The document provides guidance on assessing the abdomen, anus, and rectum. It outlines the objectives of the assessment, including discussing pertinent health history questions, describing specific examination techniques, documenting findings, and listing age-related changes. It then provides detailed instructions on inspecting, auscultating, percussing, and palpating the abdomen, as well as examining the rectum. It describes how to assess for common abnormalities and conditions affecting different areas of the gastrointestinal system.

1. Health Assessment-I
Assessment of the Abdomen, Anus & Rectum unit#06
Objectives
By the end of the unit, learners will be able to: 1. Discuss the pertinent health history questions necessary to
perform the assessment of Abdomen, Anus and Rectum.
2. Describe the specific assessment to be made during the physical examination of the abdomen.
3. Discuss components of a rectal examination.
4. Document findings.
5. List the changes in abdomen that are characteristics of aging process.
GI System
Abdominal Assessment
• Subjective Assessment:
Ask about:
– Appetite
– Wt gain or loss

2. – Dysphagia
– Intolerance to certain foods
– Any Abdominal Pain of Nausea and Vomiting
– Bowel movements
– Any past abdominal problems
– Blood in stool
Subjective Assessment…Cont
• Infants and Children –
– Ask: bottle or breast fed, any table foods, how often & how well & how much the baby eat, any
problems with constipation, c/o of any abdominal pain
• Teenagers-
– Ask: nutritional assessment, activity & exercise patterns, recent wt. loss or gain
Subjective Assessment…Cont
• Older Adults
– Ask: how do you get your groceries?
prepare your meals?
– Do you have any trouble swallowing?
– How often do your bowels move?
– How often do you take anything for constipation? Rx / OTC/ herbs
– what meds do you take?
Subjective Assessment…Cont
Take History of:
– Nutrition
– Allergies
– Medications
– Cigarette/tobacco
– Alcohol intake

3. – Recreational drug use
– Stool characteristics
– Urine characteristics
– Exposure to infectious diseases.
– Recent stressful life events
– Possibility of Pregnancy
Common Abnormalities…..Cont
Abdomen
– Distention
• Enlarged abdomen
– Excessive gas accumulation
– Tympany
– Ascities
• Accumulation of fluid within the abdominal cavity
– Bruit
• Humming or swishing sound heard through stethoscope over vessels
– Narrowing of the vessels
– Boyborygmi
– Waves of loud, gurgling sound
• Hyperactive bowel
– Rebound tenderness
• Sudden pain when fingers are withdrawn quickly
– Appendicitis
– Hernia
– Bulge or nodule in abdomen
• Appearing on straining
• Inguinal, femoral, umbilical, or incisional

4. Common Abnormalities…..Cont
Rectum and Anus
• Hemorrhoids
– Thrombosed veins in rectum and anus
• Internal or external
• Tenesmus
– Painful and ineffective straining at stool
• Steatorrhea
– Fatty, frothy, foul smelling stool
Manifestations of GI Dysfunction
• Anorexia
– Absence of the desire to eat
– Weight, dull,thin brittle hair, tired, apathetic facial expression; dry skin and nails; muscle wasting
– Lab work-malnutrition
• Albumin < 3.5 g/dL
• Lymphocyte count < 1500 mm3
• Changes in electrolytes
• Intestinal gas
– Flatus is gas passed through the rectum
– Swallowed air, or gas forming foods
– 0.6 L is passed daily
• Bleeding
– Upper or lower GI tract
– Acute- >1000mL or discrete of 100mL
– Chronic over a period of weeks or months
– Types
• Occult

5. • Melena
• Hematochezia (Fresh blood in stool)
• Retorrhagia (rectal bleeding)
• Hematemesis
Physical Assessment of the Abdomen
• Review A & P of Structures
– Organs
– Lymph nodes
– Arteries
• Function
– GI
– GU
– Vascular supply
• Signs/Symptoms of problems
– Masses
– Size
– Pain/ Referred Pain
– Other
Review Key Organs
• Small intestine
• Large Intestine
• Liver
• Gall bladder
• Spleen
• Stomach
• Pancreas
• Ovary

6. • Appendix
• Kidney-Ureter-Bladder
• Peritoneum
Normally Palpable organs
Before Physical Examination of Abdomen:
• Provide privacy
• Good lighting/appropriate temp in room
• Expose the abdomen
• Empty bladder
• Position pt supine, arms by side & head on pillow with knees slightly bent or on a pillow
• Warm stethoscope & hands
• Painful areas last
• Distraction techniques
Assessment of the Abdomen
• IAPP
• Inspect, Auscultate, Percuss, Palpate

7. • Special techniques if symptoms present on the history or abnormal physical findings
Assessment of the Abdomen
• Anatomical Mapping
– 4 quadrants
• RUQ, LUQ, RLQ, LLQ
– 9 regions
• Landmarks
– Xiphoid process
– Umbilicus
– Midline
– Costal margins
– Anterior superior iliac spine
Division of the Abdomen

8. 9 Region
Assessment Skills for the Abdomen
• Percuss
– Tympany
– Organs
• Full bladder- dull

9. • Fist percussion over the costovertebral angle (kidneys)
• Ascites
• Palpate
– Organs
– Masses, Lymph nodes
– Aorta, Femoral artery
Begin IAPP
• Inspection:
– Shape- rounded, flat, scaphoid
• Distention: unusual stretching of the abdominal wall- 6 F’s- feces, flatus, fat, fluid,
fibroid tumor, and fetus
• Symmetrical
• Note Location of asymmetrical distention
– Note position the person is assuming
– Is the person Restless or Still
– To observe for masses or enlarged liver or spleen have the person take a deep breath
• Inspect from the feet
– Asymmetry
Shape of Abdomen

10. Inspection…..Cont.
• Skin
– Pigmentation, jaundice might be more visible related to lack of sun exposure
– Lesions
– Striae
– Scars
– Veins
• Dilated veins- portal hypertension- liver
• Spider angioma (swollen blood vessels)
• Talenjectasis (tiny blood vessels)
Striae
Inspection…..Cont.
• Respiratory movement
– Males- Abdominal
• Lack of abdominal movement may indicate peritonitis
– Females- costal
• Visible peristalsis
– Waves of movement- bowel obstruction
• Pulsations

11. – Pulsations throughout the length of the abdominal aorta is normal in thin people
Auscultation
• Bowel sounds
• Vascular Sounds
• Liver Position
Auscultation….Cont.
• Bowel Sounds
– Diaphragm of the stethoscope
– Represent the passage of fluids and gases through the intestinal tract
– Best heard at the RLQ- ileocecal valve- bowel sounds more likely to be heard
– 5-15 per minute
– High pitched- gurgling noises
Auscultation of Bowel Sounds
• Systematic
• Listen over 9 areas
Abnormal Findings Related to Bowel Sounds
• Absent
– Listen for 5 minutes
– Bowel obstruction
– Low Potassium
– Surgical manipulation

12. – Lower lobe pneumonia
• Tinkling sounds, rushes of tinkling sounds
– Early bowel obstruction, low Potassium
• Increased Bowel sounds
– Increased motility of fluids
– Diarrhea
Bowel sounds
• Absent
– No BS for 5 min
• Hypoactive
– less than 5/min
• Active
– 5-30 per min
• Hyperactive
– > 30 /min
Auscultation of the Liver Position
• Scratch test
– Place diaphragm of stethoscope over the liver area on the Lower rib cage
– Use Index finger
– Scratch up the abdomen on the mid-clavicular line
– When the sound becomes really loud you have roughly identified the liver border
Auscultation of Vascular Sounds
Bell of stethoscope
– Aorta
– Renal
– Iliac
– Femoral

13. Auscultation of Vascular Sounds

14. Vascular Auscultation (Bruits)
• Common Bruits
– Aorta
• Aneurysm
• Do not palpate if you hear a bruit- rupture the aneurysm
– Renal
• Stenosis
• Radiates laterally
Percussion
• Systematic, done before palpation to prevent rupturing an aorta or spleen
• Tympany
– Percussing mostly small or large bowel- hollow structures filled with air
– Dull- abnormal, solid structure, fluid filling hollow structures, feces filling hollow structures, urine
in bladder, enlarged organ, baby
• Ascites
– Flank Dullness
– Shifting Dullness
– Fluid waves

15. Flank Dullness
Shifting Dullness
Fist Percussion of Kidneys
• Done in R & L Costovertebral angles to assess kidney tenderness
– C/O pain in this area coupled with urinary tract symptoms
– Many times pressure from fingertips is painful and then you do not need to percuss
– Kidney Infection
CVA – Costovertebral Angle

16. Palpation
• Most organs are not palpable by normal techniques
• RUQ- enlarged liver, gallbladder
• RLQ- ovarian cyst, cystic appendix
• LLQ- sigmoid colon distended with feces
• Above the pubis- distended bladder
• LUQ- distended Spleen-Dangerous!!!!!!!!!!!
Palpation…..Cont.
• Types
– Light
– Deep
– Hooking- liver
– Rebound Tenderness
– Specific points related to organ pathology
• Systematic
• Looking for
– Organs, Masses, Pulsations, flexibility
Palpation……Cont.

17. • Person needs to relax, flex knees
• Palpate painful areas last
• Light
– One hand
– flexibility of abdominal muscles, not rigid
• Deep
– One hand on top of the other
• Hooking: Liver
– Place fingers curved under the rib cage
– Have patient inhale
– Feel the border of the liver descend to your fingers
– Note smoothness, or nodules
Light and Deep Palpation
Normal Palpable Structures

18. Palpate Pulses
• Aorta
• Femoral
Palpate
Inguinal nodes
Palpating Rebound Tenderness
• Do this when symptoms present
• Place fingers perpendicular to skin
• Push in slowly
• Let out quickly
• Pain on release of pressure is positive for peritoneal irritation
Specific Points Related to Organ Pathology
• Murphy’s sign
– Gallbladder disease
– Hooking technique for liver palpation

19. – Inhale
– Gallbladder moves down, hits the palpating hand- person stops inhaling
• McBurney’s point
– Appendicitis
– RLQ spot between anterior-superior iliac crest and umbilicus
Peritoneal Irritation
• Abdomen is boardlike
• Absent Bowel sounds
• Knee-chest position
• Quiet- little movement, but C/O pain
• Severe pain
• Rebound tenderness
• Positive obturator and iliopsoas test
– appendicitis
• Nausea and vomiting
Bowel Obstruction
• General S/S
– Distention
– Tingling to absent bowel sounds
– Pain, no rebound tenderness
• Small bowel S/S
– Acute onset, Vomiting, minimal distention, severe bouts of colicky pain, restless
• Lower bowel S/S
– Slower onset, Distention, less frequent bouts of pain, less to no vomiting, restless, relieved by BM
RUQ Conditions
• Gall Bladder Disease S/S
– Stones:

20. • Severe colicky pain in RUQ in increasing intensity, R shoulder, nausea, jaundice, fever,
fair, fat, forty, Murphy’s sign
– Choleycystitis:
• Same as stones, peritoneal signs.
RUQ Conditions……Cont.
• Liver: S/S
– Anorexia, jaundice, ascites, fatigue, vascular patterns, CHF
LUQ Conditions
• Splenic Rupture: S/S
– LUQ pain referred to L shoulder- Kehr’s sign
– Hypotension, syncope
• Acute Pancreatitis S/S
– LUQ pain- referred to back, scapula, and chest- knifelike
– Fever, rigidity, rebound tenderness, nausea, vomiting, distension, decreased to absent bowel
sounds
– Elevated lipase and amylase
RLQ Conditions
• Appendicitis
• Ectopic Pregnancy
• Perforated Duodenal Ulcer
• Right Ureteral Kidney Stone
RLQ…….Cont.
• Appendicitis S/S
– Anorexia, nausea, Periumbilical colicky to aching pain-12-24 hrs-McBurney’s point, positive
peritoneal signs-iliopsoas and obturator, fever, elevated white cell count
• Ectopic Pregnancy S/S
– Symptoms of pregnancy, RLQ pain- shoulder
– Peritoneal signs, shock- low BP and high pulse

21. RLQ…..Cont.
• Perforated Duodenal Ulcer S/S
– Distension, peritoneal signs, blood in stool, pain in epigastric area and RLQ
• R Ureteral Kidney Stone S/S
– Nausea, vomiting, fever, colicky severe pain in RLQ and groin area, restless, blood in urine
LLQ Conditions
• L Ureteral Kidney Stone
• L Ectopic Pregnancy
• Diverticulitis
– Infected diverticulum
– S/S
• LLQ pain, fever, diarrhea, constipation, pain over descending colon
Examination of Rectum
• If your patient is age 40 or older, perform a rectal examination as part of your GI assessment. Be sure to
explain the procedure to the patient before you begin.
• Inspection
• Palpation
Abnormal Finding
• Abdominal Distention
• Abdominal Pain

22. • Type of abdominal Pain
• Abnormal Abdominal sounds
• Skin color Changes
• Other Common GI abnormalities
Documents the findings
References
• Caple, C. (2011). Physical assessment: Performing- cultural considerations. Glendale,
• CA: Cinahl Information Systems.
• Jarvis, C. (2011). Physical examination and health assessment, (6th ed.). St. Louis:
• W.B. Saunders.