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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 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 Muscle guarding on expiration 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