it will help the medical and nursing students to use techniques for abdominal assessment

1. Assessment of the Abdomen
(Gastrointestinal System)
Presented by: Rabia Lohani & Sehrish Naz
M.Sc Nursing Year I Semester I
Presented to : Sir Sardar Ali
Lecturer INS-KMU Peshawar

2. OBJECTIVES
• To know about the:
• Anatomy and physiology of the digestive system.
• Techniques for assessing the abdomen.
• Normal and abnormal findings of assessment.
• Nursing diagnosis related to gastrointestinal tract.
• Nursing management and teaching points for abdominal problems.
• Summary of the topic.

3. Surface Anatomy

6. Anatomy of the digestive system

8. Subjective Data—
Health History Questions
• Appetite
• Dysphagia
• Food intolerance
• Abdominal pain
• Nausea/vomiting
• Bowel habits
• Abdominal history
• Medications
• Nutritional assessment
Slide 21-8
MAGDI AWAD SASI 2014

9. Objective Data—The Physical Exam
• Preparation
• Lighting and draping
• Measures to enhance abdominal wall relaxation
• Equipment needed
• Stethoscope
• Small centimeter ruler
• Skin-marking pen
• Alcohol swab
Slide 21-9

10. General examination techniques
Wiper technique

11. General rules for abdominal examination
Charlie Goldberg, MD
Professor of Medicine, UCSD SOM
• Uncover the abdomen from above the xiphoid process to symphysis pubis.
• Use sheet to cover lower 1/2
• Good lighting, warm room, table flat, hands at side, head resting on table

13. Assessment techniques
• Inspection
• Auscultation
• Percussion
• Palpation

14. Cont….

15. Normal findings on Inspection

16. Abnormal Findings
• Abdominal Distention
• Obesity
• Air or gas
• Ascites
• Ovarian cyst
• Pregnancy
• Feces
• Tumor
• Hernia
Slide 21-16
Charlie Goldberg, MD
Professor of Medicine, UCSD SOM

17. Obese

18. Ascites (fluid)

19. Cont..
Enlarged gall bladder

21. Auscultation
• Normal intestinal propulsion of food (peristalsis) generates noise
(Borborygmi)
• Listen (diaphragm of stethoscope) x 15-20 seconds in 4 quadrants
• Pay attention to:
presence, quantity (normal ~ 2-5 seconds), & quality of sounds

23. Why we use auscultation technique?

24. Cont…
Intestinal Obstruction
• –After handled (surgery)
• –Infection of mucosa (gastroenteritis) ,Auscultation not helpful in
otherwise normal exam

25. Abnormal Findings On Auscultation
• •Bruits - sounds of turbulent arterial flow atherosclerosis
Listen over:
• –Renal arteries (several cm above umbilicus, either side rectus)
• –Iliac arteries (below umbilicus)

26. Percussion Technique
• •Stand on right side
• •Middle finger of non-percussing hand firmly against abdomen
• •Using floppy wrist action, hammer middle finger of other hand down,
aiming for last joint
• •Percuss all 4 quadrants – normal =‘s mix of dull and tympanitic

28. Percussion – Shifting Dullness
• Detect large amounts of pathological fluid (ascites)
• •Intestines will float to surface
• •Percussion can detect air-fluid interface
• •Change in position shifts point of interface
• “Intestines”
• “Ascites

31. Palpation
• Most important structures aren’t palpable
• •Warm your hands
• •Generally right hand used (left placed on top or @
your side)
• •Palpate using pads & edges of middle 3 fingers
• •Gentle pressure, no sudden movements
• •Think about what “lives” in area you’re examining

32. Palpation Technique
Superficial
• (start R lower R upper L upper L lower)
Deeper palpation
• Liver

33. Acute Abdomen Dr.Teresa Galdona PA-C

34. Acute Abdomen Dr.Teresa Galdona PA-C

35. Acute Abdomen Dr.Teresa Galdona PA-C

36. Acute Abdomen Dr.Teresa Galdona PA-C

37. Abnormal Findings
Abnormalities on Palpation
of Enlarged Organs
• Enlarged liver
• Enlarged nodular liver
• Enlarged gallbladder
• Enlarged spleen
• Enlarged kidney
Slide 21-37
http://meded.ucsd.edu/clinicalmed/ros.htm

38. Abdominal exam techniques compliment each
other
• •Ascites
• –Observe distention, bulging flanks
• –Palpation no evidence of mass
• –Percussion shifting dullness
http://meded.ucsd.edu/clinicalmed/ros.htm

39. Cont…
• •Enlarged liver (hepatomegaly)
• –Percussion indicates extension of liver below diaphragm
• –Palpation confirms location of lower edge (also detects contour,
texture)
http://meded.ucsd.edu/clinicalmed/ros.htm

40. Nursing diagnosis
• Abdominal distention related to accumulation of gas and/or fluid in
the gastrointestinal tract as evidence by decreased gastrointestinal
motility resulting from the depressant effect of some medications
(e.g. narcotic [opioid] analgesics) and decreased activity.

41. Nursing management
Pain related to abdominal distension.
Intervention:
• Observation of vital signs.
• Assess the level of pain.
• Set a comfortable position for the client.
• Give a warm compress on the area of the abdomen.
• Give painkiller as prescribed.
Gil Wayne, RN
Aug 3, 2016

42. Nursing Actions and Selected Purposes/Rationales
1.Assess for signs and symptoms of abdominal distention or gas pain (e.g.
verbal reports of abdominal fullness or gas pain, grimacing, clutching or
guarding of abdomen, restlessness, reluctance to move, increasing
abdominal girth).
2.Implement measures to reduce the accumulation of gas and fluid in the
gastrointestinal tract in order to decrease abdominal distention and gas
pain:
Gil Wayne, RN
Aug 3, 2016

43. Teaching points
• Encourage and assist client with frequent position changes and ambulation
as allowed and tolerated (activity stimulates peristalsis and expulsion of
flatus)
• Instruct client to avoid activities such as chewing gum, drinking through a
straw, and smoking in order to reduce air swallowing
• Maintain food and oral fluid restrictions as ordered
• Maintain patency of nasogastric tube if present
Gil Wayne, RN
Aug 3, 2016

44. When oral intake is allowed, instruct client to avoid the following:
1. carbonated beverages and gas-producing foods (e.g. cabbage, onions,
baked beans)
2. foods/fluids high in fat (e.g. butter, cream, whole milk, ice cream, fried
foods, gravies, nuts)
Gil Wayne, RN
Aug 3, 2016

45. Administer the following medications if ordered:
1. Atiflatulents (e.g. simethicone) to reduce gas accumulation
2. Pancreatic enzymes (e.g. pancreatin, pancrelipase) to improve fat
digestion
3. Encourage use of nonnarcotic analgesics once the period of severe pain
has subsided (narcotic [opioid] analgesics depress gastrointestinal
motility).
Gil Wayne, RN
Aug 3, 2016

46. Summary Of Skills
• □ Wash Hands
• □ Observe abdomen (shape, contours, scars, color, etc)
• □ Auscultate abdomen (bowel sounds, bruits)
• □ Percuss abdomen (general; then liver & spleen)
• □ Palpate 4 quadrants abdomen (superficial then deep)
• □ Assess for kidney area pain