Physical Assessment

Gastrointestinal System
Health History Assessment
If GI symptoms cause the patient pain or discomfort, you will need to move quickly
through the assessment. However, any GI complaint must incorporate a health history,
even if extremely brief. Assess the following areas in the health history:
Pain: Perform a pain assessment to include specific questions about when the pain
occurs – before meals, after meals, in the middle of the night, and any food
associations. Specifically ask about heartburn and problems with a sore mouth, tongue,
or throat.
Teeth/Gums: Ask about problems with bleeding gums, dental caries, abscesses, and use
of dentures and partial plates. Obtain date of last dental exam and results if possible.
Throat: Ask about any hoarseness or voice changes that might indicate the presence of
a tumor, any difficulty swallowing, and the presence or absence of tonsils.
Appetite: Assess any changes in appetite, food intolerances, and the presence of nausea
and/or vomiting.
Lower GI: Assess for problems with eructation, flatulence, hemorrhoids, hernia.
The patient should be questioned about the use of laxatives and antacids and the color,
frequency, and amount of stools. Assess previous GI disease history such as
cholecystitis, inflammatory bowel disease, or cancer.
Physical Assessment
Mouth and Throat: Assess the mouth and throat for sores,
condition of teeth and gums, irritations, or any other conditions
that could affect the intake of food and liquid. Lift the tongue
and look under it for any tumors or lesions. Assess for any
unusual breath odor.
Abdomen: Inspect for contour, symmetry, abdominal aorta
pulsation, and distention. Do not touch the abdomen during the
inspection or peristalsis can be stimulated which will provide
false data during the auscultation portion of the assessment.
Instruct the patient to not touch the abdomen during the
inspection phase.
Abdominal distention can be caused by three factors:
1. Obesity – Abdomen is soft and rounded with a sunken
umbilicus.
2. Ascites – Skin is shiny and glistening with an everted
umbilicus. Veins are dilated and prominent (more visible in
thin, malnourished skin).
3. Obstruction – There may be visible, marked peristalsis;
restlessness; lying with knees flexed; grimacing facial
expression; and uneven respirations.
Auscultation
Bowel Sounds: Bowel sounds are best heard with the diaphragm portion of the
stethoscope. Note the character (high-pitched, gurgling, clicking, etc.) and
frequency. Normally the sounds occur intermittently at 5-15 times per minute.
Judge if the sounds are normal, hypoactive or hyperactive. You must listen for 5
minutes to each quadrant before deciding that bowel sounds are absent (20 minutes
is unrealistic to expect someone to stand and listen for bowel sounds so we often
rely on the patient’s other signs and symptoms). If the patient is experiencing an
obstruction due to an ileus (absence of peristalsis), bowel sounds will be absent as
there is no enervation by the nervous system to the area. If the patient is
experiencing a mechanical obstruction (feces, volvulus, tumor, etc.), the bowel
sounds can alter between being hyperactive (as the gut tries to push feces around
the obstruction) or absent (as the gut rests and prepares for the next peristaltic
wave; the patient will also complain of pain when bowel sounds are heard).
Peritonitis presents with absent bowel sounds.
Vascular sounds: Vascular sounds are best heard with the bell of the stethoscope.
Assess all four quadrants listening for bruits (whooshing, blowing sounds that
represent impaired circulation within an artery or an aneurysm). An aortic pulsation
may be heard over the left upper quadrant in the presence of hypertension, aortic
insufficiency, or aortic aneurysm.
Percussion
Tympani: Tympani should predominate as air rises to surface of
the abdominal cavity.
Hyperresonance: Will be heard in the presence of gaseous
distention.
Dullness: Percussed over a distended bladder, adipose tissue,
fluid, or a mass in the abdomen.
Palpation: Prior to palpating the abdomen, have the patient bend
the knees and relax the abdominal muscles. Ask the patient to
point to any painful or tender areas. Save those areas to palpate
last so the patient becomes more accustomed to your touch and
does not guard throughout the exam. Lightly palpate the abdomen
by quadrants. Note any muscle guarding, rigidity, tenderness, or
masses.
Rectal Area: Examine the external rectal area for the presence of
external hemorrhoids, masses or evidence of inflammation.
Age Related Changes of the Gastrointestinal System
Saliva secretion decreases by as much as 66% and salivary ptyalin is
reduced, inhibiting the digestion of complex carbohydrates. Tooth
loss and gum disease often make nutritional intake difficult.
Peristalsis in the esophagus is no longer triggered with each swallow
and there is delayed entry of food into the stomach causing a
premature feeling of fullness. Weakness around the gastroesophageal
sphincter can cause heartburn and reflux. Gastric acid secretion
reduces significantly. Constipation is common due to decreased
intake and decreased intestinal motility.