

Visually examine the abdomen for overall shape, masses, skin abnormalities, and any abnormal movements. Auscultation is performed after inspection for more accurate assessment of bowel sounds and vascular sounds. Palpation of the abdomen involves using the flat of the hand and fingers (not the fingertips) to detect palpable organs, abnormal masses, or tenderness. Note the patient’s response to palpation, such as pain, guarding, rigidity, or rebound tenderness. A technique to determine ascites is to check for a fluid wave. While assessing the abdomen, it is important to not only recognize normal findings but to recognize abnormalities as well.

Common alterations in bowel elimination include constipation, diarrhea, and bowel incontinence. Urinary tract infection, urinary incontinence, and urinary retention are common alterations in urinary elimination. Documentation should be described using the quadrants as a reference and should include data from inspection, auscultation, percussion, and palpation.

27.3 Recognizing Common Abdominal Disorders

Nurses must perform comprehensive abdominal assessment by collecting subjective and objective data. To appropriately assess the abdomen, it is imperative the assessment be completed in a look, listen, and feel order with the patient lying in a supine position. The most common causes for abdominal distention are the “5 Fs”: fat, flatus, feces, fluid, and fetus. Assess for masses or bulges, which may indicate structural deformities like hernias or related disorders in abdominal organs. Visceromegaly is the abnormal enlargement of abdominal organs, such as the liver, stomach spleen, pancreas, or kidneys. This enlargement can be caused by a variety of diseases and conditions.

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