Health Promotion and Maintenance Q 110

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When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly palpated?

  

     A. Right upper quadrant

     B. Directly over the umbilicus

     C. Middle lower abdomen to the left of the midline

     D. Midline lower abdomen to the right of the midline

    

    

Correct Answer: C. Middle lower abdomen to the left of the midline

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The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation. The aortic pulse can be palpated just above and to the left of the umbilicus. The width of the aorta can then be measured by placing both hands palms down on the patient’s abdomen, with one index finger on either side of the aorta. Each systole should move the fingers apart.

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Option A: The right upper quadrant is a little farther from the appropriate area to be palpated. Abdominal examination includes palpation of the aorta and estimation of the size of the aneurysm. AAAs are palpated in the upper abdomen; the aorta bifurcates into the iliac arteries just above the umbilicus.

Option B: Palpating the umbilicus would yield inappropriate results. The examiner may palpate the periumbilical area for any defect, mass, or an umbilical hernia. The patient can be asked to cough or bear down to feel for any protruding mass.

Option D: The aorta lies to the left, not the right, of the umbilicus. Left lower quadrant tenderness may be a presenting sign of diverticulitis in the elderly. A mass, if present may be due to a tumor of the colon, a left ovarian cyst, or ectopic pregnancy. In the elderly, constipation leading to impacted feces may also present with a mass palpated in the left lower quadrant.

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