Download Abdominal Assessment

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 gastrointestinal 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


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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
Abdominal Assessment
Landmarks
1.
2.
3.
4.
5.
6.
7.
8.
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

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Muscle guarding on expiration

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May indicate inflammation, masses, or
enlarged organs
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


Spleen is palpable


May indicate CHF, hepatitis, cirrhosis,
encephalopathy, cancer
May indicate inflammation, CHF, cirrhosis,
mononucleosis
Kidneys are palpable

May indicate hydronephrosis, neoplasms,
polycystic kidney disease
Abnormal Findings

Aorta width > 4 cm


Able to palpate recently emptied
bladder


May indicate abdominal aortic
aneurysm
May indicate urinary retention
Palpable inguinal lymph nodes > 1
cm in diameter or tender nodes

May indicate systemic infections, cancer