{"id":678,"date":"2021-09-29T10:12:28","date_gmt":"2021-09-29T14:12:28","guid":{"rendered":"https:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/?post_type=chapter&#038;p=678"},"modified":"2024-03-07T18:25:03","modified_gmt":"2024-03-07T23:25:03","slug":"abdomen-percussion","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/chapter\/abdomen-percussion\/","title":{"raw":"Abdomen - Percussion","rendered":"Abdomen &#8211; Percussion"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Percussion of the abdomen involves<strong> tapping the body to elicit sounds<\/strong> and determining whether the sounds are appropriate for the underlying structure of the quadrant. This provides information about the <strong>overall consistency of the abdomen<\/strong> as well as the size and borders of some of the underlying structures. For example, percussion sounds of the abdomen can tell you whether the underlying structures are:<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Fluid filled with a mixture of air and contents (e.g., intestines, bladder, stomach).<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Fluid results in a tympanic sound (like a drum, usually high pitched with a long duration). General tympany with scattered dullness is the dominant sound heard over the abdomen because of the intestines.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\">Dense (e.g., liver, an abnormal mass close to the surface, intestines filled with stool).<\/span>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Density results in a dull sound (like a quiet thud, usually high pitched with a short duration).<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<div class=\"textbox textbox--examples\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\">Clinical Tip<\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<div style=\"text-align: left\"><span style=\"color: #000000\">Expected percussion notes may be influenced by each body\u2019s unique size and shape. For example, some bodies are more muscular and some have more adipose tissue. The expected percussion sounds are influenced by muscle and adipose tissue, which tends to elicit a more dull sound. You may decide to not percuss an abdomen that is extremely muscular or has a lot of adipose tissue, but percussion may still be of clinical utility in certain situations. For example, when the abdomen is distended and filled with air, the percussion note might resemble hyper-resonance; when the abdomen is filled with fluid such as with <strong>[pb_glossary id=\"787\"]ascites[\/pb_glossary]<\/strong>\u00a0<span style=\"font-size: 1em\">the percussion note might have more tympanic noise that is not scattered with dullness, depending on the severity of the ascites.<\/span><\/span><\/div>\r\n<\/div>\r\n<\/div>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"font-size: 1em\">\u00a0<\/span>\r\n<\/span><\/p>\r\n<strong style=\"text-align: initial;font-size: 1em;color: #000000\">\u00a0<\/strong><span style=\"color: #000000\"><\/span><span style=\"color: #000000\"><strong>Percussing the abdomen<\/strong> involves the following steps:<\/span>\r\n\r\n1. Use an<span style=\"color: #000000\">\u00a0<strong>indirect percussion technique<\/strong> to percuss the abdomen. As shown in <strong>Figure 5.6<\/strong>, this technique involves the application of a mediated force using parts of both hands.<\/span>\r\n\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion-1024x846.png\" alt=\"Hands demonstrating indirect percussion.\" width=\"1024\" height=\"846\" class=\"alignnone size-large wp-image-809\" \/>\r\n\r\n<span style=\"color: #000000\"><strong style=\"font-size: 1em\">Figure 5.6<\/strong><span style=\"font-size: 1em\">: Indirect percussion.\u00a0<\/span><\/span>\r\n\r\n&nbsp;\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Perform <strong>indirect percussion<\/strong> using a zig-zag pattern (see <strong>Figure 5.7<\/strong>) beginning in the right lower quadrant and progressing clockwise. Percuss about three times per quadrant. For indirect percussion (see <strong>Video 5.4<\/strong>):<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Non-dominant hand: With your hand parallel to the client\u2019s body, place the distal interphalangeal joint of the pleximeter (middle) finger of your non-dominant hand firmly on the body region to percuss. Because the abdomen is often soft, you must push down relatively firmly with the distal interphalangeal joint. Ensure that only your interphalangeal joint is touching the body (and not the rest of the hand) and that the finger is fully extended.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Dominant hand: Flex (bend) the pleximeter finger of your dominant hand and with the tip of your finger, tap twice on the distal interphalangeal joint of your non dominant hand. The pleximeter finger of your dominant hand should be at a 90-degree angle to the surface of the client\u2019s body. The motion should be firm and quick with a very short duration. To optimize this motion, the wrist of your non-dominant hand should be relaxed and loose with your forearm parallel to the client\u2019s body.<\/span><\/li>\r\n<\/ul>\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion-1024x588.jpg\" alt=\"A person's naked abdomen demonstrating the pattern of percussion starting with a blue dot in the right lower quadrant and using a zig zag pattern moving up, across and down to the left lower quadrant.\" width=\"1024\" height=\"588\" class=\"alignnone size-large wp-image-577\" \/>\r\n\r\n<span style=\"color: #000000\"><strong><strong style=\"text-align: initial;font-size: 1em;color: #000000\">Figure 5.7: <\/strong><\/strong><span style=\"text-align: initial;font-size: 1em;color: #000000\">Pattern to percuss the abdomen<\/span><\/span>\r\n\r\n&nbsp;\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Listen to the <strong>quality of the sound<\/strong> and identify the <strong>location<\/strong>.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Note the <strong>findings<\/strong>.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cGeneral tympany with scattered dullness heard in all quadrants. Dullness heard in upper right quadrant over the liver.\u201d<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cDullness heard in left lower quadrant with general tympany and scattered dullness in all other quadrants.\u201d<\/span><\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/jD2uauNk-1Q[\/embed]\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Film Clip 5.4<\/strong>: Percussing the abdomen<\/span><\/p>\r\n\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=\"46\"]<\/span>","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Percussion of the abdomen involves<strong> tapping the body to elicit sounds<\/strong> and determining whether the sounds are appropriate for the underlying structure of the quadrant. This provides information about the <strong>overall consistency of the abdomen<\/strong> as well as the size and borders of some of the underlying structures. For example, percussion sounds of the abdomen can tell you whether the underlying structures are:<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Fluid filled with a mixture of air and contents (e.g., intestines, bladder, stomach).<\/span>\n<ul>\n<li><span style=\"color: #000000\">Fluid results in a tympanic sound (like a drum, usually high pitched with a long duration). General tympany with scattered dullness is the dominant sound heard over the abdomen because of the intestines.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\">Dense (e.g., liver, an abnormal mass close to the surface, intestines filled with stool).<\/span>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Density results in a dull sound (like a quiet thud, usually high pitched with a short duration).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"textbox textbox--examples\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\">Clinical Tip<\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<div style=\"text-align: left\"><span style=\"color: #000000\">Expected percussion notes may be influenced by each body\u2019s unique size and shape. For example, some bodies are more muscular and some have more adipose tissue. The expected percussion sounds are influenced by muscle and adipose tissue, which tends to elicit a more dull sound. You may decide to not percuss an abdomen that is extremely muscular or has a lot of adipose tissue, but percussion may still be of clinical utility in certain situations. For example, when the abdomen is distended and filled with air, the percussion note might resemble hyper-resonance; when the abdomen is filled with fluid such as with <strong><button class=\"glossary-term\" aria-describedby=\"678-787\">ascites<\/button><\/strong>\u00a0<span style=\"font-size: 1em\">the percussion note might have more tympanic noise that is not scattered with dullness, depending on the severity of the ascites.<\/span><\/span><\/div>\n<\/div>\n<\/div>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"font-size: 1em\">\u00a0<\/span><br \/>\n<\/span><\/p>\n<p><strong style=\"text-align: initial;font-size: 1em;color: #000000\">\u00a0<\/strong><span style=\"color: #000000\"><\/span><span style=\"color: #000000\"><strong>Percussing the abdomen<\/strong> involves the following steps:<\/span><\/p>\n<p>1. Use an<span style=\"color: #000000\">\u00a0<strong>indirect percussion technique<\/strong> to percuss the abdomen. As shown in <strong>Figure 5.6<\/strong>, this technique involves the application of a mediated force using parts of both hands.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion-1024x846.png\" alt=\"Hands demonstrating indirect percussion.\" width=\"1024\" height=\"846\" class=\"alignnone size-large wp-image-809\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion-1024x846.png 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion-300x248.png 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion-768x634.png 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion-65x54.png 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion-225x186.png 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion-350x289.png 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/10\/Indirect-Percussion.png 1380w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong style=\"font-size: 1em\">Figure 5.6<\/strong><span style=\"font-size: 1em\">: Indirect percussion.\u00a0<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Perform <strong>indirect percussion<\/strong> using a zig-zag pattern (see <strong>Figure 5.7<\/strong>) beginning in the right lower quadrant and progressing clockwise. Percuss about three times per quadrant. For indirect percussion (see <strong>Video 5.4<\/strong>):<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Non-dominant hand: With your hand parallel to the client\u2019s body, place the distal interphalangeal joint of the pleximeter (middle) finger of your non-dominant hand firmly on the body region to percuss. Because the abdomen is often soft, you must push down relatively firmly with the distal interphalangeal joint. Ensure that only your interphalangeal joint is touching the body (and not the rest of the hand) and that the finger is fully extended.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Dominant hand: Flex (bend) the pleximeter finger of your dominant hand and with the tip of your finger, tap twice on the distal interphalangeal joint of your non dominant hand. The pleximeter finger of your dominant hand should be at a 90-degree angle to the surface of the client\u2019s body. The motion should be firm and quick with a very short duration. To optimize this motion, the wrist of your non-dominant hand should be relaxed and loose with your forearm parallel to the client\u2019s body.<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion-1024x588.jpg\" alt=\"A person's naked abdomen demonstrating the pattern of percussion starting with a blue dot in the right lower quadrant and using a zig zag pattern moving up, across and down to the left lower quadrant.\" width=\"1024\" height=\"588\" class=\"alignnone size-large wp-image-577\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion-1024x588.jpg 1024w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion-300x172.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion-768x441.jpg 768w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion-65x37.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion-225x129.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion-350x201.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2021\/09\/2.-Abdomen-percussion.jpg 1281w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<p><span style=\"color: #000000\"><strong><strong style=\"text-align: initial;font-size: 1em;color: #000000\">Figure 5.7: <\/strong><\/strong><span style=\"text-align: initial;font-size: 1em;color: #000000\">Pattern to percuss the abdomen<\/span><\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Listen to the <strong>quality of the sound<\/strong> and identify the <strong>location<\/strong>.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Note the <strong>findings<\/strong>.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cGeneral tympany with scattered dullness heard in all quadrants. Dullness heard in upper right quadrant over the liver.\u201d<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cDullness heard in left lower quadrant with general tympany and scattered dullness in all other quadrants.\u201d<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Percussion of Abdomen\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/jD2uauNk-1Q?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Film Clip 5.4<\/strong>: Percussing the abdomen<\/span><\/p>\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-46\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-46\" class=\"h5p-iframe\" data-content-id=\"46\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Drag and drop the abdominal description into the correct percussion box.\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"678-787\" hidden><p>involves the accumulation of fluid in the peritoneal cavity.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":10,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-678","chapter","type-chapter","status-publish","hentry"],"part":48,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/678","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":22,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/678\/revisions"}],"predecessor-version":[{"id":2222,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapters\/678\/revisions\/2222"}],"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\/678\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/media?parent=678"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/pressbooks\/v2\/chapter-type?post=678"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/contributor?post=678"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursing\/wp-json\/wp\/v2\/license?post=678"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}