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Learning Outcomes
20.1 Describe the anatomy and physiology of the abdomen.
20.2 Identify the anatomic, physiologic, developmental, psychosocial, and cultural

Abdomen
variations that guide assessment of the abdomen.
20.3 Determine which questions about the abdomen to use for the focused
interview
20.4 Outline the techniques for assessment of the abdomen.
20.5 Generate the appropriate documentation to describe the assessment of the
Chapter 20 abdomen.
B244 20.6 Identify abnormal findings in the physical assessment of the abdomen.
Summer 2026

Introduction Introduction
The abdomen is the largest cavity of the body
and contains many organs and structures that • The ability to perform these functions are
belong to various systems of the body. influenced by the health of many other body
systems.
These structures and many other structures are • The parasympathetic fibers of the nervous system
assessed when performing an abdominal increase digestion, whereas the sympathetic
assessment. fibers inhibit the process.
• The respiratory system provides oxygen needed
The primary responsibility of the digestive for the metabolic processes and removes the
system is to take in, break down, and absorb carbon dioxide created by metabolism.
nutrients to be used by all cells of the body. • The hormones of the endocrine system help
regulate digestion and the metabolic processes.
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6 Abdomen
The abdomen is composed
The abdomen is situated in

Anatomy and
of the alimentary canal, the
the anterior region of the The abdominal muscles, the
intestines, the accessory
body. It is inferior to the intercostal margins, and the
digestive organs, the
diaphragm of the pelvis form the anterior

Physiology
urinary system, the spleen,
respiratory system and borders of the abdomen.
and the reproductive
superior to the pelvic floor.
organs.

Review Two-point focus of the

review of the anatomy and The gastrointestinal system
The vertebral column and
physiology of the abdomen consists of the alimentary
the lumbar muscles form
include: canal and the accessory
the posterior borders of the
• The gastrointestinal system organs of the digestive
abdomen.
• The abdominal structures of other system.
systems

• The esophagus, a collapsible tube, connects • The stomach extends from the esophagus at
the pharynx to the stomach. the cardiac sphincter to the duodenum at the

Alimentary Canal • Approximately 25 c m (10 in.) in length, it

passes through the mediastinum and
pyloric sphincter.
• Located in the left side of the upper abdomen,
diaphragm to meet the stomach at the the stomach is directly inferior to the
cardiac sphincter. diaphragm.
• The primary function of the esophagus is to • The diameter and volume of the stomach are
• The alimentary canal, a propel food and fluid from the mouth to the directly related to the food it contains.
continuous, hollow, muscular stomach. • Food mixes with digestive juices in the
stomach and becomes chyme before entering
tube, begins at the mouth and the small intestine.
terminates at the anus. • The primary function of the stomach is the
chemical and mechanical breakdown of food.
• The accessory organs include
the teeth, salivary glands,
liver, gallbladder, and
pancreas.
• The boundaries include the
Esophagus Stomach
mouth, pharynx, esophagus,
stomach, small and large
intestines, rectum, and anus.
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•The small intestine is the body’s primary digestive and •The last portion of the alimentary canal is the large
absorptive organ. intestine, which extends from the ileocecal valve to the

Accessary Organs
•Approximately 6 m (18 to 21 f t) in length, it is divided into anus.
three subdivisions. •The large intestine is approximately 1.5 m (5 to 5.5 f t ) in
•The first segment, the duodenum, meets the stomach at the length. It consists of the cecum, ascending colon,
pyloric sphincter and extends to the middle region, called transverse colon, descending colon, sigmoid colon, rectum,
the jejunum. The ileum extends from the jejunum to the and anus.
ileocecal valve at the cecum of the large intestine. •The vermiform appendix is attached to the large intestine at
•Intestinal juices, bile from the liver and gallbladder, and the cecum.
pancreatic enzymes mix with the chyme to promote •The appendix contains masses of lymphoid tissue that
digestion and facilitate the absorption of nutrients. make only a minor contribution to immunity; however, when
•The primary functions of the small intestine are the
continuing chemical breakdown of food and the absorption
inflamed, the appendix causes significant health problems.
•The large intestine is on the periphery of the abdominal
• Accessary digestive organs include the
liver, gallbladder, and pancreas.
of digested foods. cavity, surrounding the small intestine and other structures.
•The main functions of the large intestine are absorbing
water from indigestible food residue and eliminating the

• The accessary organs contribute to the

residue in the form of feces.

digestive process of foods.

Small Large • These structures are connected to the
Intestine Intestine alimentary canal by ducts.

•The largest gland of the body, the liver is located in •Chiefly a storage organ for bile, the gallbladder, a thin- •An accessory digestive organ, the pancreas is a •Structures located in the abdomen have no
the right upper portion of the abdominal cavity, walled sac, is nestled in a shallow depression on the triangular-shaped gland located in the left upper connection to the digestive process. They are part of
directly inferior to the diaphragm to just below the ventral surface of the liver. portion of the abdomen. other systems and are considered with the general
costal margin and extends into the left side of the •The main functions of the gallbladder are storing of •The head of the pancreas is nestled in the C curve of assessment of the abdomen.
abdomen. bile and assisting in the digestion of fats. the duodenum, and the body and tail of the pancreas •The parietal peritoneum lines the walls of the
•The lower portion of the rib cage, which makes only •The gallbladder releases stored bile into the lie deep to the left of the stomach and extend toward abdominal cavity.
the lower border of the liver palpable, protects the duodenum when stimulated and thus promotes the the spleen at the lateral aspect of the abdomen. •The serous fluid secreted by the membranes helps
liver. emulsification of fats. •The pancreas is an endocrine and exocrine gland. lubricate the surface of the organs, allowing motion of
•The only digestive function of the liver is the •As an endocrine gland, it secretes insulin, an structures without friction.
production and secretion of bile for fat emulsification. important factor in carbohydrate metabolism.
•The liver has a major role in the metabolism of •As an exocrine gland, it releases pancreatic juice,
proteins, fats, and carbohydrates. which contains a broad spectrum of enzymes that
•The liver has the ability to store some vitamins, mixes with bile in the duodenum.
produce substances for coagulation of blood, produce •The main function of the pancreas is assisting with
antibodies, and detoxify harmful substances. the digestion of proteins, fats, and carbohydrates.

Liver Gallbladder Pancreas Peritoneum

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Muscles of the Abdominal Wall Aorta

• Having no bony reinforcements, the • As the descending aorta passes
anterior and lateral abdominal walls
depend on the musculature for support through the diaphragm and enters
and protection. the abdominal cavity, it becomes the
• The four pairs of abdominal muscles, abdominal aorta.
when well toned, support and protect
the abdominal viscera most effectively. • This penetration occurs at the T12
• The muscle groups include the rectus level of the vertebral column slightly
abdominis, external oblique, internal to the left of the midline of the body.
oblique, and transverse abdominis.
• Secondary functions of these muscle
• The abdominal aorta continues to
groups include lateral flexion, rotation, the L4 level of the vertebral column,
and anterior flexion of the trunk. where it bifurcates to form the right
• Simultaneous contraction of the and left common iliac arteries.
muscle groups increases intra-
abdominal pressure by compressing • The many branches of the abdominal
the abdominal wall. aorta serve all the parietal and
• Weakness in the muscular structure visceral structures.
will produce herniation of structures.

• The spleen, the largest of the lymphoid • In the female, the uterus, fallopian
organs, is located in the left upper tubes, and ovaries are in the pelvic
portion of the abdomen directly inferior portion of the abdominal cavity.
•The kidneys are located in the •The slender tubelike structures •The primary function of the bladder to the diaphragm. • In the male, the prostate gland
posterior abdomen on either side of that carry the urine from the is to store urine until it can be • Surrounded by a fibrous capsule, the surrounds the urethra just below the
the spine, protected by the lower kidneys to the bladder are the released.
ribs. ureters. spleen provides a site for lymphocyte bladder.
•As the bladder fills with urine, it
•Besides filtering nitrogenous •The urinary bladder, a smooth, may rise above the symphysis proliferation and immune surveillance
wastes from blood and producing collapsible muscular sac, is pubis into the abdominal cavity. and response.
urine, the kidneys produce a located in the pelvis of the
biologically active form of vitamin abdominal cavity. • The spleen filters and cleanses blood,
D. destroying worn-out red blood cells and
•The kidneys also secret returning their breakdown products to
erythropoietin and renin.
the liver.

Kidneys Ureters Bladder

Reproductive
Spleen
Organs
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17 Anatomy Landmarks 18 Anatomy Landmarks

• Reference points and anatomic structures • The quadrants are named as right
must be identified when assessing the upper quadrant (R U Q), right lower
abdomen. Defined landmarks help to identify
specific underlying structures and provide a quadrant (R L Q), left upper quadrant
source for description and recording of (L U Q), and left lower quadrant (L L
findings. Q).
• Landmarks for the abdomen include the • The second mapping method divides
xiphoid process, umbilicus, costal margin, the abdomen into nine regions.
iliac crests, and pubic bone.
• Mapping is the process of dividing the • To obtain these abdominal regions,
abdomen into quadrants or regions for the one extends the right and left
purpose of examination. midclavicular lines to the groin and
• To obtain the four quadrants, extend the then draws a horizontal line across
midsternal line from the xiphoid process the lowest edge of the costal margin.
through the umbilicus to the pubic bone and The final step is to draw another
then draw a horizontal line perpendicular to horizontal line at the level of the iliac
the first line through the umbilicus.
crests.

Anatomy Landmarks 20 Anatomy Landmarks

When using the quadrant method, The kidneys are posterior to the abdominal contents and situated in the retroperitoneal
it is important to pay attention to space, protected by the 11th and 12th pairs of ribs.
structures that are in the midline
The quadrant method is more of the abdomen and do not
commonly used. belong to any specific quadrant.
These structures include the The costovertebral angle is formed as the ribs articulate with the vertebra.
abdominal aorta, urinary bladder,
and uterus.

The liver displaces the right kidney, thus making the lower pole palpable.

It is important to select one The gallbladder sits in the upper The spleen, part of the lymphatic system, is at the level of the 10th rib lateral to the left
mapping method and use it right quadrant of the abdomen
midaxillary line (L M A L).
consistently to visualize the inferior to the liver and lateral to
underlying structures before the right midclavicular line (R M
proceeding with the assessment. C L). The lower pole of the spleen moves into the abdomen toward the midline when
enlarged.
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Special Considerations

Special
A variety of factors may influence health, including age, developmental level, race,
ethnicity, work history, living conditions, socioeconomics, and emotional well-being.

Considerations
A healthy digestive system promotes efficient nutrient absorption, which is essential
for healthy growth and development.

Digestive health also allows for adequate elimination of wastes and toxins from the
body.

The collection of data and the interpretation of findings in relation to normative

values are important.

Special Considerations Special Considerations

• Developmental factors are considered
during assessment of the abdomen.
• High stress levels may cause or aggravate Surgical scars may alter an individual’s body image.
abdominal problems. Gastritis, gastric or
duodenal ulcers, and ulcerative colitis are
several examples of stress-related Gastrointestinal surgery may require a colostomy, which might be a temporary or
problems. permanent change. Many adults consider “wearing a bag” a significant limitation,
• Self-perception may have a subtle causing embarrassment and anxiety.

influence on the patient’s weight. Patients

who perceive themselves as naturally thin
may show greater dedication to restricting This often leads to depression and withdrawal.

their caloric intake and exercising to

maintain that self-image.
• Conversely, patients who perceive Culture, customs, family, and religious practices influence the foods patients choose
themselves as naturally fat may overeat to eat. Certain foods may be prescribed or avoided in certain cultures or religions.
and avoid exercise, feeling that there is
nothing they can do to alter their weight.
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25

Special Considerations

The financial security of the patient also

has an impact on eating habits.
In some areas, certain foods may not be
available year-round or may be much Subjective
Health History
more costly than in other areas.

Cultural factors also may affect the

incidence of gastrointestinal disorders. Likewise, the incidence of infection by
For example, African Americans Helicobacter pylori, which is a major
experience a higher rate of colorectal cause of peptic ulcer disease, is highest
cancer compared with White, Asian/ among individuals of African American
Pacific Islander, American Indian/Alaska heritage and Mexican Americans (Mapel,
Native, or Hispanic individuals (C D C, Roberts, Overhiser, and Mason, 2013).
2017c).

28

Subjective Health History Subjective Health History

• Use open-ended and closed-ended questions to obtain
information.
• Subjective data collection occurs during the patient interview before the • The focused interview guides the physical assessment of the
actual physical assessment. abdomen.
• During the interview use a variety of communication techniques to elicit • The information is always considered in relation to norms and
general and specific information about the patient’s state of abdominal
expectations about the function of organs and systems within
health or illness. the abdomen.
• Health records, the results of laboratory tests, and radiologic studies are • Age, gender, race, culture, environment, health practices, past
important secondary sources to be reviewed and included in the data-
and concurrent problems, and therapies should be considered
gathering process. when framing questions and using techniques to elicit
• The focused interview for assessment of the abdomen concerns data information.
related to the structures and functions of organs within the abdomen.
• Consider the patient’s ability to participate in the focused
• While gathering the subjective data be prepared to observe the patient interview and physical assessment of the abdomen.
and listen for cues related to the function of the organs and systems • If a patient is experiencing pain, cramping, problems with
within the abdomen.
elimination (including frequency or urgency), difficulty
swallowing, nausea and vomiting, or the anxiety that
accompanies any of these problems, attention must focus on
identification of immediate problems and relief of symptoms.
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Subjective Health History

Focused interview questions include:

• General questions Physical
Assessment
• Questions related to illness or infection
• Questions related to symptoms, pain, and
behaviors
• Questions related to age and pregnancy
• Questions related to the environment: Internal
and External

Objective Data: Physical Assessment Objective Data: Physical Assessment

Physical assessment of the abdomen Techniques for • Survey

requires the use of inspection,
auscultation, and palpation.
physical • Inspection of the abdomen: Map the abdomen
assessment • Auscultation of the Abdomen
The skin of the abdomen • Palpation of the Abdomen
should be consistent with the
include:
skin of the rest of the body.

The umbilicus should be midline in Additional physical • Palpate for rebound tenderness
an abdomen that may be round,
flat, convex, or protuberant. assessments • Test for psoas sign
include: • Test for Murphy’s sign
The abdomen should be symmetric and free of
bulges. Pulsations and wavelike movements below
the xiphoid process are normal in thin adults.
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Contour of the Abdomen

Patient Positioned and Auscultating the Abdomen

Auscultatory Areas for
Draped for Bowel Sounds
Vascular Sounds

Murphy’s Sign

Deep Palpation of Abdomen

Light Palpation of Abdomen
Using a Bimanual Technique
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Testing for
Appendicitis
Palpating for Rebound Palpating for Rebound
Tenderness: Applying Pressure Tenderness: Rapid Release

Psoas Sign Documentation

• Documentation of both subjective and
objective assessment data must be
accurate, professional, complete, and
confidential.
• Measurements should be used whenever
appropriate to ensure accuracy, use
appropriate medical terminology include all
pertinent information, and avoid language
that could identify the patient.
• The information in the documentation should
make it clear what questions were asked
and should use language to indicate whether
it is the patient’s response or the nurse’s
findings.
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42 Abnormal Findings

Abnormal
Abnormal findings in the abdomen occur in association with general health and in illness.

Findings
Alterations of the gastrointestinal tract include nutritional problems, eating disorders, cancers,
ulcers, and inflammatory and infectious processes.

For accurate diagnosis in many abdominal and gastrointestinal problems, the health history and
physical assessment are accompanied by observations of products of elimination and require
diagnostic testing.

Diagnostic testing includes laboratory studies of blood, urine, and feces as well as radiographic
and magnetic resonance imaging (M R I).

Abnormal Findings Abdominal Distention

• Abdominal distention occurs for a variety of reasons including obesity, gaseous
When conducting an abdominal assessment, auscultate for bowel distention, and ascites.
sounds and for vascular sounds.

Pain is associated with acute and chronic conditions that affect the
digestive organs and abdominal structures.

Disruption of function of the abdominal structures may result in

referred pain.

Referred pain is pain or discomfort that is perceived in an area of the

body other than the region or point from which the pain originates.
Obesity Distended Abdomen Abdominal Tumor Ascites
Abdominal distention occurs for a variety of reasons including obesity,
gaseous distention, and ascites.
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Abdominal Hernia Abdominal Hernias

A hernia, commonly called a rupture, is a protrusion of an organ or

structure through an abnormal opening or weakened area in a body wall.

The abdominal wall is the most common site of hernias. This

weakening could be congenital or acquired.

If the protruding or displaced abdominal contents return to their

normal position when the patient relaxes, the hernia is said to be
reducible or reduced.

When the displaced or protruding structures do not return to their

normal position, the hernia is said to be incarcerated or nonreducible.
An incarcerated hernia can become strangulated.
Umbilical Hernia Ventral Hernia

In strangulated hernias, the blood supply to the displaced abdominal

contents is compromised.

Abdominal Hernias Abnormal Findings

Inflammatory processes
GI tract cancers include: include:
• Esophageal
• Ulcerative colitis
• Hepatic
• Esophagitis
• Pancreatic
• Peritonitis
• Stomach
• Hepatitis
• Colorectal
• Crohn disease

Sliding Hiatal Hernia Rolling Hiatal Hernia

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NCLEX Review NCLEX Review

Answer: 3

Explanation:
The nurse is performing an abdominal assessment on a client. While the
1. Blumberg sign can be elicited when the nurse presses on an area of the abdomen. If
nurse is palpating the lower border of the liver, the nurse asks the client the client complains of pain as the nurse pulls back and releases the compressed area,
to take a deep breath and hold it. The client complains of a sharp pain the client has a positive Blumberg sign which is present when the client has peritoneal
located in the right upper quadrant. How will the nurse document this irritation.
finding in the medical record? 2. Pain at McBurney's point is associated with appendicitis. This area is located in the
right lower quadrant of the client's abdomen.
3. Murphy sign can be elicited when the client takes a deep breath and holds it while the
1. Positive Blumberg's sign.
nurse presses into the right upper quadrant. The nurse is pressing against the
2. Presence of pain at McBurney's point. gallbladder. Normally, the client will not complain of pain.
3. Positive Murphy sign. 4. With the client in a supine position, the nurse places her left hand just above the level
4. Positive psoas sign. of the client's right knee. The client is requested to raise the leg to meet the nurse's
hand. Flexion of the hip causes contraction of the psoas muscle and indicates that the
client is experiencing peritoneal inflammation or appendicitis.

Questions?
Reference: Fenske, C., D’Amico, D., Watkins,
K., Saunders, T., & Barbarito, C. (2020). Health
& physical assessment in nursing. Fourth
edition. River Street, New Jersey: Pearson
Education, Inc. (ISBN 978-0134868172)