Gastrointestinal System

Health Assessment
Objectives

• Upon completion of this lecture , you will be able to:

• Recall the anatomy and physiology of the abdomen.
• Identify landmarks that guide assessment of the abdomen.
• Develop questions to be used when completing the focused
interview.
• Explain client preparation for assessment of the abdomen.
• Differentiate normal from abnormal findings in physical
assessment of the abdomen.
• Describe the variation in techniques required for
assessment of the abdomen.
• Document findings
:General principles of exam

• Good light
• Relaxed patient in Supine position
• Full exposure of abdomen
• Empty bladder
• Arms across chest, not above head.
• Ask patient where pain is, and examine last.
• If the patient is ticklish or frightened, initially use
the patients hand under yours as you palpate. When
patient calms then use your hands to palpate.
• Watch the patient’s face for discomfort
Abdomen

• Gastrointestinal system
• Structures of other body systems
 Gastrointestinal System

• Alimentary canal
• Mouth
• Pharynx
• Esophagus
• Stomach
• Small and large intestines
• Rectum
• Anus
 Gastrointestinal System

• Accessory organs
• Teeth
• Salivary glands
• Liver
• Gallbladder
• Pancreas
.Organs of the alimentary canal and related accessory organs
Related Structures

• Peritoneum
• Abdominal wall muscles
• Aorta
• Kidneys
• Ureters
• Bladder
• Spleen
• Reproductive organs
.Muscles of the abdominal wall
.Abdominal vasculature and deep structures
Abdomen

• Largest cavity of the body

• Contains structures from the digestive system and other
body systems
Abdomen

• Inferior to the Diaphragm and Superior to the Pelvic

Floor
Mapping

• Dividing the Abdomen Into Four Quadrants and Nine

Regions
 Four Quadrants

• Midsternal line from the xiphoid process through the

umbilicus to the pubic bone
• Horizontal line perpendicular to the first line through
the umbilicus
• Two perpendicular lines form four equal quadrants of
the abdomen
 Four Quadrants

• Quadrants named
• Right upper quadrant (RUQ)
• Right lower quadrant (RLQ)
• Left upper quadrant (LUQ)
• Left lower quadrant (LLQ)
.Figure 19.4 Mapping of the abdomen into four quadrants
Four-Quadrant Method

• Gallbladder
• Kidneys
• Costovertebral angle
• Liver
• Spleen
• Midline structures
• Abdominal aorta
• Urinary bladder
• Uterus
.Mapping of the abdomen into nine regions
Upper torso: Organs of the four abdominal quadrants. Lower torso: Organs of the nine
.abdominal regions
Focused Interview

• General questions
Focused Interview

• Specific questions
• Illness or infection
• Symptoms
• Pain
• Behaviors
• Infants and children
• Pregnant female
• Older adult
• Environment
Equipment

• Examination gown and drape

• Examination gloves
• Examination light
• Stethoscope
• Skin marker
• Metric ruler
• Tissues
• Tape measure
Other Considerations

• Age
• Gender
• Language
• Culture
Abnormal Abdominal Findings

• Abnormal sounds
• Pain
• Distention
• Hernias
Abnormal Abdominal Sounds
Pain in Common Abdominal Disorders
Abnormal Abdominal Sounds

• Hypo- and hyperactive bowel sounds

• Vascular sounds of bruits and venous hums
• Friction rubs
Abdominal Pain

• Direct
• Referred
Abdominal Distention

• Obesity
• Gas
• Tumor
• Ascites
. Obesity
.Distended abdomen
.Abdominal tumor
.Ascites
.Ascites )continued(
 Abdominal Hernias
• Umbilical
• Ventral
• Hiatal
.Umbilical hernia
Alterations of the
Gastrointestinal Tract
• Nutritional problems
• Eating disorders
• Cancers
• Ulcers
• Inflammatory and infectious diseases
Nutritional Disorders

• Malnutrition
• Anorexia
• Obesity
Cancers of the
Gastrointestinal Tract
• Esophagus
• Stomach
• Colon
Inflammatory Processes

• Ulcerative colitis
• Esophagitis
• Peritonitis
• Hepatitis
Physical Assessment of the
Abdomen
• Techniques
• Inspection
• Auscultation
• Percussion
• Palpation
Areas of the Abdominal
Assessment
• Inspection of the abdomen
• Auscultation of the abdomen
• Percussion of the abdomen
• Percussion of the liver
• Percussion of the spleen
• Palpation of the abdomen
• Palpation of the liver
• Palpation of the spleen
Areas of the Abdominal
Assessment
• Palpation of the aorta
• Palpation for rebound tenderness
• Percussion for ascites
.Auscultating the abdomen for bowel sounds
Auscultation
• Listen for bowel sounds and note
their frequency and character
• Normal sounds consist of clicks and
gurgles
• The frequency of which has been
estimated at from 5 to 34 per minute
• Because bowel sounds are widely
transmitted through the abdomen,
listening in one spot, such as the
right lower quadrant, is usually
sufficient.
 Auscultation
• If the patient has high blood pressure, listen in the
epigastrium and in each upper quadrant for bruits

• If you suspect arterial insufficiency in the legs, listen

for bruits over the aorta, the iliac arteries, and the
femoral arteries
.Light palpation of abdomen
.Deep palpation of abdomen
 Physical Examination of the Abdomen: Deep Palpation-Palpating
the liver-(Standard technique)

 Use your left hand to lift the lower rib cage and flank.
 Press down just below the right costal margin with your right hand.
 Ask the patient to take a deep breath.
 You may feel the edge of the liver press against your fingers. A normal liver is not tender.
 Physical Examination of the Abdomen: Deep Palpation-Palpating
the liver-(hooking technique)

• The “hooking technique” can be helpful when a patient is obese.

• Place both hands, side by side, on the right abdomen below the border of liver
dullness.
• Press in with the fingers and go up toward the costal margin. Ask the patient to
take a deep breath. The liver edge should be palpable under the finger pads of
both hands.
Physical Examination of the Abdomen: Deep
Palpation-Palpating the spleen
 Use your left hand to lift the lower rib cage and flank.
 Press down just below the left costal margin with your right hand.
 Ask the patient to take a deep breath.
 The spleen is not normally palpable on most individuals.
.Percussion pattern for ascites
 Special Tests-Shifting Dullness
This is a test for peritoneal fluid (ascites).
(Ascites: is a gastroenterological term for an accumulation of fluid in the peritoneal cavity)
Percuss the patient's abdomen to outline areas of dullness and tympany.
Position the patient on the right or left side.
Percuss and again outline areas of dullness and tympany. If the dullness has shifted to areas
of prior tympany, the patient may have excess peritoneal fluid.
-Special Tests-Rebound Tenderness
This is a test for peritoneal irritation and appendicitis.
(Appendicitis a condition characterized by inflammation of the appendix)
Warn the patient what you are about to do (should be in supine position).
Press deeply on the lower right side of the abdomen with your hand (at a 90-
degree angle).
After a moment, quickly release pressure.
Ask if the client feels any pain. Normally, the client feels the pressure but no
pain.
Special Tests-Rovsing's sign
This is a test for appendicitis.
Applying hand pressure to the lower left side of the
abdomen.
Pain felt on the lower right side of the abdomen upon the
release of pressure on the left side indicates the presence of
Rovsing's sign.
Special Tests-Psoas Sign
This is a test for appendicitis.
Place your hand above the patient's right knee.
Ask the patient to flex the right hip against resistance.
Increased abdominal pain indicates a positive psoas sign.
Special Tests-Obturator Sign
This is a test for appendicitis.
Raise the patient's right leg with the knee flexed.
Rotate the leg internally at the hip.
Increased abdominal pain indicates a positive obturator
sign.
 Glossary
• abdomen The largest cavity of the body and contains
many organs and structures that belong to various
systems of the body.
• accessory digestive organs The structures connected to
the alimentary canal by ducts.—the liver, gallbladder,
and pancreas— that contribute to the digestive process
of foods.
• alimentary canal A continuous, hollow, muscular tube,
begins at the mouth and terminates at the anus.
• anorexia nervosa A complex psychosocial problem
characterized by a severely restricted intake of
nutrients and a low body weight.
• ascites An abnormal collection of fluid in the
peritoneal cavity.
• bruit A vascular sound; pulsatile and blowing.
• dysphagia Difficulty swallowing.
 Glossary
• esophagitis Inflammatory process of the
esophagus, caused by a variety of irritants.
• friction rub A rough, grating sound caused
by the rubbing together of organs or an
organ rubbing on the peritoneum.
• hernia (Rupture) is a protrusion of an
organ or structure through an abnormal
opening or weakened area in a body wall.
• malnutrition An imbalance, whether a
deficit or excess, of the required nutrients
of a balanced diet.
• mapping The process of dividing the
abdomen into quadrants or regions for the
purpose of examination.
 Glossary
• obesity Weight of 20% or more above
recommended body weight.
• overweight A weight of 10% to 20% in excess of
recommended body weight.
• peritoneum A thin, double layer of serous
membrane in the abdominal cavity.
• peritonitis A local or generalized inflammatory
process of the peritoneal membrane of the
abdomen.
• referred pain Pain located where the
development of structures occurred in the fetus.
• striae (Stretch Marks) are silvery, shiny, irregular
markings on the skin, and are seen in obesity,
pregnancy, and ascites.