Advance Concept in Health
Assessment
1
Abdomen Assessment
SAFFORA SHOUKAT
04/17/2025
Objectiv
By the end of thees
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.
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Anatomy of the
Abdomen
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4
Quadrants
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9
Regions
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Location! Location!
Location!
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Location! Location!
Location!
RLQ
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Location! Location!
Location!
LLQ
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Position of
Kidney
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History
Are you experiencing abdominal pain?
Questions
How would you describe the pain? How bad is the
pain (severity) on a scale of 1 to 10, with 10
being the worst?
How did (does) the pain begin?
Where is the pain located? Does it move or has it
changed from the original location?
When does the pain occur (timing and relation to
particular events such as eating, exercise,
bedtime)?
What seems to bring on the pain (precipitating
factors), make it worse (exacerbating factors),
or make it better (alleviating factors)?
Is the pain associated with any other symptoms
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such as nausea, vomiting, diarrhea, constipation, 12
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Characteristics of Pain (Dull Aching)
Appendicitis Irritable
Acute hepatitis bowel
Biliary colic syndrome
Cholecystitis
Hepatocellul
ar cancer
Cystitis
Pancreatitis
Dyspepsia
Pancreatic
Glomerulonephri
cancer
tis
Perforated gastric
Incarcerated or
or duodenal
strangulated
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Characteristics of
Burning Pain
Dyspepsia
Peptic ulcer disease
Cramping
Acute mechanical
obstruction
Appendicitis
Colitis
Diverticulitis
Gastroesophageal reflux
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Characteristics of Pain (Pressure)
Benign prostatic
hypertrophy
Prostate cancer
Prostatitis
Urinary retention
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Characteristics of Pain
Colicky
Colon cancer
Sharp, Knifelike
Splenic abscess
Splenic rupture
Renal colic
Renal tumor
Ureteral colic
Vascular liver
tumor
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History
Questions
Do you experience indigestion?
Describe.
Does anything in particular seem to
cause or aggravate this condition?
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History
Questions
Do you experience nausea? Describe.
Is it triggered by any particular
activities, events, or other factors?
Have you been vomiting? Describe
the vomitus. Is it associated with any
particular trigger factors?
Have you noticed a change in your
appetite? Has this change affected
how much you eat or your normal
weight?
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History
Questions
Have you experienced a change in bowel
elimination patterns? Describe.
Do you have constipation? Describe. Do
you have any accompanying symptoms?
Have you experienced diarrhea? Describe.
Do you have any accompanying
symptoms?
Have you experienced any yellowing of your
skin or whites of your eyes, itchy skin, dark
urine (yellow- brown or tea colored), or clay-
colored stools?
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GI Variations Due to
Age
Aging- should not
affect GI function
unless associated
with a disease
process
Decreased:
salivation, sense of
taste, gastric acid
secretion,
esophageal
emptying, liver size,
bacterial flora
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GI Variations with
pregnancy
Decrease in
gastric motility
High incidence of
Nausea, Vomiting (r/t
pregnancy hormones)
and “heartburn” or
acid reflux
Bowel sounds
diminished r/t
enlarged uterus
displacing intestines
Linea nigra-
increased
pigmentation of
abd midline
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Techniques for
Exam
Provide privacy
Good lighting/appropriate temp in rm
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
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Inspectio
S.
No.
Test n
Normal Abnormal
1 Coloration Paller than Purple
the general discoloration(Turner
skin sign, internal bleeding),
trauma, pancreatitis.
2 Vascularit Scattered Dilated veins may be seen
y fine veins with cirrhosis of liver,
may be obstruction of inferior
visible vena cava
Dilated Spider angioma in
superfici portal hypertension
al Dark bluish-pink striae
capillarie with cushing syndrome
s
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Silvery Striae b/c ascites
5
12/
Inspectio
S.
No
Test
n
Normal Abnormal
3 Scars Pale, smooth, Non-healing,
minimally redness in
raised scars inflammation
Keliods result from
scar tissue
4 Lesions Flat, free Changes in mole; size,
and from color and border
rashes leisons symmetry ( cancer), red,
purple petechiea
5 Umbilicus Skin tone is Bluish, purplish(cullen
similar sign) intra-abdominal
bleeding
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Umbilicus is caused by pressure from
Inspectio
# Test Normaln Abnormal
Contour Inverted or Everted umbilicus is
of protruding seen in abdominal
umbilicu no more distention
s than 0.5 cm
and round Enlarged umbilical is
or conical seen in umbilical hernia
6 Abdomin Abdomen is *Generlized protubent or
a l flat or distended due to gas, obesity.
contour scapoid *Distension under the
umbilicus is due to full
bladder, ovarian tumor
*Distension on the upper
side of umbilicus may be
seen with the pancreas or
gastric dilation
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1 terminal illness
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Inspectio
#
7
Test
Symmetry
n
Normal
Completel
Abnormal
Enlarged masses;
y hernia, diastasis
symmetric recti, bowel
al obstruction
8 Abdomin *Normal *Diminished abdominal
al peristaltic respiration in male
moveme movement in the peritoneal irritation
nt abdominal wall Ripple from the LUQ-
of thin RLQ with intestinal
*Slight visible obstruction, ,abdominal
pulsation of distension (obstruction)
aorta in mid *Vigorous, wide,
epigastric exaggerated pulsation
* Abdominal may be seen in the
respiratory aortic aneurysm
movement in *Absences may be
the males in peritonitis
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Diastasis
Recti
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Auscultati
S.
No.
Test
on
Normal Abnormal
1 Auscultation 5- 30 /min, Hypoactive in
hyperactive sounds surgery, bowel
heard like stomach obstruction
growling are called
borborygmi Hyperactive in diarrhea,
gastroenteritis, early
bowel obstruction
2 Vascular No bruits on the renal, Bruits on both systolic
sounds iliac or femoral arteries and diastolic were
observed in the
aneurysm, stenosis
Venous hum is not
heard in the Hum is listen in the
epigastric and liver cirrohsis
umbilical areas
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liver or matastasis
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Normal percussion
findings
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Percussio
S. No.
1
Test
Percuss all
n
Normal
Generalize
Abnormal
Hyper ressonance is
the d seen in gas
quadrant tympany accumulation
Dullness on enlarged
Dullness on the spleen, liver, distended
decending colon bladder, ascities
is heard
2 Percuss for Lower border is
the 1-2 cm at the
span of liver costal margins
Difficult in the lung
Upper border is consolidation, plural
between 5th to effusion
7th intercostal
space Hapatomegaly
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12/5/ b/w the 2 Higher; paralysed
Percussio
S. Test Normal Abnormal
No n
1 To assess the lower On deep The upper
border, begin in the inspiratio border of liver
RLQ at the mid- n, the dullness may
clavicular line (MCL) lower be difficult to
and percuss upward. border estimate if
Note the change of liver obscured by
from tympany to dullness pleural fluid of
dullness. may lung
descend consolidation.
from 1 to
4 cm
below
the costal
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margin.
Percussio
S. No.
3
Test
Spleen
n
Normal
7 cm near 10 rib
th
Abnormal
Enlargement;
slightly portal
posterior(MAL) hypertension,
trauma,
4 Perform Normally no Inflammation of
blunt tenderness kidney, gall bladder
percussion or liver
( Liver interiorly,
kidney posteriorly)
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Splee
n
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Palpatio
# Test Normal Abnormal
1 Light palpation n no
Nontender, Guarding ; peritoneal
(1cm) guarding irritation, rt sided may
be b/c of cholecystitis
2 Deep palpation Normal Severe in
(5- 6cm) tenderness is on peritonitis,
xiphiod, cecum, infections,
sigmoid, ovaries tumours
3 Masses Unremarkable In tumours,
cysts,
aneurysm.
4 Palpate liver Not palpable Hard firm liver may
indicate
cancer, cirrohsis
5 Palpate spleen Not palpable Enlargement
6 Kidney (MCL Not palpable Tumor, hydro
below costal nephrosis, cyst.
margin)
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7 Bladder Not palpable Distended , dull
Special Tests
(ASCITES)
Shifting
Dullness
Perform the
fluid test
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Special
tests
Test for Appendicitis
Rosving Sign (rebound
tenderness)
Psoas Sign
Obturator Sign
Hypersensitivity test
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Special
Test
Test for
Cholecystitis
Tenderness
Rebound
tenderness
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Rectum and
Anus
History
Have you ever had anal or rectal trauma or
surgery? Were you born with any congenital
deformities of the anus or rectum?
Have you had prostate surgery? Have
you had hemorrhoids or surgery for
hemorrhoids?
When was the last time you had a stool test to
detect blood?
Have you ever had proctosigmoidoscopy?
When was the last time you had a digital
rectal examination (DRE) by a
physician?
Is there a history of polyps, colon or rectal
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Inspectio
S.
No
Inspection
nNormal Abnormal
1 Inspect the The anal Lesions: STD’s,
perianal area. opening should cancer, or
Spread the appear hemorrhoids.
client’s buttocks hairless, moist, A thrombosed external
and inspect the and tightly hemorrhoid appears
anal closed. swollen is hemorrhoid.
opening and The skin Painful, hardened,
surrounding around the reddened- perianal
area for the anal opening abscess. A swollen skin
following: is more tag on the anal margin-
• Lumps coarse and fissure, excoriation-
• Ulcers more darkly infected by fungi or
• Lesions pigmented. pinworms.
• Rashes The A small opening in the
• Redness surrounding skin that surrounds the
• Fissures perianal area anal opening -anorectal
12
• Thickening of
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the epithelium of redness, epithelium suggests
Inspectio
S. Inspection n Normal Abnormal
No
2 Ask the client to perform No bulging or Bulges of red
Valsalva’s maneuver by lesions appear. mucous
straining or bearing down. membrane may
Inspect the anal opening indicate a
for any bulges or lesions. rectal
Inspect the sacrococcygeal prolapse.
area. Inspect this area for Hemorrhoids
any signs of swelling, or an anal fissure
redness, dimpling, or hair. may also be
seen
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12
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Inspectio
S.
No
Inspection n Normal Abnormal
3 Inspect the Area is A reddened,
sacrococcygeal normally swollen, or
area. Inspect smooth, and dimpled area
this area for any free of covered by a
signs of redness and small tuft of hair
swelling, hair. located
redness, midline on the
dimpling, or lower sacrum
hair. suggests a
pilonidal cyst
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Palpatio
S. Assessment Normal Abnormal
No n
4 Palpate the anus. Client’s Sphincter
Inform the client sphincte tightens,
that you are r making further
going to perform relaxes, examination
the internal permitti unrealistic
examination at ng indicating leison
this point. Explain entry.
that it ay feel like
his or her bowels
are going
to move but that
this will not
happen.
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Palpatio
S. Assessment Normal Abnormal
No n
5 Ask the client The client Poor sphincter
to tighten can tone may be the
the external normally result of
sphincter; note close the a spinal cord
the tone. sphincter injury, previous
around the surgery, trauma,
gloved or a prolapsed
finger. rectum.
Tightened
sphincter tone
may indicate
anxiety,
scarring,
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or inflammation.
Palpatio
S. Assessment
No
n
Normal Abnormal
6 Ask the client to The rectal Hardness and
tighten the mucosa is irregularities
external normally soft, may be
sphincter; note smooth, from scarring
the tone. nontender, and or cancer.
free of Nodules may
nodules. indicate polyps
or cancer.
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Palpatio
S. Assessment
No
n Normal Abnormal
7 Palpate the This area A peritoneal
peritoneal cavity. is protrusion into
In men above the normally the rectum,
prostate gland in smooth called a rectal
the area of the and shelf
seminal nontender may
vesicles on the . indicate a
anterior surface of cancerous
the lesion or
rectum. In women, peritoneal
this area may be metastasis.
palpated on the Tenderness may
anterior rectal
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indicate
Palpatio
In male clients, palpate
the prostate. n normally
The prostate is A swollen,
tender
The prostate can be palpated nontender and prostate may
on the anterior surface of rubbery. It has indicate
the rectum by turning the two lateral lobes acute prostatitis.
hand fully counterclockwise that are divided An enlarged
so the by a median smooth, firm,
pad of your index finger faces sulcus. slightly elastic
toward the client’s umbilicus. The lobes are prostate
Tell the client that he may feel normally suggests
an urge smooth, benign
to urinate but that he will not. 2.5 cm long, prostatic
Move the pad of your and heart- hypertrophy
index finger over the prostate shaped. (BPH). A hard
gland, trying to feel the sulcus area on the
between the lateral lobes. prostate or
Note the size, shape, and hard, fixed,
consistency
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of the prostate, and identify
Sample
Documentation
Normal Exam-
Abdomen soft, rounded and symmetric
without distention; no lesions or scars, or
visible peristalsis. Aorta midline without
bruit or visible pulsation; umbilicus
inverted and midline without herniation;
bowel sounds present in all 4 quadrants.
Liver, kidney and spleen non- palpable; no
tenderness on palpation. Reports good
appetite; no constipation, nausea or
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diarrhea. Voiding well and denies laxative
Referenc
esBates’ guide to physical
Bicklay, L. S. (2012).
examination and history taking (10th ed). Wolters
Kluwer/Lippincott Williams & Wilkins Health.
Carol, [Link] (2010). Physical Assessment for
Nurses
(2nd. Ed) Blackwell Publishing Ltd.
Chiocca, E. M. (2011). Advanced pediatric
assessment. Phildelphia, U.S: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
Weber, J., & Kelley, J. H. (2015). Health Assessment
in Nursing (5th ed). Phildelphia: Lippioncot.
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