ASSESSING THE ABDOMEN OR THE

GASTROINTESTINAL (GI) SYSTEM

A LOOK AT THE GI SYSTEM

● GI system’s major functions include ingestion and digestion of food

and elimination of waste products.
● When these processes are interrupted , the patient can experience
problems.

HOW TO ASSESS :

1. OBTAINING A HEALTH HISTORY - stomach cramps , pain , nausea or

vomiting strongly suggest a GI problem , it maybe that they just
eaten too much.
- If your patient has GI problem , he or she will usually complain
about abdominal or chest pain , belching ,cramping
,heartburn , nausea , cramitting or outer bowel habits
- To investigate these or other signs and symptoms : Ask him or
her about allocation , quality , onset duration , frequency and
severity range
- Ask him or her what relieves signs and symptoms

● Asking about past health - to determine if your patient’s problem is

new or recurring , ask about your past GI illnesses such as ulcer and
etc
- Ask about if he or she has abdominal surgery or trauma
- Ask about taking any medications

● Asking about current health - gnawing problems ( changes in

appetite , difficulty of chewing and swallowing , bowel movements)
- Travel plans (find how he recently traveled or in abroad or how
he travel)
- Asking about the family health - some GI disorders are
inherited
- Asking about psychosocial health - financial problems ,
alcohol , caffeine and oral hygiene
CULTURE AND THE GI HISTORY

- When taking a health history , consider your patient’s ethnic

background

ASSESSING THE GI system

To perform an abdominal assessment , use this sequence :

IAPP ( Inspection , Auscultation , Percussion and Palpation)

BEFORE BEGINNING YOUR EXAMINATION :

● Explain techniques
● Warn the patient
● Provide privacy - perform in a quiet and private room

EXAMINING THE MOUTH

Use inspection and palpation to assess the mouth. Be sure to put on

gloves before examining the patient.

● First , inspect the patient’s mouth and jaw for color , symmetry , and
swelling
● Assess the tongue , checking for coating , tremors , swelling and
ulcerations.
● Note unusual breath odors

EXAMINING THE ABDOMEN

To ensure an accurate assessment , take these :

● Ask the patient to empty his or her bladder

● Drape the genitalia and if the patient is female , her breasts
● Place a small pillow under the patient’s knees to help relax the
abdominal muscles
● Ask the patient to keep his or her arms at his or her sides
● Keep the room warm . chilling can cause abdominal muscles to
become tense.
● Warm your hands and the stethoscope head
● Speak softly , and encourage the patient to perform breathing
exercises or one injury during uncomfortable procedures.
 ● Ask the patient to point to any areas of pain
● Assess painful areas last to help prevent the patient from tensing his
or her abdominal muscles

INSPECTION
- Begin by mentally dividing the abdomen into four quadrants and
then imagining the organs in each quadrant.

● EPIGASTRIC - above the umbilicus and between the costal margins

● UMBILICAL - around the navel
● SUPRAPUBIC - above the symphysis pubis

KEY CHARACTERISTIC

Visible , rippling waves of peristalsis may signal a bowel obstruction . Be

sure to report such a finding immediately.
 ● Battle of the bulge
● Innie or Outie ? (umbilicus)
● Stretch to the limit
● Riding the peristaltic wave

AUSCULTATION

● Listen for at least 5 mins on each quadrant

● Silent the suction
● Pardon myborbygmus
● Too much activity or not enough ?
PERCUSSION

● DIRECT PERCUSSION
● INDIRECT PERCUSSION

● You normally hear two sounds during percussion of the abdomen :

tympany and dullness
PALPATION

Abdominal palpation includes light and deep touch to help determine the
size , shape , position , and tenderness of major abdominal organs and to
detect masses and fluid accumulation. Palpate all four quadrants , leaving
painful and tender areas for last.
ELICITING REBOUND TENDERNESS IN CHILDREN

● Perform the test for rebound tenderness when you suspect

peritoneal inflammation. Check for rebound at the end of your
examination.
● Be alert for such clues as an anguished facial expression , a
grimace, or intensified crying.
● When attempting to assess this symptoms , use techniques that
elicit minimal tenderness (hopping or jumping)
CHECKING ASCITES
● ASCITES - a large accumulation of fluid in the peritoneal cavity
- Caused by kidney failure , cancer and etc.
Examining the rectum and anus

● Patients age 40 and older should undergo a rectal examination

ABNORMAL FINDINGS IN GI DISORDERS :

● Nausea or vomiting
● Dysphagia

TYPES OF ABDOMINAL PAIN

● BURNING PAIN - factors caused by : peptic ulcer , gastroesophageal

reflux disease
● CRAMPING PAIN - caused by biliary colic , irritable bowel syndrome ,
diarrhea , constipation, flatulence
● SEVERE CRAMPING - caused by Appendicitis , Crohn’s disease ,
diverticulitis
● STABBING - caused by Pancreatitis and Cholecystitis

KEY POINTS TO REMEMBER !!

GASTROINTESTINAL SYSTEM
● ANATOMY AND PHYSIOLOGY :
- INGESTION AND DIGESTION OF FOOD
- ELIMINATION OF WASTE PRODUCTS

● HEALTH HISTORY
Ask the patient about :
- Past GI illnesses , surgery and trauma
- Medications , including laxative , enema and suppository use
- Current GI signs or symptoms
- Family medical history , especially history of ulcerative colitis ,
colorectal cancer , peptic ulcers , and gastric cancer
- Diet , exercise patterns , and alcohol , caffeine , and tobacco
use.
● PHYSICAL ASSESSMENT
a. Mouth
- Inspect the mouth and jaw as well as the inner and outer lips ,
teeth , gums and oral mucosa
- Inspect the tongue
- Palpate for areas of tenderness or lesions.
 b. Abdomen

- Inspect the abdomen for color , symmetry , shape and

contour
- Note abdominal movements and pulsations
- Auscultate in each of the four abdominal quadrants to
assess bowel sounds and over the abdominal arteries to
check for bruits , venous hums , and friction rubs
- Percuss the abdomen , listening for tympany over hollow
organs (such as an empty stomach or intestine) and for
dullness over solid organs ( such as the liver) or
feces-filled intestines
- Palpate in all four quadrants of the abdomen, leaving
painful areas for last
- Check for rebound tenderness if you suspect peritoneal
inflammation; also check for ascites , a large
accumulation of fluid in the peritoneal cavity

c. Rectum and Anus

- Inspect the perineal area

- Palpate the rectum using a water-soluble lubricant on
your gloved index finger
● ABNORMAL FINDINGS :
A. Nausea and vomiting - may be caused by existing illness or by
certain medications
B. Dysphagia - difficulty of swallowing; has various causes ; may
lead to aspiration and pneumonia
C. Cullen’s sign - a bluish umbilicus;indicates intra-abdominal
hemorrhage
D. Turner’s sign - bruising on the flank; indicates retroperitoneal
hemorrhage
E. Constipation - may cause a dull abdominal ache , a full feeling
, and hyperactive bowel sounds
F. Diarrhea - may cause cramping , abdominal tenderness ,
anorexia and hyperactive bowel sounds
G. Abdominal distention - may occur with gas , a tumor , or a
colon filled with feces
H. Abnormal bowel sounds - may be hyperactive (indicating
increased intestinal motility) hypoactive , or absent
I. Friction rubs - may indicate splenic infarction or hepatic
tumor
J. Abdominal pain - may result from abdominal trauma , ulcers ,
intestinal obstruction , appendicitis . cholecystitis , peritonitis ,
or disorders.