Abdomen, Anus & Rectum Assessment PDF

UNIT-V: Assessment of the Abdomen, Anus & Rectum By: Farzana Kausar Lecturer INS-KMU  OBJECTIVES At the end of this presentation, students will be able to:  Discuss the pertinent health history questions necessary to perform the assessment of the Abdomen, Anus, and...

UNIT-V: Assessment of the Abdomen, Anus & Rectum By: Farzana Kausar Lecturer INS-KMU  OBJECTIVES At the end of this presentation, students will be able to:  Discuss the pertinent health history questions necessary to perform the assessment of the Abdomen, Anus, and Rectum.  Describe the specific assessment to be made during the physical examination of the abdomen.  Discuss components of a rectal examination.  Document findings.  List the changes in abdomen that are characteristics of aging process. 01/16/2025 Farzana Kausar 2 Digestive System: The system of organs responsible for getting food into and out of the body and for making use of food to keep the body healthy. 01/16/2025 Farzana Kausar 3 HEALTH HISTORY  Biographical data  Current health status  Past history  Family history  Symptoms Analysis 01/16/2025 Farzana Kausar 4  HEALTH HISTORY Ask the client about  Nutritional History: appetite, weight loss or gain.  Gastrointestinal Symptoms: dysphagia, nausea, vomiting, and indigestion.  Bowel Habits: pattern, and stool characteristics.  Pain: location, quality, pattern, and relationship to ingestion of food.  Use of Medications: Aspirin, Antiinflammatory drugs, and steroids.  Gastrointestinal diagnostic tests and surgeries. 01/16/2025 Farzana Kausar 5  HEALTH HISTORY  How is your appetite (loss of appetite is called anorexia)  Ask For vomiting:  Coffee ground or red blood vomiting is called Hematemesis  Incase of indigestion (Epigastric pain): ask for the COLDERRA, especial focus on exacerbating and relieving factors of hurt burn.  Heartburn is a painful burning feeling in chest or throat. It happens when stomach acid backs up into the esophagus. 01/16/2025 Farzana Kausar 6  BOWEL FUNCTION HISTORY QUESTIONS  How are your bowel movements?  How frequent are they?  Do you have any difficulties during bowel movements?  Have you noticed any change in your bowel habits? Common terms:  Malena: Means black tarry stools  Hematochezia: Fresh red blood in the stool 01/16/2025 Farzana Kausar 7  ABDOMINAL PAIN ( ASK FOR COLDERRA) Some sample questions are:  What is the pain like (character)? Nature of pain (e.g. Aching, throbbing, stabbing, or burning). How severe is the pain ?How about on a scale of 1 to 10?  Onset  Where does the pain start (location)?  Duration  Exacerbating factors  Does it radiate or travel any where (radiation)?  Relieving factors  Associating factors 01/16/2025 Farzana Kausar 8 01/16/2025 Farzana Kausar 9 01/16/2025 Farzana Kausar 10  SIGNS AND SYMPTOMS OF GIT SYSTEM  B------>Bleeding  A------>Abdominal Pain  D------>Dysphagia  C------>Constipation  A------>Abdominal Bloating A LS  N------>Nausea and vomiting A N  A------>Anorexia D C  BA L------>Lethargy T H   S------>Steatorrhea W----->Weight Loss WI  I------->Increased Bilirubin (jaundice)  T------>Temperature  H------>Heart Burn 01/16/2025 Farzana Kausar 11 01/16/2025 Farzana Kausar 12 ASSESSMENT STARTS WITH  W---> Wash Hand  I----> Introduce Yourself  P----> Permission/Privacy RS I P E  E----> Expose area under ExaminationW  R----> Right Side Approach  S-----> Setup Light, Temperature 01/16/2025 Farzana Kausar 13 HEALTH HISTORY  S-----> Sign & Symptoms i.e. Nausea &Vomiting, Pain  A----->Allergy i.e. Food & Medications LE P  M-----> Medications History i.e. NSAIDs SAM  P------> Past History i.e. Hospitalization, surgeries  L------> Last Oral Intake i.e. When, What, How  E------> Event to Presents i.e. History of chief complaints 01/16/2025 Farzana Kausar Slide 21-14  ASSESSMENT TECHNIQUE  Inspection  Auscultation  Percussion (Direct/Indirect)  Palpation (Light/Deep) 01/16/2025 Farzana Kausar 15  EQUIPMENT’S NEEDED  Gloves  Tongue Depressor  Stethoscope  Measuring Tape  Skin-marking pen  Alcohol swab  Note Book  Flash Light 01/16/2025 Farzana Kausar 13 01/16/2025 Farzana Kausar 17 01/16/2025 Farzana Kausar 18 01/16/2025 Farzana Kausar 19 01/16/2025 Farzana Kausar 20  ABDOMINAL ASSESSMENT Perform the abdominal examination in a warm, private environment. Have your patient empty her or his bladder before the examination so that you do not mistake a full bladder for a mass. Ask the patient to lie supine with her or his arms at the sides. Warm both your stethoscope and your hands before proceeding with the examination, and remember to work from the right side of your patient. Good Lighting Position (supine, knee bent, arms at the side) Avoidance of abdominal tensing (Make the patient relax) Inquire about painful area Expose the abdomen Covering the genitalia 01/16/2025 Farzana Kausar 21  ABDOMINAL ASSESSMENT Patient needs to be exposed from above the xiphoid process to the symphasis pubis. If patient have patient pointed out any areas of pain or tenderness. Examine these last. During exam continue to monitor your patient’s facial expression for pain and discomfort. Use inspection, auscultation, percussion, and palpation to perform the exam. Always auscultate before percussing or palpating. These manipulations may alter your patient’s bowel motility and resulting bowel sounds. 01/16/2025 Farzana Kausar 22  POSITION FOR ABDOMINAL ASSESSMENT 01/16/2025 Farzana Kausar 23  GENERAL INSPECTION  Nutritional state (wasting)  Pallor  Jaundice (liver disease)  Pigmentation (hemochromatosis)  Cullen’s Sign: Bruising over the umbilicus  Grey Turner’s Sign: Discoloration over the flanks 01/16/2025 Farzana Kausar 24 ABDOMINAL ASSESSMENT  D-->Distension: Liver problems, bowel obstruction  R-->Rigidity: Bleeding  G-->Guarding: Muscular tension when touched RM  E-->Ecchymosis R GE  R-->Rebound Tenderness: InfectionD  M-->Masses 01/16/2025 Farzana Kausar 25 INSPECTION 7S 4Ps  Symmetry & movements with Respiration  Prominent Vein (Caput  Scars Medusa)  Striae  Pulsation Visible (Aortic  Stoma aneurysm)  Peristalsis Visible  Shape of Umbilicus (Inverted/flat/everted)  Shape of the flank (Full, Straight)  Pigmentation (Cullen sign’s)  Skin Lesions 1D  Distension (Nine Fs: fat, fluid, fetus, flatus, fibroid, full bladder, false pregnancy, fatal tumor and feces) 01/16/2025 Farzana Kausar 26 01/16/2025 Farzana Kausar 27 01/16/2025 Farzana Kausar 28 01/16/2025 Farzana Kausar 29 01/16/2025 Farzana Kausar 30 01/16/2025 Farzana Kausar 31 01/16/2025 Farzana Kausar 32 01/16/2025 Farzana Kausar 33 01/16/2025 Farzana Kausar 34 01/16/2025 Farzana Kausar 35  Farzana Kausar 36 01/16/2025 01/16/2025 Farzana Kausar 37 01/16/2025 Farzana Kausar 38 01/16/2025 Farzana Kausar 39 01/16/2025 Farzana Kausar 40 01/16/2025 Farzana Kausar 41 ABDOMINAL EXAMINATION PALPATION  Ensure that your hands are warm  Stand on the patient’s right side  Help to position the patient  Ask whether the patient feels any pain before you start  Begin with superficial examination  Move in a systematic manner through the abdominal quadrants  Repeat palpation deeply. 01/16/2025 Farzana Kausar 42  43 Farzana Kausar Farzana Kausar 01/16/2025 44 01/16/2025 Farzana Kausar 45 01/16/2025 Farzana Kausar 46 01/16/2025 Farzana Kausar 47 Farzana Kausar 01/16/2025 48 01/16/2025 Farzana Kausar 49 01/16/2025 Farzana Kausar 50 01/16/2025 Farzana Kausar 51 01/16/2025 Farzana Kausar 52 01/16/2025 Farzana Kausar 53 01/16/2025 Farzana Kausar 54 01/16/2025 Farzana Kausar 55 01/16/2025 Farzana Kausar 56 DOCUMENTATION 01/16/2025 Farzana Kausar 57 ANUS, RECTUM & PROSTATE ASSESSMENT 01/16/2025 Farzana Kausar 58  GENERAL PRINCIPLES Anal canal is the final segment of digestive system. It measures from 2.5 cm to 4 cm long. It is lined with skin that contains no hair or sebaceous glands but does contain many somatic sensory nerves, making it very sensitive to touch. Within the anus are the two sphincters that normally hold the anal canal closed except when passing gas and feces. 01/16/2025 Farzana Kausar 59 EXAMINATION OF ANUS & RECTUM History:  Bowel habits (Changes).  The character of stools(Blood).  Rectal Pain  C/O Constipation, Diarrhea  Hemorrhoids  Screening, (PR Proctoscopy)  Use of Laxatives or medications  Prostate problems 01/16/2025 Farzana Kausar 60 RECTAL EXAMINATION Assist patient into position:  Male – left lateral, or standing upper body resting on a table.  Female – Lithotomy  Then… Inspection Palpation: Males Females 01/16/2025 Farzana Kausar 61  EXAMINATION OF ANUS & RECTUM INSPECTION: Position- Side lying is preferred or lithotomy if genitalia exam in a female or standing with the upper body resting on a table for men. Inspect perianal tissue/Sacrococcygeal area by retracting buttocks. Look for skin characteristics, Lumps, lesions, hemorrhoids, ulcers, Rashes, Redness, inflammation, and pigmentation. Ask the client to bear down prolapse of the rectum or hemorrhoids. 01/16/2025 Farzana Kausar 62  EXAMINATION OF ANUS & RECTUM PALPATION: Surrounding tissue for lumps and tenderness. Per rectal examination, anal sphincter, tone, grasp, laxity. Rectal wall, irregularity, tenderness nodular, lesions. Perform DRE in male. The prostate gland is round, heart- shaped, 2.5-4cm, firm & non-tender, and palpable on the anterior rectal wall. Observe fecal matter on gloved finger for color (blood) & consistency. 01/16/2025 Farzana Kausar 63 01/16/2025 Farzana Kausar 64 01/16/2025 Farzana Kausar 65 01/16/2025 Farzana Kausar 66  REFERENCES 1. F.A. Davis (2002). Nursing Health Assessment: A Critical Thinking, Case Study Approach, second edition. 2. Waugh. A, Grant. A. (2001). Ross and Wilson: Anatomy and Physiology in health and illness.(9th ed.).Churchill Livingstone.Page # 281-338. 3. Quigley.B.H, Bicklay, L.S, Palm.M.S. (2012). Bates’ nursing guide to: Physical Examination and History Taking.(7th ed.). Lippincott: Philadelphia. Page # 431-454. 4. Inayatullah. M, Nasir. S.A. (2019). Bedside Techniques: Methods of Clinical Examination. (5th ed.). Paramount Books (Pvt) Ltd. Page #92- 102. 5. Smeltzer. S.C, Bare. B.G.(2004). Brunner & Suddarth, Textbook of Medical Surgical Nursing (10th ed). Lippincott. Page # 1010-1024 01/16/2025 Farzana Kausar 67 01/16/2025 Farzana Kausar 68