Medical Assessment Techniques: Abdominal Exam

Unit V: Assessment of the Abdomen, Anus & Rectum

• The unit covers the assessment of the abdomen, anus, and rectum.
• Students will learn how to gather pertinent health history information for this assessment.
• They will also learn specific assessment techniques for the abdomen during a physical examination.
• The unit includes details on the components of a rectal examination.
• It also includes expected changes in the abdomen associated with the aging process.

Digestive System

• The digestive system processes food, transporting it into and out of the body. It also uses the food for bodily functions.
• The gastrointestinal tract includes the mouth, pharynx, esophagus, stomach, small intestine, and large intestine.
• Accessory structures to the tract include teeth, tongue, salivary glands, liver, gallbladder, and pancreas.

Health History

• Biographical data and current health status are key elements.
• Previous medical history is crucial.
• Family history of relevant conditions should be collected.
• A thorough symptom analysis, including nutritional history and gastrointestinal symptoms (e.g., dysphagia, vomiting) is essential.
• Questions to ask patients regarding bowel habits and pain, medications, and previous procedures/surgeries are pertinent.

Health History (cont'd)

• Nutritional history includes information about appetite, weight changes.
• Gastrointestinal symptoms such as dysphagia, nausea, vomiting, or indigestion should be investigated.
• Bowel habits regarding patterns and stool characteristics are crucial.
• Pain location, quality, and relationship to eating should be collected.
• Record any relevant medications (e.g., aspirin, anti-inflammatory drugs).
• Document past digestive diagnostic tests or surgeries performed.

Health History (cont'd)

• Questions about appetite, loss of appetite (anorexia) should be included in the history.
• Information on vomiting, including the color of the vomitus (coffee-ground, red blood), and reasons should be collected.
• For indigestion, inquiries into exacerbating and relieving factors of the pain are important.
• Questions about heartburn (stomach acid reflux) and its relationship to meals should be asked.

Bowel Function History Questions

• Questions about daily bowel movements and their frequency are vital.
• Difficulties during bowel movements and any recent changes in habits need to be documented.
• Common terms should be clear and defined (e.g., melena, hematochezia).
• Malena indicates black, tarry stools, and hematochezia describes fresh red blood in the stool.

Abdominal Pain Questions

• Nature (e.g., aching, throbbing, stabbing, burning) and severity (1-10 scale) of the pain need to be assessed.
• The onset, location, duration, exacerbating and relieving factors, and any radiating pain should be clear.
• Any associated symptoms need to be recorded.

Focused Abdominal History

• Determine pertinent digestive and elimination symptoms.
• Ask about abdominal pain, previous gastrointestinal surgeries or medical history, and family history of relevant conditions (e.g., ulcer, gallbladder disease).
• Inquiries about problems with swallowing; heartburn, nausea, vomiting, jaundice, abdominal bloating, and allergies or intolerances are critical.
• Detailed notes and data should be recorded.

Signs and Symptoms of GIT System

• Signs and symptoms related to the gastrointestinal tract are covered (e.g., bleeding, abdominal pain, dysphagia).
• The presence of abdominal bloating, nausea, vomiting, anorexia, lethargy, steatorrhea, weight loss, increased bilirubin (jaundice), and temperature.
• Heartburn is also listed in the abnormal findings.

Significance of Pain by Abdominal Quadrant

• Different quadrant pain may indicate several conditions affecting gastrointestinal organs (e.g., heart, lungs, pancreas, spleen, liver, gallbladder).
• Different areas of the abdomen have specific organs and anatomical features that assist in determining the cause of abdominal pain.

Assessment Techniques

• Initial assessment begins with washing hands, introduction, and gaining patient permission to expose area and adjust the room temperature. Taking a proper patient history, including any pain the patient may experience, and ensuring the patient is comfortable. These procedures start the assessment.
• Examination techniques include inspection, auscultation, percussion, and palpation.

Equipment Needed

• Necessary equipment for the assessment includes gloves, tongue depressors, stethoscopes, measuring tapes, skin marking pens, alcohol swabs, notepads, and flashlights.

Four-Quadrant Method

• Organ localization in the abdominal quadrants is indicated to identify potential issues. Specific organs are associated with each quadrant.

Nine Regions of the Abdomen

• Another method of segmenting the abdomen; to evaluate the anatomy of the abdominal area is further broken down by body regions.

Abdominal Assessment

• General rules/information regarding the positioning of the patient for assessment, good lighting, and avoidance of abdominal tensing is covered.
• The assessment of the abdomen starts with a visual inspection
• To adequately assess the patient, palpation techniques are explained, along with areas of the abdomen to be examined.

General Inspection

• Observation techniques and notable findings are examined, such as: nutritional state, pallor, jaundice, skin/tissue pigmentation, and presence of bruises or discoloration, noted during the general inspection process. Other findings should be noted (e.g., lesions, scars, striae).

Abdominal Assessment (cont'd)

• Visible indicators such as distension, rigidity, guarding, ecchymosis, and rebound tenderness are crucial signs/symptoms in an assessment.
• Presence or absence of masses (palpable lumps or solid irregular formations) and masses are significant findings, that may point to internal issues/problems.

Inspection (cont'd)

• Key elements include symmetry, contour, and distension. Inspection assesses the patient's overall appearance (skin characteristics) for abnormalities like scars, striae, and specific signs (color changes).

Abdominal Assessment: Umbilicus

• The inspection of the umbilicus and any abnormalities is detailed.

Abdominal Assessment: Symmetry

• The assessment considers the patient's symmetry between the left and right side of the abdomen.
• A lack of symmetry might indicate abnormalities.

Abdominal Assessment: Contour and Distension

• Evaluating abdominal contour from different angles to identify its shape (flat, round, or scaphoid), along with any distention.
• Distension, its causes, and specific situations (pregnant, infants, etc.) are also analyzed.

Abdominal Assessment: Surface Movements

• Respiratory, pulsation, and peristalsis details during the assessment's procedures are included.
• Variations and abnormalities observed during inspection are included.

Auscultation of the Abdomen

• Procedures and appropriate instruments for the auscultation process for bowel sounds are covered, along with helpful hints.
• Determining normal versus abnormal bowel sounds is critically significant.

Arterial and Venous Vascular Sounds

• Auscultation techniques covering the abdominal aorta, renal arteries, iliac arteries, and femoral arteries are explained.
• Recognizing normal versus abnormal vascular sounds (bruits) and venous hums is highlighted.

Percussion of the Abdomen

• Percussion techniques are evaluated(direct/indirect)
• Recording areas of dullness/tympany (characteristic sounds) depending on abdominal content.
• Interpretation techniques of abnormal sounds are included.

Percussion for Liver, Spleen, and Bladder

• Procedures for evaluating liver size (upper and lower edge), spleen, and bladder dullness are specified.

Palpation of the Abdomen

• Methods are outlined (light/deep palpation, bimanual)
• Relevant findings, as well as specific areas checked/assessed during palpation procedures, are included (e.g., superficial characteristics, areas of tenderness, organomegaly, masses).

Palpating the Abdominal Aorta

• Method for locating and palpating the aortic pulsation.
• Alert cautions for patients with possible abdominal aortic aneurysms.

Palpating the Liver, Spleen, Kidneys

• Assessing relevant structures and noting their consistency, tenderness, and size, during palpation.
• Abnormal findings, including factors pointing to possible issues, are noted.

Palpating the Bladder

• Procedure for palpating and assessing potential bladder abnormalities.
• Expected physical characteristics of a filled bladder and the related palpable findings are presented.

Palpating Inguinal Lymph Nodes

• Evaluation of inguinal lymph nodes and normal findings.

Other Physical Assessment Techniques: Abdominal Reflexes

• Methodology and interpretation of abnormal findings (diminished or absent responses) in abdominal reflexes.

Other Physical Assessment Techniques: Ballottement

• The assessment method, normal findings, and interpretation of abnormal findings for free-floating masses are presented.

Other Physical Assessment Techniques: Kehr's Sign

• Observing potential referral pains (e.g., referred pain to the left shoulder) and how to elicit the sign.

Other Physical Assessment Techniques: Ballance's Sign

• Identifying the techniques used, possible causes, and the meaning of a positive sign.

Other Physical Assessment Techniques: Murphy's Sign

• Procedures for eliciting Murphy's sign and recognizing associated abnormalities.

Abdominal Signs of Appendicitis: McBurney's Sign

• Methods for performing the test and documenting findings.

Other Physical Assessment Techniques: Obturator Muscle Test, Rovsing's Sign, Iliopsoas Muscle Test, Rebound Tenderness

• How to conduct these tests, expected results, and the significance of abnormal results in relation to possible conditions.

Documentation of Physical Exam (Anus, Rectum, Prostate)

• Guidelines explaining how to record physical exam findings for the anus, rectum, and prostate regions, with normal and abnormal findings for documentation.

General Principles (Anus, Rectum, Prostate)

• The structure and function of the anal canal, including its lining, the role of the sphincters, and the location of sensory nerves are reviewed.

Examination of the Anus & Rectum: History

• The history aspect of assessment, which includes (changes) in bowel habits, the character of stool (blood), rectal pain, constipation, diarrhea, hemorrhoids, screenings (PR Proctoscopy), use of laxatives/medications, and prostate problems are discussed.

Rectal Examination

• Procedures and steps involved in a rectal examination based on the patient's gender.

Examination of Anus & Rectum: Inspection

• Instructions on how to inspect the perianal and sacrococcygeal areas for abnormalities.

Examination of Anus & Rectum: Palpation

• Techniques for palpating surrounding tissue, the rectal wall, and the prostate gland are reviewed, including what to observe in each area, documenting abnormal findings, and how to identify abnormalities for each of the respective areas.

Recording Physical Examination (Anus, Rectum, Prostate)

• Guidelines for documenting normal and abnormal findings from rectal examinations are presented.

Table of Abnormalities on Rectal Examination

• The table provides examples of conditions/abnormalities that could be found during the rectal examination.

Rectal Examination: Abnormalities

• Descriptions of possible abnormal findings are presented, including specific examples of benign and malignant conditions.

References

• The list of references used to create the study notes in the previous sections is presented.