4.2 Physical Assessment of Digestive Organs

Examining digestive organs involves a systematic approach using inspection, auscultation, percussion, and palpation. These techniques help identify abnormalities like distension, tenderness, or masses, providing crucial insights into gastrointestinal health.

Understanding normal and abnormal findings is key for accurate assessment. Conditions like peritonitis, bowel obstruction, or organ enlargement can be detected through careful examination, guiding further diagnostic steps and treatment decisions.

Physical Assessment of Digestive Organs

Steps in digestive organ assessment

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• Inspection
  • Observe abdomen for contour, symmetry, skin changes, and visible pulsations (distension, scars, rashes)
  • Note surgical scars, lesions, or hernias indicating previous surgeries or underlying conditions
• Auscultation
  • Listen for bowel sounds in all four quadrants using stethoscope diaphragm
  • Assess frequency, character, and intensity of bowel sounds (normal, hyperactive, hypoactive)
  • Identify abnormal sounds such as absent, hyperactive, or tinkling bowel sounds suggesting ileus or obstruction
• Percussion
  • Lightly tap abdomen to determine presence of air, fluid, or solid masses
  • Percuss in all four quadrants to assess liver size, spleen size, and presence of ascites (fluid accumulation)
  • Identify tympany (drum-like sound) indicating air or dullness (flat sound) suggesting fluid or solid masses
• Palpation
  • Lightly palpate abdomen to assess tenderness, guarding, rigidity, or masses
  • Palpate deeply to assess organ size, consistency, and abnormalities (hepatomegaly, splenomegaly)
  • Check for rebound tenderness and referred pain suggesting peritoneal irritation or underlying inflammation

Abnormal abdominal findings and causes

• Abdominal distension
  • Ascites due to liver disease (cirrhosis), heart failure, or cancer
  • Bowel obstruction causing air and fluid accumulation
  • Pregnancy or large abdominal masses (tumors, cysts)
• Abdominal tenderness and guarding
  • Peritonitis due to infection (appendicitis) or perforation (ulcer)
  • Inflammatory conditions like diverticulitis or inflammatory bowel disease (Crohn's, ulcerative colitis)
  • Pancreatitis or peptic ulcer disease causing epigastric pain
• Abnormal bowel sounds
  • Absent sounds indicating ileus or bowel obstruction
  • Hyperactive sounds suggesting gastroenteritis or early bowel obstruction
  • Tinkling sounds indicating late bowel obstruction or intestinal fluid accumulation
• Hepatomegaly
  • Fatty liver disease, hepatitis, or cirrhosis causing liver enlargement
  • Congestive heart failure or metastatic cancer infiltrating the liver
• Splenomegaly
  • Infections like mononucleosis or malaria enlarging the spleen
  • Hematologic disorders such as leukemia or lymphoma
  • Liver disease or portal hypertension causing splenic congestion

Gastrointestinal Tract Function and Disorders

• Peristalsis: The rhythmic contraction of smooth muscles in the gastrointestinal tract that propels food and waste through the digestive system
• Abdominal pain: Can be caused by various factors, including inflammation, infection, or obstruction in the gastrointestinal tract
• Malnutrition: May result from inadequate nutrient absorption or intake, often associated with digestive disorders
• Gastric motility: The movement of food through the stomach, which can be affected by various conditions and impact overall digestion

Technique for mouth and rectum examination

• Mouth and oropharynx examination
  1. Ensure adequate lighting and patient comfort
  2. Inspect lips, buccal mucosa, gums, teeth, tongue, and palate for lesions, ulcers, or inflammation (thrush, leukoplakia)
  3. Assess tonsils and posterior pharynx for size, color, and exudates (tonsillar hypertrophy, pharyngitis)
  4. Palpate floor of mouth and tongue for masses or tenderness
• Digital rectal examination (DRE)
  1. Explain procedure and obtain patient consent
  2. Position patient in left lateral decubitus position with knees flexed
  3. Wear gloves and lubricate index finger
  4. Inspect perianal area for hemorrhoids, fissures, or masses
  5. Gently insert lubricated finger into rectum, assessing anal sphincter tone
  6. Palpate rectal walls for masses, tenderness, or irregularities (polyps, tumors)
  7. In males, assess prostate gland for size, consistency, and nodules (benign prostatic hyperplasia, prostate cancer)
  8. Remove finger, inspect for blood or abnormal discharge, and dispose of gloves appropriately