1. Assessment of the Abdomen (Gastrointestinal System)
Health Assessment Across the Lifespan

2. Structure and Function
Subjective Data—Health History Questions
Objective Data—The Physical Exam
Abnormal Findings

3. Structure and Function
Surface landmarks
Borders of abdominal cavity
Abdominal muscles
Internal anatomy (viscera)
Solid viscera
Liver
Pancreas
Spleen
Adrenal glands
Kidneys
Ovaries
Uterus

4. Structure and Function (cont.)
Internal anatomy (viscera) (cont.)
Hollow viscera
Stomach
Gallbladder
Small intestine
Colon
Bladder

5. Internal Anatomy
© Pat Thomas, 2006.

6. Deep Internal Anatomy
© Pat Thomas, 2006.

7. Structure and Function (cont.)
Abdominal wall divided into four quadrants
Right upper (RUQ)
Left upper (LUQ)
Right lower (RLQ)
Left lower (LLQ)

8. Quadrants

9. Subjective Data— Health History Questions
Appetite
Dysphagia
Food intolerance
Abdominal pain
Nausea/vomiting
Bowel habits
Abdominal history
Medications
Nutritional assessment
Dysphagia: Any difficulty swallowing? When did you first notice this?
Abdominal pain: Any abdominal pain? Please point to it.
Nausea/vomiting: Any nausea or vomiting? How often? How much comes up?
Bowel habits: How often do you have a bowel movement?
Abdominal history: Any history of gastrointestinal problems: ulcer, gallbladder disease, hepatitis/jaundice, appendicitis, colitis, hernia?
Nutritional assessment: Now I would like to ask you about your diet. Please tell me all the food you ate yesterday, starting with breakfast.

10. Objective Data—The Physical Exam
Preparation
Lighting and draping
Measures to enhance abdominal wall relaxation
Equipment needed
Stethoscope
Small centimeter ruler
Skin-marking pen
Alcohol swab

11. Objective Data—The Physical Exam (cont.)
Inspect the abdomen
Contour
Symmetry
Umbilicus
Skin
Pulsation or movement
Hair distribution
Demeanor

12. Contour

13. Objective Data—The Physical Exam (cont.)
Auscultate the abdomen
Bowel sounds
Vascular sounds (bruits)
Percuss the abdomen
General tympany
Liver span
Usual technique
Scratch test
Splenic dullness
Costovertebral angle tenderness
Special procedures
Fluid wave
Shifting dullness

14. Objective Data—The Physical Exam (cont.)
Palpate the liver
Measures to enhance muscle relaxation
Light palpation
Deep palpation
Bimanual palpation
Normally palpable structures
Liver
Usual technique
Hooking technique
Spleen
Kidneys
Aorta

15. Special Procedures for Advanced Practice
Rebound tenderness (Blumberg’s sign)
Inspiratory arrest (Murphy’s sign)
Iliopsoas muscle test
Obturator test

16. Normally Palpable Structures

17. Sample Charting

18. Sample Charting (cont.)

19. Abnormal Findings Abdominal Distention
Obesity
Air or gas
Ascites
Ovarian cyst
Pregnancy
Feces
Tumor

20. Abnormal Findings Abnormalities on Inspection
Umbilical hernia
Epigastric hernia
Incisional hernia
Diastasis recti

21. Abnormal Findings Abnormal Bowel Sounds
Succussion splash
Hypoactive bowel sounds
Hyperactive bowel sounds

22. Abnormal Findings Abnormalities on Palpation of Enlarged Organs
Enlarged liver
Enlarged nodular liver
Enlarged gallbladder
Enlarged spleen
Enlarged kidney
Aortic aneurysm