Nursing Field Notes / GI · Master Reference & Assessment Course

Abdominal Assessment 🗺️🩺

Quick Overview — the master quadrant map for the whole GI batch

NG-046 GI · Assessment ADHD-friendly visual edition

This page is your reference map — the 4 abdominal quadrants, the one rule that's backwards from every other assessment (auscultate BEFORE palpate), and where the pain shows up for the diseases in this batch. Learn this page once, apply it to every GI diagnosis you study.

📄 Simple Nursing original — opens in Drive →

🗺️ 4 quadrantsRUQ · LUQ · RLQ · LLQ — split at the umbilicus.

👂 Listen BEFORE you touchAuscultate before palpate — palpation can change bowel sounds.

⏱️ 1 full minute per quadrantDon't call bowel sounds "absent" before 5 full minutes.

📍 Pain has an addressRLQ=appendicitis · RUQ=cholecystitis · LUQ/epigastric=pancreatitis.

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MAP

STEP 1 · THE 4 QUADRANTS

Draw a cross through the umbilicus — everything the exam asks about lives in one of these four boxes.

🧭 The abdomen, divided into 4 quadrants (RUQ / LUQ / RLQ / LLQ)

🟦 RUQ = liver/gallbladder🟩 LUQ = stomach/spleen/pancreas 🩷 RLQ = appendix🟨 LLQ = sigmoid colon

🧠 “RUQ, LUQ on top — RLQ, LLQ down below.” Right is always the patient's right, not yours — stand at the bedside and mirror it in your head.

🔤 Reading the letters

R/L = patient's Right / Left
U = Upper (above umbilicus)
L = Lower (below umbilicus)
Q = Quadrant

🧠 Always the patient's right/left, never the observer's — a classic first-semester trap.

📋 Inspection — what "normal" looks like

🫃 Contour: flat, rounded, scaphoid (sunken), or distended
⚖️ Symmetry: should be symmetric side to side
🩹 Skin: no lesions, striae are common/benign, no bulging at umbilicus (hernia)
💓 No visible pulsations (except faint epigastric aortic pulsation is normal in thin clients)

🧠 Look before you touch — a visibly distended, rigid, or asymmetric abdomen changes your whole plan before you even auscultate.

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TECHNIQUE

STEP 2 · THE ORDER IS BACKWARDS

Every other body system: inspect → palpate → percuss → auscultate. The abdomen breaks that rule on purpose.

🔄 IAPP — Auscultate BEFORE you Palpate

👀 Inspect — contour, symmetry, skin, pulsations

👂 Auscultate — bowel sounds in all 4 quadrants

🥁 Percuss — tympany (gas) vs dullness (fluid/organ)

🤲 Palpate — light first, then deep, tender areas LAST

Why? Percussion and palpation can stimulate or falsely change bowel motility/sounds — so you must listen first to get an accurate baseline.

🧠 “Look, Listen, Tap, Touch.” Every other system is Inspect-Palpate-Percuss-Auscultate — the abdomen swaps the last two to the front: I-A-P-P.

👂 Bowel sounds — how to actually listen

📈 Hyperactive ("borborygmi") — early obstruction, gastroenteritis, diarrhea
📉 Hypoactive — post-op ileus, peritonitis, opioids
🚫 Absent — must listen 5 full minutes per quadrant before documenting "absent"; late obstruction, paralytic ileus, peritonitis = emergency

🧠 “Silence is not nothing — silence is an emergency.” Never chart "absent bowel sounds" after a quick listen.

🤲 Palpation — light, then deep, painful area LAST

✅ Start away from the painful area
✅ Light palpation first (~1 cm), then deep (~5–8 cm)
🚨 Guarding, rigidity, rebound tenderness = peritoneal signs → stop, this is an emergency finding

🧠 If a stem describes a rigid, board-like abdomen with rebound tenderness, fever, and rising pain — think peritonitis, report to the HCP immediately, don't keep palpating.

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APPLY IT

STEP 3 · WHERE EACH DISEASE LIVES

Same 4-box map, now with the special signs and diagnoses from this batch pinned onto it.

📍 Special signs by location — the batch cheat-sheet

🧠 One map, four diseases. Every time you learn a new GI diagnosis this batch, come back and pin it on this same quadrant map — the location IS the clue.

Quadrant / point	Special sign	Condition
RUQ	Murphy's sign — pain & inspiratory pause on deep RUQ palpation	Cholecystitis (gallbladder)
LUQ / Epigastric	Pain boring straight through to the back	Pancreatitis
RLQ	McBurney's point — 1/3 way from iliac crest to umbilicus; + Rovsing's sign	Appendicitis
LLQ	Constant, localized aching pain, fever, ↑WBC	Diverticulitis
Periumbilical / flank	Cullen's sign (umbilicus) / Grey Turner's sign (flanks)	Hemorrhagic pancreatitis

🚨 Red-flag findings — stop and report

🪵 Rigid, board-like abdomen
🤲 Rebound tenderness
🌡️ Fever >100.3°F
📈 Increasing, worsening pain
💓 Tachycardia / tachypnea + restlessness

🧠 This exact red-flag cluster = peritonitis — you'll see it repeat across GERD, pancreatitis, appendicitis, and diverticulitis pages. Learn it once here.

📝 Documentation shape

Chart: contour → symmetry → bowel sounds (present/hyper/hypo/absent, which quadrants) → tenderness/guarding location → masses/pulsations.

🧠 “Look, Listen, Tap, Touch — then write it down in that order.” Matching your documentation order to your exam order keeps you from skipping steps.

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QUICK RECALL

SAY IT OUT LOUD

🗺️ 4 quadrantsRUQ · LUQ · RLQ · LLQ around the umbilicus

👂 Auscultate before palpatethe one backwards order in nursing assessment

⏱️ 1 min/quadrant, 5 min to call "absent"don't rush bowel sounds

📍 Location = diagnosisRLQ appendix · RUQ gallbladder · LUQ pancreas · LLQ sigmoid

🎯 Cover & check — 4 rapid-fire questions

Q1: What is the correct order of abdominal assessment, and why does it differ from other systems?

Inspect → Auscultate → Percuss → Palpate. Auscultation comes before palpation because percussion/palpation can alter bowel motility and change the sounds you hear.

Q2: How long should you listen before charting "absent" bowel sounds?

A full 5 minutes per quadrant — don't document "absent" after a quick listen.

Q3: A client has pain and an inspiratory pause when you press deep under the right costal margin — what sign, and what condition?

Murphy's sign — cholecystitis (RUQ, gallbladder).

Q4: What abdominal finding cluster means peritonitis and requires immediate provider notification?

Rigid/board-like abdomen, rebound tenderness, fever >100.3°F, increasing pain, restlessness, tachycardia/tachypnea.