Reference — Gastrointestinal
Acute Abdomen Assessment Reference
The “acute abdomen” is sorted at the bedside by a handful of named signs, the right exam sequence, and a short list of red flags. Here they are, with what each one points to.
Educational use only. These signs support — they don’t replace — provider evaluation and imaging. Any acute abdomen needs prompt surgical assessment; report red flags immediately. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Named Signs
| Sign | Finding | Points to |
|---|---|---|
| McBurney's point tenderness | Tenderness ⅓ from the right anterior iliac spine to the umbilicus | Appendicitis |
| Rovsing's sign | Palpating the LLQ produces pain in the RLQ | Appendicitis (peritoneal irritation) |
| Psoas sign | RLQ pain on extension of the right hip (or resisted hip flexion) | Retrocecal appendicitis |
| Obturator sign | Pain on internal rotation of the flexed right hip | Pelvic appendicitis |
| Murphy's sign | Inspiration halts from pain during RUQ palpation | Cholecystitis |
| Blumberg's sign (rebound) | Pain worse on release of deep palpation than on pressure | Peritoneal inflammation / peritonitis |
| Cullen's sign | Periumbilical bruising | Hemorrhagic pancreatitis / intra-abdominal bleed |
| Grey Turner's sign | Flank bruising | Hemorrhagic pancreatitis / retroperitoneal bleed |
The Exam Sequence — Order Matters
For the abdomen, the order is Inspect → Auscultate → Percuss → Palpate — auscultation comes before palpation because pressing first can alter bowel sounds.
Inspect: contour (distension), scars, hernias, visible peristalsis, bruising. Auscultate: high-pitched/hyperactive (early obstruction) vs hypoactive/absent (ileus, peritonitis, late obstruction). Percuss/palpate: tympany vs dullness, localized vs diffuse tenderness, guarding, rebound, rigidity. Palpate the painful area LAST.
Peritonitis Red Flags
Board-like rigidity, diffuse rebound tenderness, absent bowel sounds, a patient lying very still (movement hurts), high fever, tachycardia, and signs of sepsis/hypovolemia. Sudden relief of localized pain can signal a perforation that is about to become diffuse peritonitis — escalate, don’t relax.
What NOT to Do Before Evaluation
No heat to the abdomen (can worsen inflammation/rupture), no laxatives or enemas (increased pressure/motility can perforate), and keep the patient NPO in case of surgery. Analgesia is appropriate and no longer thought to mask the diagnosis — but follow orders and reassess.
NCLEX Pearls
- ✦Abdomen sequence: Inspect, Auscultate, Percuss, Palpate — auscultate before you touch.
- ✦McBurney's/Rovsing's/psoas/obturator = appendicitis; Murphy's = cholecystitis; rebound (Blumberg's) = peritonitis.
- ✦Cullen's (periumbilical) and Grey Turner's (flank) bruising = hemorrhagic pancreatitis.
- ✦Rigid, silent abdomen + rebound + fever = peritonitis; sudden pain relief can mean perforation.
- ✦Before surgical eval: no heat, no laxatives/enemas, keep NPO.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American College of Gastroenterology (ACG) / AGA · ASPEN (nutrition support). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →