Abdominal Assessment

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

• Patients 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

6
Characteristics of Chief Complaint

• Quality
• Associated manifestations
• Aggravating factors
• Alleviating factors
• Timing

7
Past Health History

• Medical
• 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
• Patients 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
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
Inspection

• Contour
• Symmetry
• Rectus abdominis muscles
• Pigmentation and color
• Scars
• Ascites

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

30
(No Transcript)
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

1. Xiphoid process
2. Costal margin
3. Abdominal midline
4. Umbilicus
5. Rectus Abdominis Muscle
6. Anterior Superior Iliac Spine
7. Inguinal Ligament
8. 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 gt 12 cm or lt 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 AscitesFluid 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

• 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 gt 4 cm
• May indicate abdominal aortic aneurysm
• Able to palpate recently emptied bladder
• May indicate urinary retention
• Palpable inguinal lymph nodes gt 1 cm in diameter
  or tender nodes
• May indicate systemic infections, cancer