Chapter 17
Abdomen
Copyright 2002, Delmar, A division of Thomson Learning
Competencies


Identify the physiological function
of the gastrointestinal organs.
Assess the health status of a patient
with a gastrointestinal complaint.
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Competencies



Demonstrate the techniques of
gastrointestinal assessment.
Relate abnormal physical gastrointestinal findings to pathological
processes.
Outline the gastrointestinal
variations associated with the aging
process.
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology




Abdominal cavity
Peritoneum
Abdominal vasculature
Abdominal quadrants




Right upper
Right lower
Left upper
Left lower
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology





Stomach
Small intestine
Large intestine
Liver
Gall bladder
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology





Pancreas
Spleen
Veriform appendix
Kidneys, ureters, and bladder
Lymph nodes
Copyright 2002, Delmar, A division of Thomson Learning
Health History

Patient profile

Age



Child to young adult: appendicitis
Adult: peptic ulcers, cholecystitis, DM,
gastrointestinal malignancies
Gender


Female: gallbladder disease
Male: GI cancers, cirrhosis, duodenal ulcers
Copyright 2002, Delmar, A division of Thomson Learning
Common Chief
Complaints




Nausea and vomiting
Anorexia
Dysphagia
Diarrhea or constipation
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Common Chief
Complaints





Abdominal distension
Abdominal pain
Increased eructation or flatulence
Dysuria
Nocturia
Copyright 2002, Delmar, A division of Thomson Learning
Characteristics of
Chief Complaint





Quality
Associated manifestations
Aggravating factors
Alleviating factors
Timing
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History

Medical



Abdomen specific
Nonabdomen specific
Surgical

GI procedures
Copyright 2002, Delmar, A division of Thomson Learning
Common Medications





Histamine: two antagonists
Antibiotics
Lactulose
Antacids
Antiemetics
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Common Medications






Antidiarrheals
Laxatives or stool softeners
Pancreatic enzymes
Steroids
Chemotherapeutics
Antiflatulents
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History




Communicable diseases
Allergies
Injuries/accidents
Family health history

Malignancies of stomach, liver,
pancreas; peptic ulcer disease,
DM, irritable bowel syndrome,
colitis
Copyright 2002, Delmar, A division of Thomson Learning
Social History







Alcohol use
Drug use
Travel history
Work environment
Hobbies/leisure activities
Stress
Economic status
Copyright 2002, Delmar, A division of Thomson Learning
Health Maintenance
Activities






Sleep
Diet
Exercise
Stress management
Use of safety devices
Health checkups
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History





Allergies
Injuries/accidents
Family health history
Social history
Health maintenance activities
Copyright 2002, Delmar, A division of Thomson Learning
Assessment of the
Abdomen


Equipment
Order




Inspection
Auscultation
Percussion
Palpation
Copyright 2002, Delmar, A division of Thomson Learning
Inspection





Contour
Symmetry
Rectus abdominis muscles
Pigmentation and color
Scars
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Inspection






Striae
Respiratory movement
Masses or nodules
Visible peristalsis
Pulsation
Umbilicus
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
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
Nonexaggerated pulsation of the abdominal
aorta may be present
Umbilicus is depressed
Copyright 2002, Delmar, A division of Thomson Learning
Auscultation


Assess all four quadrants
Listen for at least 5 minutes before
concluding bowel sounds are absent
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Auscultation

Normal findings



Bowel sounds are heard in all
quadrants
Usually sounds are high pitched
Occur 5 to 30 times per minute
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
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
Copyright 2002, Delmar, A division of Thomson Learning
Percussion



Percuss all four quadrants
Assess liver span, liver descent,
margins of spleen, stomach,
kidneys, bladder
Sounds heard: tympany or dullness
Copyright 2002, Delmar, A division of Thomson Learning
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
Copyright 2002, Delmar, A division of Thomson Learning
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
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Abnormal Findings

Liver descent > 2 to 3 cm


Dullness > 8 cm line


May indicate splenic enlargement
Costovertebral angle tenderness


May indicate hepatomegaly or cirrhosis
May indicate pyelonephritis
Ability to percuss a recently emptied
bladder

May indicate urinary retention
Copyright 2002, Delmar, A division of Thomson Learning
Palpation



Light vs. Deep
Palpate all quadrants
Normal findings



No tenderness
Abdomen feels soft
No muscle guarding
Copyright 2002, Delmar, A division of Thomson Learning
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
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
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
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
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
Copyright 2002, Delmar, A division of Thomson Learning
Advanced Techniques






Rebound tenderness
Rovsing’s sign
Cutaneous hypersensitivity
Iliopsoas muscle test
Obturator muscle test
Ballotment
Copyright 2002, Delmar, A division of Thomson Learning
Gerontological
Variations






Abdominal musculature diminishes in
mass and tone
Increased fat deposition in abdominal
area
Altered GI motility resulting in
indigestion and altered absorption
Decreased gastric acid secretion
Increased incidence of malignant disease
Changes in bowel habits
Copyright 2002, Delmar, A division of Thomson Learning