1. Abdominal Assessment
Cathy Gibbs BSN, RN

2. 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

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

4. Common Chief Complaints
Nausea and vomiting
Anorexia
Dysphagia
Diarrhea or constipation

5. Common Chief Complaints
Abdominal distension
Abdominal pain
Increased eructation or flatulence
Dysuria
Nocturia
Eructation-producing gas from the stomach-belching

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

7. Past Health History Medical Surgical Abdomen specific
Nonabdomen specific
Surgical
GI procedures

8. 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

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

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

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

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

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

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

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

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

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

18. Assessment of the Abdomen
Equipment
Order
Inspection
Auscultation
Percussion
Palpation

19. Anatomy and Physiology
Abdominal quadrants
Right upper
Right lower
Left upper
Left lower

20. Anatomy and Physiology
Stomach
Small intestine
Large intestine
Liver
Gallbladder

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

22. Note position of heart in relation to stomach

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

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

27. Inspection Striae Respiratory movement Masses or nodules
Visible peristalsis
Pulsation
Umbilicus

28. Abdominal Striae

29. 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

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

32. Stethoscope placement for Auscultating Abdominal Vasculature

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

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

35. 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

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

37. 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

38. 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

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

40. Palpation Light vs. Deep Palpate all quadrants Normal findings
No tenderness
Abdomen feels soft
No muscle guarding

41. Light palpation of the abdomen

42. Palpitation for Ascites; Fluid Wave

43. 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

44. 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

45. 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