{"id":672,"date":"2021-09-29T10:11:00","date_gmt":"2021-09-29T14:11:00","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/?post_type=chapter&#038;p=672"},"modified":"2024-03-07T16:08:44","modified_gmt":"2024-03-07T21:08:44","slug":"abdomen-inspection","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/chapter\/abdomen-inspection\/","title":{"raw":"Abdomen - Inspection","rendered":"Abdomen &#8211; Inspection"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Inspection of the abdomen provides information about the client\u2019s GI system, particularly the intestines, as well as the liver and the abdominal cavity overall. Refer to <strong>Figure 5.4<\/strong>\u00a0for the quadrants and regions: a horizontal and a vertical imaginary line bisects the umbilicus to help you visualize the four quadrants. Note any abnormalities of the abdomen using these quadrants and regions. <\/span><\/p>\r\n<p style=\"text-align: left\"><img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-1024x754.jpg\" alt=\"A person's naked abdomen divided into four quadrants with red line: right upper, left upper, right lower, and left lower quadrants.\" width=\"1024\" height=\"754\" class=\"alignnone size-large wp-image-576\" \/><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Figure 5.4<\/strong><span style=\"text-align: initial;font-size: 1em\">: Abdominal quadrants \u00a0<\/span><\/span><\/p>\r\n\r\n<pre><\/pre>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspecting the abdomen<\/strong> involves the following steps:<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Before inspecting the abdomen, note the client\u2019s<strong> level of consciousness, facial expression<\/strong>, and assess for the <strong>presence of jaundice<\/strong>.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Clients are usually alert with a relaxed expression, although some may be nervous\/anxious. Be attentive to any non-verbal signs of pain such as grimacing or [pb_glossary id=\"1964\"]guarding[\/pb_glossary], and continue to observe the client\u2019s expression throughout the assessment. In addition to providing information about non-verbal signs of pain, this can also sometimes help you assess whether further support or guidance is needed.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Jaundice is associated with high levels of bilirubin in the blood. It is included in the abdominal assessment because it can be associated with diseases of the liver, pancreas, gallbladder, and bile duct. Clients with jaundice have a yellowish discolouration of the [pb_glossary id=\"2216\"]sclera[\/pb_glossary] and sometimes the skin. An inclusive approach to evaluating jaundice is to inspect the sclera of the eyes, because the melanin in skin influences how jaundice appears. Clients with lighter skin may have yellow discolouration of the skin beginning in the face and transmitting to the rest of the body, but relying on assessment of the skin alone is an example of how health assessment practices can be non-inclusive or racist.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Ask the client to <strong>expose their abdomen<\/strong> so you can observe from the epigastric (inferior to xiphoid process) down to the hypogastric region (superior to the pubic bone).<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Note any <strong>stoma bags, tubes, drains, incisions, scarring, dressings<\/strong>, or <strong>medical equipment<\/strong> (e.g., monitors). NOTE: If you observe discharge\/bleeding on a dressing, outline it with a marker\/pen and observe whether it increases in size. However, if there is a significant quantity, you should investigate the cause and perform a primary survey.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Use [pb_glossary id=\"488\"]tangential lighting[\/pb_glossary] and <strong>observe all four quadrants<\/strong>.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Observe <span style=\"font-size: 1em\">the profile view (side view) while standing on the client\u2019s right side. Standing on this side will help you visualize any peristaltic movement, which will move away from you. These movements are the waves caused by the gastrointestinal tract (e.g., large intestine contractions). Peristalsis movement is usually not observable on the abdomen. You may see it in a client who is thin; otherwise, visible peristalsis is a cue that should act as a concern and can suggest an intestinal blockage. In a newborn, observable peristalsis may be associated with pyloric stenosis (narrowing of the opening between the stomach and the intestines), but this condition is associated with other symptoms such as projectile vomiting.<\/span><\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Next, <span style=\"font-size: 1em\">position yourself so that your eyes are at about the level of the abdomen at the side, and also view the abdomen from the end of the bed. This will allow a full view of the abdomen so you can compare the left and right sides of the full abdomen (including the umbilicus) and assess symmetry. Tangential lighting will highlight any protrusions like a lump\/mass.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Note\u00a0any potential signs of <strong>observable pain<\/strong>. (Remember: if you suspect pain, always ask the client.)<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Observe for\u00a0<span style=\"font-size: 1em\">signs of pain may include facial expressions, behavioural changes (e.g., complete stillness or restlessness or guarding) or physiological changes (e.g., holding their breath, shallow breathing).<\/span><\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">In\u00a0<span style=\"font-size: 1em\">pre-verbal children (or other non-verbal clients), signs of pain may include groaning, grimacing, shallow breathing, irregular rhythm of breathing, and tachypnea. Newborns and infants may flex their hips and knees, moving their legs up to their chest.<\/span><\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Note\u00a0<span style=\"font-size: 1em\">that a client may be experiencing pain\u00a0<\/span><span style=\"font-size: 1em\">even if you do not observe signs of it. Clients with chronic pain often do not exhibit behavioural signs of pain.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">6. Note\u00a0the <strong>abdominal shape<\/strong>.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Identify\u00a0<span style=\"font-size: 1em\">the presence of symmetry or asymmetry and any bulging.<\/span><\/span>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"font-size: 1em\">The abdomen should be symmetrical and the umbilicus should be midline. <\/span>Note\u00a0<span style=\"font-size: 1em\">the location of any asymmetry. If you suspect asymmetry, you can ask the client to take a deep breath in and out; this can accentuate any asymmetry or potential bulges. If the client is able to, you can also ask them to hold their head and upper shoulder area off the bed (like a little sit-up) or onto their elbows as this maneuver can accentuate any asymmetry or bulges. You could also ask them to cough; this can increase the intra-abdominal pressure and accentuate a hernia if present.<\/span><\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">If\u00a0<span style=\"font-size: 1em\">you observe any bulging, further assess the area and note the location. Inspect the umbilicus for bulging, which can sometimes appear as an everted umbilicus. Normally, an umbilicus is inverted. Although an everted umbilicus can be normal, so always inquire if it is new. If you observe bulging, ask the client if they have noticed it, when it began, whether they know what it is, and ask about any associated pain. At the end of the overall inspection, you can gently palpate it to assess its consistency (soft or hard) and the presence of pain.<\/span><\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Identify\u00a0<span style=\"font-size: 1em\">the contour (i.e., the abdominal curve).<\/span><\/span>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">The\u00a0<span style=\"font-size: 1em\">normal contour of the abdomen is typically flat or rounded.<\/span><\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">A\u00a0<span style=\"font-size: 1em\">concave contour (inward curve of the abdomen that looks sunken in) is concerning because it can be associated with dehydration and malnutrition, and sometimes with anorexia nervosa and cancer. In newborns, it can also suggest a congenital anomaly in which the abdominal contents have shifted elsewhere, such as up into the thorax.<\/span><\/span><\/li>\r\n \t<li><span style=\"color: #000000\">A <span style=\"font-size: 1em\">distended abdomen is an enhanced outward contour, which can have many causes. See <strong>Figure 5.5<\/strong>.<\/span><\/span>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">The\u00a0<span style=\"font-size: 1em\">outward contour of the abdomen is typically enhanced when a client has increased air, fluid, and\/or content inside the intestines, or outside the intestines within the <strong>[pb_glossary id=\"764\"]peritoneal cavity[\/pb_glossary]<\/strong>.\u00a0<\/span><span style=\"font-size: 1em\">Distension may be associated with constipation, bowel obstruction, or irritable bowel syndrome. Severe malnutrition associated with protein deficiency and water retention can also distend the abdomen so it looks bloated. Another cause is ascites, which is the accumulation of fluid in the peritoneal cavity. Ascites has many causes, but most commonly <\/span><b style=\"font-size: 1em\">liver cirrhosis<\/b><span style=\"font-size: 1em\"> associated with hepatitis or chronic alcohol use. In rare cases, a tumor might cause distension. Keep in mind that an infant normally has a protuberant abdomen that sticks out because of muscles that are not developed - don't confuse this with distension. A distended abdomen is firm to touch.\u00a0<\/span><\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">7. Note\u00a0<strong>skin colour, discolouration, integrity<\/strong>, and <strong>swelling<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Skin\u00a0<span style=\"font-size: 1em\">colour varies based on a client\u2019s racial background and should be consistent across the abdomen and the umbilicus. If you observe a discolouration (e.g., redness), describe it and the location. No swelling should be present and the skin should be intact; describe and note the location of any swelling or damaged skin (e.g., an open ulcer). Examine the umbilicus, which may become infected from a piercing. Note any scars, which may indicate past surgeries.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">8. Note\u00a0the <strong>presence of peristaltic movement<\/strong>.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">9. Note the <strong>findings<\/strong>.\u00a0<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Normal\u00a0findings might be documented as: \u201cAbdomen flat, symmetrical with no bulging, swelling, discolouration. Skin intact.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient grimacing with shallow irregular breathing. Abdomen distended.\u201d<\/span><\/li>\r\n<\/ul>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-262x300.jpeg\" alt=\"\" width=\"400\" height=\"457\" class=\"alignnone wp-image-2185\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 5.5<\/strong>: Abdominal distention (By James Heilman, MD - Own work, CC BY-SA 3.0,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=15335623\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=15335623)<\/a>\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Signs associated with an intestinal blockage is a priority of care because it may indicate the need for surgical intervention. Pain, constipation, vomiting, and abdominal distention are possible signs of a blockage. If any are present, notify the physician\/nurse practitioner after performing a primary survey with a complete set of vital signs and a full abdominal assessment. It is especially important to auscultate and palpate the abdomen, because absent bowel sounds or a distended\/firm and painful abdomen are associated with blockages.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">All abnormal signs observed upon inspection require a full abdominal assessment. If you observe signs of pain, begin with a subjective assessment. Any asymmetry, bulging, abnormal contour, swelling, and lesions should be reported to the physician\/nurse practitioner.<\/span><\/p>\r\n\r\n<\/div>\r\n<\/div>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Activity: Check Your Understanding<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">[h5p id=\"43\"]<\/span>\r\n<div><\/div>\r\n<div><span style=\"color: #000000\">[h5p id=\"42\"]<\/span><\/div>\r\n<div><\/div>\r\n<div><\/div>\r\n&nbsp;","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Inspection of the abdomen provides information about the client\u2019s GI system, particularly the intestines, as well as the liver and the abdominal cavity overall. Refer to <strong>Figure 5.4<\/strong>\u00a0for the quadrants and regions: a horizontal and a vertical imaginary line bisects the umbilicus to help you visualize the four quadrants. Note any abnormalities of the abdomen using these quadrants and regions. <\/span><\/p>\n<p style=\"text-align: left\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-1024x754.jpg\" alt=\"A person's naked abdomen divided into four quadrants with red line: right upper, left upper, right lower, and left lower quadrants.\" width=\"1024\" height=\"754\" class=\"alignnone size-large wp-image-576\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-1024x754.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-300x221.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-768x566.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-1536x1131.jpg 1536w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-2048x1508.jpg 2048w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-65x48.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-225x166.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/1-Abdominal_Quadrants-350x258.jpg 350w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong style=\"text-align: initial;font-size: 1em\">Figure 5.4<\/strong><span style=\"text-align: initial;font-size: 1em\">: Abdominal quadrants \u00a0<\/span><\/span><\/p>\n<pre><\/pre>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspecting the abdomen<\/strong> involves the following steps:<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Before inspecting the abdomen, note the client\u2019s<strong> level of consciousness, facial expression<\/strong>, and assess for the <strong>presence of jaundice<\/strong>.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Clients are usually alert with a relaxed expression, although some may be nervous\/anxious. Be attentive to any non-verbal signs of pain such as grimacing or <button class=\"glossary-term\" aria-describedby=\"672-1964\">guarding<\/button>, and continue to observe the client\u2019s expression throughout the assessment. In addition to providing information about non-verbal signs of pain, this can also sometimes help you assess whether further support or guidance is needed.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Jaundice is associated with high levels of bilirubin in the blood. It is included in the abdominal assessment because it can be associated with diseases of the liver, pancreas, gallbladder, and bile duct. Clients with jaundice have a yellowish discolouration of the <button class=\"glossary-term\" aria-describedby=\"672-2216\">sclera<\/button> and sometimes the skin. An inclusive approach to evaluating jaundice is to inspect the sclera of the eyes, because the melanin in skin influences how jaundice appears. Clients with lighter skin may have yellow discolouration of the skin beginning in the face and transmitting to the rest of the body, but relying on assessment of the skin alone is an example of how health assessment practices can be non-inclusive or racist.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Ask the client to <strong>expose their abdomen<\/strong> so you can observe from the epigastric (inferior to xiphoid process) down to the hypogastric region (superior to the pubic bone).<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Note any <strong>stoma bags, tubes, drains, incisions, scarring, dressings<\/strong>, or <strong>medical equipment<\/strong> (e.g., monitors). NOTE: If you observe discharge\/bleeding on a dressing, outline it with a marker\/pen and observe whether it increases in size. However, if there is a significant quantity, you should investigate the cause and perform a primary survey.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Use <button class=\"glossary-term\" aria-describedby=\"672-488\">tangential lighting<\/button> and <strong>observe all four quadrants<\/strong>.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Observe <span style=\"font-size: 1em\">the profile view (side view) while standing on the client\u2019s right side. Standing on this side will help you visualize any peristaltic movement, which will move away from you. These movements are the waves caused by the gastrointestinal tract (e.g., large intestine contractions). Peristalsis movement is usually not observable on the abdomen. You may see it in a client who is thin; otherwise, visible peristalsis is a cue that should act as a concern and can suggest an intestinal blockage. In a newborn, observable peristalsis may be associated with pyloric stenosis (narrowing of the opening between the stomach and the intestines), but this condition is associated with other symptoms such as projectile vomiting.<\/span><\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Next, <span style=\"font-size: 1em\">position yourself so that your eyes are at about the level of the abdomen at the side, and also view the abdomen from the end of the bed. This will allow a full view of the abdomen so you can compare the left and right sides of the full abdomen (including the umbilicus) and assess symmetry. Tangential lighting will highlight any protrusions like a lump\/mass.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Note\u00a0any potential signs of <strong>observable pain<\/strong>. (Remember: if you suspect pain, always ask the client.)<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Observe for\u00a0<span style=\"font-size: 1em\">signs of pain may include facial expressions, behavioural changes (e.g., complete stillness or restlessness or guarding) or physiological changes (e.g., holding their breath, shallow breathing).<\/span><\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">In\u00a0<span style=\"font-size: 1em\">pre-verbal children (or other non-verbal clients), signs of pain may include groaning, grimacing, shallow breathing, irregular rhythm of breathing, and tachypnea. Newborns and infants may flex their hips and knees, moving their legs up to their chest.<\/span><\/span><\/li>\n<li><span style=\"color: #000000\">Note\u00a0<span style=\"font-size: 1em\">that a client may be experiencing pain\u00a0<\/span><span style=\"font-size: 1em\">even if you do not observe signs of it. Clients with chronic pain often do not exhibit behavioural signs of pain.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">6. Note\u00a0the <strong>abdominal shape<\/strong>.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Identify\u00a0<span style=\"font-size: 1em\">the presence of symmetry or asymmetry and any bulging.<\/span><\/span>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"font-size: 1em\">The abdomen should be symmetrical and the umbilicus should be midline. <\/span>Note\u00a0<span style=\"font-size: 1em\">the location of any asymmetry. If you suspect asymmetry, you can ask the client to take a deep breath in and out; this can accentuate any asymmetry or potential bulges. If the client is able to, you can also ask them to hold their head and upper shoulder area off the bed (like a little sit-up) or onto their elbows as this maneuver can accentuate any asymmetry or bulges. You could also ask them to cough; this can increase the intra-abdominal pressure and accentuate a hernia if present.<\/span><\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">If\u00a0<span style=\"font-size: 1em\">you observe any bulging, further assess the area and note the location. Inspect the umbilicus for bulging, which can sometimes appear as an everted umbilicus. Normally, an umbilicus is inverted. Although an everted umbilicus can be normal, so always inquire if it is new. If you observe bulging, ask the client if they have noticed it, when it began, whether they know what it is, and ask about any associated pain. At the end of the overall inspection, you can gently palpate it to assess its consistency (soft or hard) and the presence of pain.<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Identify\u00a0<span style=\"font-size: 1em\">the contour (i.e., the abdominal curve).<\/span><\/span>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">The\u00a0<span style=\"font-size: 1em\">normal contour of the abdomen is typically flat or rounded.<\/span><\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">A\u00a0<span style=\"font-size: 1em\">concave contour (inward curve of the abdomen that looks sunken in) is concerning because it can be associated with dehydration and malnutrition, and sometimes with anorexia nervosa and cancer. In newborns, it can also suggest a congenital anomaly in which the abdominal contents have shifted elsewhere, such as up into the thorax.<\/span><\/span><\/li>\n<li><span style=\"color: #000000\">A <span style=\"font-size: 1em\">distended abdomen is an enhanced outward contour, which can have many causes. See <strong>Figure 5.5<\/strong>.<\/span><\/span>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">The\u00a0<span style=\"font-size: 1em\">outward contour of the abdomen is typically enhanced when a client has increased air, fluid, and\/or content inside the intestines, or outside the intestines within the <strong><button class=\"glossary-term\" aria-describedby=\"672-764\">peritoneal cavity<\/button><\/strong>.\u00a0<\/span><span style=\"font-size: 1em\">Distension may be associated with constipation, bowel obstruction, or irritable bowel syndrome. Severe malnutrition associated with protein deficiency and water retention can also distend the abdomen so it looks bloated. Another cause is ascites, which is the accumulation of fluid in the peritoneal cavity. Ascites has many causes, but most commonly <\/span><b style=\"font-size: 1em\">liver cirrhosis<\/b><span style=\"font-size: 1em\"> associated with hepatitis or chronic alcohol use. In rare cases, a tumor might cause distension. Keep in mind that an infant normally has a protuberant abdomen that sticks out because of muscles that are not developed &#8211; don&#8217;t confuse this with distension. A distended abdomen is firm to touch.\u00a0<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">7. Note\u00a0<strong>skin colour, discolouration, integrity<\/strong>, and <strong>swelling<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Skin\u00a0<span style=\"font-size: 1em\">colour varies based on a client\u2019s racial background and should be consistent across the abdomen and the umbilicus. If you observe a discolouration (e.g., redness), describe it and the location. No swelling should be present and the skin should be intact; describe and note the location of any swelling or damaged skin (e.g., an open ulcer). Examine the umbilicus, which may become infected from a piercing. Note any scars, which may indicate past surgeries.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">8. Note\u00a0the <strong>presence of peristaltic movement<\/strong>.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">9. Note the <strong>findings<\/strong>.\u00a0<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Normal\u00a0findings might be documented as: \u201cAbdomen flat, symmetrical with no bulging, swelling, discolouration. Skin intact.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient grimacing with shallow irregular breathing. Abdomen distended.\u201d<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-262x300.jpeg\" alt=\"\" width=\"400\" height=\"457\" class=\"alignnone wp-image-2185\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-262x300.jpeg 262w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-896x1024.jpeg 896w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-768x878.jpeg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-1343x1536.jpeg 1343w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-1791x2048.jpeg 1791w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-65x74.jpeg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-225x257.jpeg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2023\/11\/Hepaticfailure-350x400.jpeg 350w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 5.5<\/strong>: Abdominal distention (By James Heilman, MD &#8211; Own work, CC BY-SA 3.0,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=15335623\" target=\"_blank\" rel=\"noopener\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=15335623)<\/a><\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p style=\"text-align: left\"><span style=\"color: #000000\">Signs associated with an intestinal blockage is a priority of care because it may indicate the need for surgical intervention. Pain, constipation, vomiting, and abdominal distention are possible signs of a blockage. If any are present, notify the physician\/nurse practitioner after performing a primary survey with a complete set of vital signs and a full abdominal assessment. It is especially important to auscultate and palpate the abdomen, because absent bowel sounds or a distended\/firm and painful abdomen are associated with blockages.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">All abnormal signs observed upon inspection require a full abdominal assessment. If you observe signs of pain, begin with a subjective assessment. Any asymmetry, bulging, abnormal contour, swelling, and lesions should be reported to the physician\/nurse practitioner.<\/span><\/p>\n<\/div>\n<\/div>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Activity: Check Your Understanding<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\"><\/p>\n<div id=\"h5p-43\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-43\" class=\"h5p-iframe\" data-content-id=\"43\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch.5 Abdomen - Inspection\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<div><\/div>\n<div><span style=\"color: #000000\"><\/p>\n<div id=\"h5p-42\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-42\" class=\"h5p-iframe\" data-content-id=\"42\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch.5 Abdomen Inspection\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/div>\n<div><\/div>\n<div><\/div>\n<p>&nbsp;<\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"672-1964\" hidden><p>refers to tense abdominal muscles as a result of nervousness, pain, cold room temperature or hands of the nurse, or ticklishness.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"672-2216\" hidden><p>is the white part of the eye.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"672-488\" hidden><p>refers to use of a penlight directed from the side as opposed to direct light at a 90 degree angle.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"672-764\" hidden><p>is the potential space in between the parietal peritoneum (a membrane which surrounds the abdominal cavity) and the visceral peritoneum (a membranes which surrounds the abdominal organs).<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":7,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-672","chapter","type-chapter","status-publish","hentry"],"part":48,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/672","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":42,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/672\/revisions"}],"predecessor-version":[{"id":2218,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/672\/revisions\/2218"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/parts\/48"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/672\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/media?parent=672"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapter-type?post=672"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/contributor?post=672"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/license?post=672"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}