Chapter 5 – Gastrointestinal System Assessment
Abdomen – Palpation
Palpation of the abdomen provides information about the organs associated with the GI system. The palpation technique follows auscultation, so the abdomen is already exposed. Additionally, you should not palpate the abdomen if vascular bruits are present (e.g., aortic, renal, iliac, and femoral). If the client has experienced a physical injury or trauma to the abdomen, you also might not palpate the abdomen.
Remember, always palpate on bare skin.
Palpation of the abdomen involves the following steps (see Video 5.3):
1. If not already, ask the client to bend their knees up and ensure they are draped.
2. Ask the client if they have any pain and if so, palpate that area last.
3. Use the pads of your four fingers to gently palpate the abdomen, keeping your fingers together and your wrist and forearm at about the same plane as the client’s body.
- Avoid a more angled position: this will create a feeling that you are poking the client in the abdominal region, which can be uncomfortable and also does not permit you to assess the area as well.
- Only the pads of your fingers should be touching the client during light palpation.
4. Begin in the right lower quadrant and proceed clockwise. If the client indicates they have pain in the right lower quadrant, begin in the right upper quadrant instead and palpate the area with pain last.
5. Press down about one to two centimeters (light palpation) and move your fingers together in a circular motion.
- Sometimes, you will notice voluntary guarding (tense abdominal muscles) as a result of nervousness, pain, cold room temperature or hands of the nurse, or ticklishness. The tenseness of the muscles usually covers the whole abdomen (i.e., bilateral). It can help to ask the client to take a deep breath when you palpate to help them relax the muscles. Remember to use light palpation and do the painful area last. Only expose the abdomen as long as needed so the client stays warm, and warm your hands by rubbing them together. If the client is ticklish, use a sandwich technique: put their hand on top of your palpating hand, and place your other hand over top of both to control the pressure.
6. Lift fingers up together and move on to the next location, ensuring that you palpate every square centimeter of the abdomen in all four quadrants.
7. Assess the following:
- Overall consistency (soft or firm) and associated pain/tenderness. The abdomen is usually soft upon palpation. Note the location of any firmness and any associated pain/tenderness. The consistency of the abdomen is influenced by the amount of adipose tissue or muscle, but these are symmetrical across the abdomen.
- Presence of masses. Describe any masses in terms of location, size (dimensions), shape, consistency (soft or firm), and associated pain/tenderness.
- Presence of swelling. Note the location of any swelling.
- Presence of pain. If the client feels pain/tenderness upon palpation, note the location and ask them to rate the severity on a scale of 0 to 10.
- Presence of rigidity and spasms. Rigidity is involuntary firmness/hardness of the abdominal muscles associated with peritoneal inflammation. This rigidity is felt over the inflamed area; it is not bilaterally symmetrical and not voluntary like guarding. You may also feel spasms which are muscle contractions that are often painful.
8. Note the findings.
- Normal findings might be documented as: “Abdomen soft to touch with no masses, swelling, pain, and rigidity.”
- Abnormal findings might be documented as: “Client noted generalized pain all over abdomen upon palpation, rating it 5/10. Abdomen firm to touch in all quadrants. Left lower quadrant mass, circular in shape, 5 x 5 cm.”
Video 5.3: Palpation of the abdomen
Clinical Tip
Priorities of Care
Urgent surgical intervention is required when a client has appendicitis (inflammation of the appendix that is at risk of perforating). In these cases, the client usually presents with an increasing level of pain in the right lower quadrant, often beginning in the periumbilical region. This can also be associated with lack of appetite, nausea, vomiting, fever, chills, and muscle rigidity. If you suspect appendicitis, notify the physician immediately. Continue to monitor the client, measure vital signs, do not allow the client to take anything by mouth, and begin an intravenous if there are standing orders. A physician or nurse practitioner may assess for rebound tenderness, which involves palpating in the right lower quadrant and quickly removing one’s hand. Positive rebound tenderness (pain when the assessor removes their hand) is often indicative of appendicitis.
All abnormal findings (e.g., masses, swelling, pain, rigidity) should be further investigated with a focused abdominal assessment. Report any new, worsening, or unexpected findings to the physician or nurse practitioner.
Activity: Check Your Understanding
