NUR 505 Advanced Health Assessment
Module 9 Abdomen Study Guide
1. Identify the nine regions of the ABD.
1. Epigastric
2. Umbilical
3. Hypogastric
4. Right hypochondriac
5. Left hypochondriac
6. Right lumbar
7. Left lumbar
8. Right inguinal
9. Left inguinal
2. Complete the Percussion Note Table
Note Description Location
Tympany Musical note of higher Over air-filled viscera
**predominant sound pitch than resonance
because air is present
in the stomach and
intestines
Hyperresonance Pitch lies between Base of left lung
tympany and
resonance
Resonance Sustained note of Over lung tissues and
moderate pitch sometimes over the
abdomen
,Dullness Short, high-pitched Over solid organs
note with little adjacent to air-filled
resonance structures
3. Complete the Exam Table
Organ Assessment Technique Expected Findings Unexpected
Findings and
Possible
Indications
Liver: Percussion: begin at right Percussion Percussion
midclavicular line over an area -Area of liver -Lower liver
Best to report liver of tympany. Percuss upward dullness is usually border > 2-3 cm
size in 2 ways: along midclavicular line to heard at the costal may indicate
1. Liver span determine lower border of margin or slightly organ
as liver. Mark the border with the below it. (7th ICS) enlargement or
determine marking pen. To determine downward
d from upper border of liver, begin on -Upper border is displacement of
percussing right midclavicular line at an usually in the 5th diaphragm
upper and area of lung resonance around ICS because of
lower the 3rd ICS. Continue emphysema or
borders downward until percussion -Usual liver span is other pulmonary
2. Extent of tone changes to dullness; this 6-12 cm (2.5-4.5 disease.
liver marks upper border of liver. inches); liver span -Upper liver
projection Measure distance between is usually greater border below the
below the the marks to estimate vertical in males and tall 5th ICS may
costal span of the liver. individuals indicate
margin If liver enlargement is downward
suspected, percuss upward -Midsternal liver displacement or
and then downward over the span: 4-8 cm (1.5- liver atrophy.
right midaxillary line. You can 3 inches) -Dullness
also percuss along the extending above
midsternal line to estimate the -While assessing the 5th ICS
midsternal liver span. To descent of liver, suggests upward
assess the descent of the liver, the area of lower displacement
ask the patient to take a deep border dullness from abdominal
breath and hold it while you should move fluid or masses.
percuss upward again from downward 2-3 cm -Liver span > 12
the abdomen and the right cm may indicate
, midclavicular line -healthy liver is liver
nontender to enlargement,
Palpation: place your left hand percussion whereas a lesser
under the patient at the 11th span indicates
and 12th ribs, pressing upward atrophy
to elevate the liver toward the Palpation: -Midsternal liver
abdominal wall. Place your span > 8 cm
right hand on the abdomen, -ordinarily, the suggests liver
fingers pointing toward the liver is not enlargement
head and extended so the tips palpable, although
rest on the right midclavicular it may be felt in Palpation:
line below the level of liver thin persons
dullness. Alternatively, you can without
place your right hand parallel underlying cause;
to the right costal margin; in if the liver edge is
either case, place your right felt, it should be
hand gently, but deeply, in and firm, smooth,
up. Have the patient breathe even, and
regularly a few times and then nontender
take a deep breath. Try to feel
the liver edge as the -Scratch test
diaphragm pushes it down to when you
meet your fingertips. Feel for encounter the
nodules, tenderness, and liver, the sound
irregularities. If the liver is you hear
palpable, repeat the maneuver intensifies
medially and laterally to the
costal margin to assess the -when liver is
liver contour and surface nonpalpable and
Alternative techniques: there is clinical
Hook your fingers over the suspicion for
right costal margin below the hepatobiliary
border of liver dullness. Stand infection, use
on the patient’s right side indirect fist
facing his/her feet. Press in percussion
and up toward the costal healthy liver is
margin with your fingers and nontender
ask the patient to take a deep
breath. Try to feel the liver
edge as it descends to meet
your fingers. If the abdomen is
distended or the abdominal
Module 9 Abdomen Study Guide
1. Identify the nine regions of the ABD.
1. Epigastric
2. Umbilical
3. Hypogastric
4. Right hypochondriac
5. Left hypochondriac
6. Right lumbar
7. Left lumbar
8. Right inguinal
9. Left inguinal
2. Complete the Percussion Note Table
Note Description Location
Tympany Musical note of higher Over air-filled viscera
**predominant sound pitch than resonance
because air is present
in the stomach and
intestines
Hyperresonance Pitch lies between Base of left lung
tympany and
resonance
Resonance Sustained note of Over lung tissues and
moderate pitch sometimes over the
abdomen
,Dullness Short, high-pitched Over solid organs
note with little adjacent to air-filled
resonance structures
3. Complete the Exam Table
Organ Assessment Technique Expected Findings Unexpected
Findings and
Possible
Indications
Liver: Percussion: begin at right Percussion Percussion
midclavicular line over an area -Area of liver -Lower liver
Best to report liver of tympany. Percuss upward dullness is usually border > 2-3 cm
size in 2 ways: along midclavicular line to heard at the costal may indicate
1. Liver span determine lower border of margin or slightly organ
as liver. Mark the border with the below it. (7th ICS) enlargement or
determine marking pen. To determine downward
d from upper border of liver, begin on -Upper border is displacement of
percussing right midclavicular line at an usually in the 5th diaphragm
upper and area of lung resonance around ICS because of
lower the 3rd ICS. Continue emphysema or
borders downward until percussion -Usual liver span is other pulmonary
2. Extent of tone changes to dullness; this 6-12 cm (2.5-4.5 disease.
liver marks upper border of liver. inches); liver span -Upper liver
projection Measure distance between is usually greater border below the
below the the marks to estimate vertical in males and tall 5th ICS may
costal span of the liver. individuals indicate
margin If liver enlargement is downward
suspected, percuss upward -Midsternal liver displacement or
and then downward over the span: 4-8 cm (1.5- liver atrophy.
right midaxillary line. You can 3 inches) -Dullness
also percuss along the extending above
midsternal line to estimate the -While assessing the 5th ICS
midsternal liver span. To descent of liver, suggests upward
assess the descent of the liver, the area of lower displacement
ask the patient to take a deep border dullness from abdominal
breath and hold it while you should move fluid or masses.
percuss upward again from downward 2-3 cm -Liver span > 12
the abdomen and the right cm may indicate
, midclavicular line -healthy liver is liver
nontender to enlargement,
Palpation: place your left hand percussion whereas a lesser
under the patient at the 11th span indicates
and 12th ribs, pressing upward atrophy
to elevate the liver toward the Palpation: -Midsternal liver
abdominal wall. Place your span > 8 cm
right hand on the abdomen, -ordinarily, the suggests liver
fingers pointing toward the liver is not enlargement
head and extended so the tips palpable, although
rest on the right midclavicular it may be felt in Palpation:
line below the level of liver thin persons
dullness. Alternatively, you can without
place your right hand parallel underlying cause;
to the right costal margin; in if the liver edge is
either case, place your right felt, it should be
hand gently, but deeply, in and firm, smooth,
up. Have the patient breathe even, and
regularly a few times and then nontender
take a deep breath. Try to feel
the liver edge as the -Scratch test
diaphragm pushes it down to when you
meet your fingertips. Feel for encounter the
nodules, tenderness, and liver, the sound
irregularities. If the liver is you hear
palpable, repeat the maneuver intensifies
medially and laterally to the
costal margin to assess the -when liver is
liver contour and surface nonpalpable and
Alternative techniques: there is clinical
Hook your fingers over the suspicion for
right costal margin below the hepatobiliary
border of liver dullness. Stand infection, use
on the patient’s right side indirect fist
facing his/her feet. Press in percussion
and up toward the costal healthy liver is
margin with your fingers and nontender
ask the patient to take a deep
breath. Try to feel the liver
edge as it descends to meet
your fingers. If the abdomen is
distended or the abdominal
