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 Eructation-producing gas from the stomach-belching

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

Past Health History Medical Surgical 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

Note position of heart in relation to stomach

Referred pain is felt where the internal abdominal organs were located in fetal development

Inspection Contour Symmetry Rectus abdominis muscles Pigmentation and color Scars Ascites Ask students to define terms

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

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 Spleen is palpable 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