Your patient is complaining of abdominal pain during assessment. What is your priority?
A. Auscultate to determine changes in bowel sounds.
B. Observe the contour of the abdomen.
C. Palpate the abdomen for a mass.
D. Percuss the abdomen to determine if fluid is present.
Correct Answer: B. Observe the contour of the abdomen.
The first step in assessing the abdomen is to observe its shape and contour, then auscultate, palpate, and then percuss. It is important to begin with the general examination of the abdomen with the patient in a completely supine position. The presence of any of the following signs may indicate specific disorders. Distension of the abdomen could be present due to small bowel obstruction, masses, tumors, cancer, hepatomegaly, splenomegaly, constipation, abdominal aortic aneurysm, and pregnancy.
Option A: The last step of the abdominal examination is auscultation with a stethoscope. The diaphragm of the stethoscope should be placed on the right side of the umbilicus to listen to the bowel sounds, and their rate should be calculated after listening for at least two minutes. Normal bowel sounds are low-pitched and gurgling, and the rate is normally 2-5/min.
Option C: The examiner should begin with superficial or light palpation from the area furthest from the point of maximal pain and move systematically through the nine regions of the abdomen. It is important to press slowly as pressing too fast may trap a gas pocket within the intestinal lumen and distend the wall resulting in false-positive tenderness.
Option D: A proper technique of percussion is necessary to gain maximum information regarding abdominal pathology. While percussing, it is important to appreciate tympany over air-filled structures such as the stomach and dullness to percussion which may be present due to an underlying mass or organomegaly (for example, hepatomegaly or splenomegaly).
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