🩺 Comprehensive Abdominal Assessment
Notes
5. Diarrhea
may result from ingestion of contaminated food or water.
acute infection, stress, fecal impaction, and certain drugs are possible causes.
chronic infection, obstructive or inflammatory bowel disease, malabsorption syndromes, endocrine
disorders, or GI surgery also may be involved.
2 Types of Diarrhea:
acute → stress
chronic → obstruction or inflammatory bowel disease
Periodic diarrhea
only occurs when you eat sour, spicy foods, and excessive intake of foods rich in fiber
Excessive intake of coffee
Sounds if you have diarrhea→ hyperactive bowel sounds
o cramping pain
o abdominal tenderness
o anorexia – eating disorder (kaya pumapayat)
Special Points During Diarrhea
In children, commonly results from infection
In elderly patients, consider ischemia before Crohn’s Disease (large intestines as main problem)
Constipation
caused by immobility, sedentary lifestyle, habitual laxative use, medications, or IBS
complete intestinal obstruction signaled by absence of flatus, stool, or bowel sounds
Hematochezia
may result from coagulation disorder, toxic exposure, or diagnostic test, may precipitate
Special Points Hematochezia:
less common in children, but may result from intussusception or Meckel’s diverticulum
rule out colon cancer in elderly patients
Dysphagia – difficulty of swallowing
caused by obstruction, achalasia of the lower esophagogastric junction, stroke, or Parkinson’s
disease; may lead to aspiration and pneumonia
Magfoforce ang epiglottis na mag open kaya nagkakaroon ng aspiration (?)
6. Achalasia
Lower esophageal sphincter fails to relax properly
ASSESSING THE GI SYSTEM
Involves examination of mouth, abdomen, and rectum
Involves inspection, auscultation, percussion, palpation
Assessing the Oral Cavity
Mouth and Jaw:
asymmetry and swelling, note bite
Lips, teeth, gums, and oral mucosa:
note bleeding, ulcerations; carious, loose, missing, or broken teeth; and color changes
Tongue:
coating, swelling, white or reddened areas, nodules, and ulcerations; note unusual breath odors
Pharynx
uvular deviation
Tonsils
lesions, plaques, and exudate
NOTE:
1. Ask the patient to empty his bladder.
2. Drape the genitalia and the breast of a female patient.
3. Place a small pillow under the patient’s head to help relax the abdominal muscles.
4. Ask the patient to keep his arms at his sides.
5. Keep the room warm. Chilling can cause abdominal muscles to become tense.
6. Warm your hands and the stethoscope.
7. Approach the patient slowly and calmly and avoid quick, unexpected movements.
8. Speak softly and encourage the patient to perform breathing exercises or use imagery during
uncomfortable procedures. Distract the patient with conversation or questions.
9. Ask the patient to point to any areas of pain.
10. Assess painful areas last to help prevent the patient from becoming tense.
11. Watch the patient’s face for signs of pain such as grimacing
INSPECTION
Region: 9 regions
Right Hypochondriac Region
Liver
Gallbladder
Right kidney
Epigastric Region
Stomach
Liver
Pancreas
Right kidney
Left kidney
Left Hypochondriac Region
Stomach
Liver
Left kidney
Spleen
Right Lumbar Region
Liver (tip)
Small intestines
Ascending colon
Right kidney
Umbilical Region
Stomach
Pancreas
Small intestines
Transverse colon
Left Lumbar Region
Small intestines
Descending colon
Left kidney
Right Iliac Region
Small intestines
Appendix
Cecum and ascending colon
Hypochondriac Region
Small intestines
Sigmoid colon
Bladder
Left Iliac Region
Small intestines
Descending colon
Sigmoid colon
4 QUADRANTS
Right upper quadrant:
o Right lobe of liver
o Gall bladder
o Pylorus
o Duodenum
o Head of the pancreas
o Hepatic flexure of the colon
o Portions of the ascending and transverse colon
ABDOMINAL FINDINGS: ABDOMINAL AREA
Swelling abdomen (bladder distention or hernia)
Protruding abdomen (obesity, pregnancy, ascites, abdominal distention, gas, tumor, or colon filled
with feces)
Protruding umbilicus (pregnancy, ascites, or an underlying mass)
Striae (pregnancy, excessive weight gain, or ascites)
Redness (inflammation); bruising on flank or Turner’s sign (retroperitoneal hemorrhage)
Dilated, tortuous, visible veins (inferior vena cava obstruction) - may be a manifestation of
progressing liver disease
Cutaneous angiomas (liver disease)
Visible rippling waves (bowel obstruction)
Marked pulsations (hypertension, aortic insufficiency, and aortic aneurysm)
Hernia
Muscles na naglolose kaya may lumalabas na organs like intestines which is nagproprotude -finifill
yung mga bakaneng space kaya nagkakaroon ng umbilical hernia
Ascites
Fluid accumulation in your stomach
Abdominal Hemorrhage
Pumutok yung abdominal aorta
Cullen’s sign
Bluish discoloration of the umbilicus region due to abdominal hemorrhage
Turner’s sign
Bruising in your flank or pantal pantal na kulay red
Striae
Stretchmarks
Pulsating aorta
Makikita sa epigastric region
🔊 AUSCULTATION
Performed in a clockwise fashion in each quadrant
Reveals character and quality of bowel sounds
Uncovers absent bowel signs
Detects bruits, venous hums, and friction rubs over renal, iliac, and femoral arteries
Bowel sounds are normally high-pitched, gurgling noises
Normal pulsations na maririnig in a minute: 5-30 pulsations
Bowel Sounds
Borborygmus – stomach gurgling; normal
Types of sounds: normal, hyper, hypo
ABNORMAL FINDINGS
1. Hyperactive
Loud, high-pitched, frequent, tinkling
Indicates increased motility (e.g. diarrhea, early obstruction, laxative use)
2. Hypoactive
Infrequent
Associated with ileus, bowel obstruction, peritonitis
Absent – critical, suggests cessation of peristalsis
Abnormal Findings
1. Hyperactive bowel sounds
→ Diarrhea, early obstruction, laxatives
2. Hypoactive bowel sounds
→ Ileus, obstruction, peritonitis
3. Friction rubs – over liver & spleen
4. Abdominal bruits – whining/whooshing (suggests aortic aneurysm)
Vascular Sounds (Use the Bell of the Stethoscope)
Assess over:
Aorta
Right and Left Renal Arteries
Right and Left Iliac Arteries
Right and Left Femoral Arteries
Interpretation of Abnormal Sounds
1. Abnormal bowel sounds
o Causes: diarrhea, laxative use, early obstruction, paralytic ileus,peritonitis, intestinal fluid, or
intestinal obstruction
2. Systolic bruits
o Causes: partial arterial obstruction or turbulent blood flow, renal artery stenosis,
hepatomegaly, or arterial insufficiency in the legs
3. Venous hum
o Increased collateral circulation between portal and system venous system, such as with
cirrhosis
4. Friction rub
o Suggests inflammation of peritoneal surface of an organ (e.g. liver or spleen)
🥁 PERCUSSION
Types
Direct – tapping directly on the skin
Indirect – striking a finger placed on the body surface
Purpose
Detect size, location, and density of abdominal organs
Identify presence of air, fluid, or masses
Follows clockwise direction over all quadrants
Abdominal Percussion Pattern
Use systematic approach
Move clockwise from quadrant to quadrant
Contraindications to Percussion
Appendicitis
Abdominal Aortic Aneurysm
Acute Pyelonephritis
Large abdominal tumors
Children with suspected Wilms’ Tumor in children (kidney tumor)
Pending peritoneal surgery
Transplants
Percussion Notes (Sounds)
Percussion Note Description Examples
Flat Soft, high-pitched, very short Thigh
Dull Muffled, medium-pitched Liver, spleen, rectum, uterus, fluid
Resonant Loud, low-pitched lung, air-filled areas
Hyperresonant Louder, lower-pitched Unhealthy lung
Tympany Loud, high-pitched, musical Stomach or gastric air bubble
Liver Span by Percussion
Normal: 5–7 cm (vertical span)
Abnormal: ↑ may suggest hepatomegaly, ↓ may suggest liver atrophy
🧍♂️LIVER & SPLEEN ASSESSMENT
Liver Percussion
Purpose: Estimate liver size
Start at right midclavicular line
1. Percuss downward from lung resonance → mark dullness
2. Percuss upward from below umbilicus → mark dullness
Normal span: 6.5–12 cm (2½ to 4¾ inches)
Abnormal Liver Findings
Hepatomegaly – enlarged liver (hepatitis, tumors, CHF)
Obscured liver borders – gas, tumors, infection, fluid in lungs
Spleen Percussion
Located in left upper quadrant
Normally not percussible due to overlying bowel gas
Produces dullness if enlarged
Abnormal Spleen Findings
Splenomegaly – enlargement due to:
o Mononucleosis
o Trauma
o Sickle cell anemia
o Cancer
Palpation Overview
Light Palpation – checks for:
o Tenderness
o Masses
o Rigidity
Deep Palpation – detects:
o Deeper masses
o Enlarged organs
o Areas of pain/tenderness
🤲 PALPATION TECHNIQUES & SPECIAL TESTS
Palpation Technique
Use fingers of one hand with gentle or bating movements
Start with light then proceed to deep palpation
⚠️
Palpation Contraindications
Do not palpate rigid abdomen – may signal peritoneal inflammation → risk of rupture
Do not palpate pulsating midline mass – indicates aortic aneurysm
Liver Palpation
Patient: Supine
Examiner: Stand at right side
Place left hand under patient’s back (approximate location of liver)
Place right hand below rib cage, press gently upward while patient inhales
Liver edge should be smooth, non-tender
Spleen Palpation
Not palpable unless enlarged
🧪 SPECIAL ABDOMINAL TESTS
Test Purpose
Blumberg’s Sign Rebound tenderness – peritonitis or appendicitis
Murphy’s Sign Pain on inspiration with RUQ palpation – cholecystitis (gallbladder)
Iliopsoas Muscle Test Pain with leg raise – appendicitis
Psoas Sign Pain with right thigh extension – appendicitis
Obturator Sign Pain with internal rotation of flexed right thigh – appendicitis
Rovsing’s Sign RLQ pain on palpation of LLQ – appendicitis
Ballottement Detects floating mass in ascites – retroperitoneal tumor or enlarged kidney
Ascites Test Fluid in peritoneal cavity due to liver disease, HF, pancreatitis, or cancer
Other Notes
Pulsation in epigastric area → may suggest pyloric stenosis
Ileocecal valve area – commonly heard bowel sounds