REVIEW ON PHYSICAL ASSESSMENT
Gastrointestinal System
Physical Examination
 includes assessment of the mouth,
abdomen, and rectum
 mouth, tongue, buccal mucosa,
teeth, and gums are inspected, and
ulcers, nodules, swelling,
discoloration, and inflammation are
noted >> INSPECTION &
PALPATION
 ABDOMEN >> I, A, PER, PA
RATIONALE of ABDOMEN >> I, A, PER,
PA
 Auscultation is done before
palpation and percussion because
palpation and percussion cause
movement or stimulation of the
bowel, which can increase bowel
motility and thus heighten the bowel
sounds, creating false results.
Abdominal Assessment
 Inspection: note the contour,
symmetry, skin changes and scars,
localized bulging, distention, or
peristaltic waves
 Auscultation: bowel sounds in all
four quadrants using the diaphragm
of the stethoscope
 normal (sounds heard about
every 5 to 20 seconds)
 hypoactive (one or two sounds in
2 minutes)
 hyperactive (5 to 6 sounds heard
in less than 30 seconds)
 absent (no sounds in 3 to 5
minutes).
 Percussion: Tympany (gas in
stomach and intestines) Or Dullness
(over solid masses or fluid)
 Palpation: Light Palpation is
appropriate for identifying areas of
tenderness or swelling; the nurse
may use Deep Palpation to identify
masses in any of the four quadrants
Palpation:
 Use a systematic pattern beginning
in the lower left quadrant, proceed to
the upper left quadrant, the upper
right quadrant, and the lower right
quadrant.
QUADRANTS OF THE ABDOMEN
Quadrants Underlying Organs
Right Lower lobe of right kidney,
Lower cecum, appendix, section of
ascending colon, right
ovary, right fallopian tube,
right ureter, right spermatic
cord, part of uterus
Right Liver, gallbladder,
Upper duodenum, head of
pancreas, right adrenal
gland, upper lobe of right
kidney, hepatic flexure of
colon, section of ascending
colon, section of transverse
colon
Left Left lobe of liver, stomach,
Upper spleen, upper lobe of left
kidney, pancreas, left
adrenal gland, splenic
flexure of colon, section of
transverse colon, section
of descending colon
Left Lower lobe of left kidney,
Lower sigmoid colon, section of
descending colon, left
ovary, left fallopian tube,
left ureter, left spermatic
cord, part of uterus
REGIONS OF THE ABDOMEN

Regions Underlying Organs

Left Stomach, spleen, tail of pancreas, splenic flexure of colon, upper half of
Hypochondriac left kidney, suprarenal gland

Right Right lobe of liver, gallbladder, part of duodenum, hepatic flexure of

Hypochondriac colon, upper half of right kidney, suprarenal gland

Epigastric Aorta, pyloric end of stomach, part of duodenum, pancreas, part of liver

Left Lumbar Descending colon, lower half of left kidney, part of jejunum and ileum

Right Lumbar Ascending colon, lower half of right kidney, part of duodenum and jejunum

Umbilical Omentum, mesentery, lower part of duodenum, part of jejunum and ileum

Left Iliac Sigmoid colon, left ureter, left spermatic cord, left ovary

Right Iliac Cecum, appendix, lower end of ileum, right ureter, right
spermatic cord, right ovary

Hypogastric (Pubic) Ileum, urinary bladder uterus