Abdominal Assessment Cathy Gibbs BSN, RN

Competencies     Assess the health status of a patient with a gastrointestinal complaint Demonstrate the techniques of a gastrointestinal assessment Relate abnormal physical gastro intestinal findings to pathological processes Outline the gastrointestinal variations associated with the aging process

Gastrointestinal System Assessment       Patient’s history Current signs & symptoms Vital signs Level of consciousness Age & gender Bowel habits or alterations in elimination

Common Chief Complaints     Nausea and vomiting Anorexia Dysphagia Diarrhea or constipation

Common Chief Complaints      Abdominal distension Abdominal pain Increased eructation or flatulence Dysuria Nocturia

Characteristics of Chief Complaint      Quality Associated manifestations Aggravating factors Alleviating factors Timing

Past Health History   Medical  Abdomen specific  Nonabdomen specific Surgical  GI procedures

Past Health History       Allergies Injuries/accidents Social history Health maintenance activities Communicable diseases Family health history  Malignancies of stomach, liver, pancreas; peptic ulcer disease, DM, irritable bowel syndrome, colitis

Common Medications          Histamine: two antagonists Antibiotics Antacids Antiemetics Anti-diarrheals Laxatives or stool softeners Steroids Chemotherapeutics Anti-flatulents

Social History        Alcohol use Drug use Travel history Work environment Hobbies/leisure activities Stress Economic status

Health Maintenance Activities       Sleep Diet Exercise Stress management Use of safety devices Health checkups

Gastrointestinal System Assessment  Stool sample  Evaluate for consistency, color, & odor   Occult blood Stetorrhea

Gastrointestinal System Assessment   Evaluate dietary program  Type of food, amount Assess urine  Amount, color, odor  Fluid intake

Gastrointestinal System Assessment  Signs of dehydration  Dry mucous membranes   Poor skin turgor Decreased urine output  Increase in pulse

Gastrointestinal System Assessment     Evaluate laboratory tests Presence of hemorrhoids Skin color  Yellow, pallor, flushing Sphincter control  Reports of control of bowel movements  Incontinence

Gastrointestinal System Assessment   Presence of pain  Nonverbal signs  Flinching & grimacing  Onset, location, intensity, duration, & aggravating factors Palpate for rebound tenderness

Gastrointestinal System Assessment   Signs of shock following trauma Patient’s knowledge of diagnostic test & procedures

Assessment of the Abdomen   Equipment Order   Inspection Auscultation   Percussion Palpation

Anatomy and Physiology Abdominal quadrants     Right upper Right lower Left upper Left lower

Anatomy and Physiology      Stomach Small intestine Large intestine Liver Gallbladder

Anatomy and Physiology      Pancreas Spleen Veriform appendix Kidneys, ureters, and bladder Lymph nodes

Inspection       Contour Symmetry Rectus abdominis muscles Pigmentation and color Scars Ascites

Inspection       Striae Respiratory movement Masses or nodules Visible peristalsis Pulsation Umbilicus

Abdominal Striae

Inspection  Normal findings         Abdomen is flat or round, symmetrical Uniform in color and pigmentation No scars or striae present No respiratory retractions No masses or nodules Ripples of peristalsis may be visible Non-exaggerated pulsation of the abdominal aorta may be present Umbilicus is depressed

Auscultation   Assess all four quadrants Listen for at least 5 minutes before concluding bowel sounds are absent

Stethoscope placement for Auscultating Abdominal Vasculature

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Abdominal Assessment Landmarks Xiphoid process Costal margin Abdominal midline Umbilicus Rectus Abdominis Muscle Anterior Superior Iliac Spine Inguinal Ligament Symphysis Pubis

Auscultation  Normal findings  Bowel sounds are heard in all quadrants   Usually sounds are high pitched Occur 5 to 30 times per minute

Auscultation   Abnormal findings: absent, hypoactive or hyperactive bowel sounds Pathophysiological indications   Absent and hypoactive bowel sounds may indicate decreased motility and possible obstruction Hyperactive bowel sounds indicate increased motility and possible diarrhea, gastroenteritis

Percussion    Percuss all four quadrants Assess liver span, liver descent, margins of spleen, stomach, kidneys, bladder Sounds heard: tympany or dullness

Normal Findings     Tympany heard over air-filled areas, such as stomach and intestines Dullness heard over solid areas, such as liver, spleen, or a distended bladder No tenderness elicited over kidneys and liver Empty bladder is not percussable above the symphysis pubis

Abnormal Findings   Dullness over areas where tympany is normally heard  This finding may indicate a mass or tumor, ascites, full intestine, pregnancy Liver span > 12 cm or < 6 cm  This finding may indicate hepatomegaly or cirrhosis

Abnormal Findings   Costovertebral angle tenderness  May indicate pyelonephritis Ability to percuss a recently emptied bladder  May indicate urinary retention

Palpation    Light vs. Deep Palpate all quadrants

Normal findings

  No tenderness Abdomen feels soft  No muscle guarding

Light palpation of the abdomen

Palpitation for Ascites; Fluid Wave

Abnormal Findings    Tenderness on palpation  May indicate inflammation, masses, or enlarged organs Muscle guarding on expiration  May indicate peritonitis Presence of masses, bulges, or swelling  May indicate enlarged organs, tumors, cholecystitis, hepatitis, cirrhosis

Abnormal Findings    Liver is palpable below the costal margin  May indicate CHF, hepatitis, cirrhosis, encephalopathy, cancer Spleen is palpable  May indicate inflammation, CHF, cirrhosis, mononucleosis Kidneys are palpable  May indicate hydronephrosis, neoplasms, polycystic kidney disease

Abnormal Findings    Aorta width > 4 cm  May indicate abdominal aortic aneurysm Able to palpate recently emptied bladder  May indicate urinary retention Palpable inguinal lymph nodes > 1 cm in diameter or tender nodes  May indicate systemic infections, cancer