Abdominal assessment

An abdominal assessment is a vast undertaking and the symptoms, often described as gastrointestinal symptoms, are varied. However, it is important to note that there are many differential diagnoses for the gastrointestinal symptoms (Table 1).

This article discusses the current

As with any assessment in healthcare, the assessment of a patient presenting with symptoms that could be related to the bowels must start with a general examination and history taking (Bickley et al, 2020).

There are simple assessments that can be done before the patient is physically seen at the GP (Crisford, 2016). For example, a verbal assessment of bowel function using the Bristol stool chart (Figure 1) and other bowel disease scores, such as the Harvey Bradshaw Index used in Crohn's Disease (Harvey, 2023), can be used to understand a patient’s symptoms.

While physical examination in a healthcare setting poses minimal risk, there are factors to consider when undertaking a physical examination. For example, the temperature of the environment should be pleasant, not to hot or cold, and the privacy and dignity of the patient should be a priority (Bickley et al, 2020).

The health professional must gain consent from the patient for the examination and inform the patient that chaperones can be present if wanted. It is important to document these conversations and build a therapeutic relationship with patients by setting out the agenda at the start of a consultation (Fine, 2005; Mocciaro et al, 2014). Remember to familiarise yourself with the emergency equipment in the area you are working in, and how to alert for help in the event of an emergency (Resuscitation Council UK, 2021).

• Gloves
• Stethoscope
• Lubricant

General examination

When a patient enters a room, or when the nurse approaches the patient, immediate observations can be made. Look for alertness, any alterations in gait, slurring of speech and whether they are looking after themselves (eg if the patient smells) (Bickley et al, 2020). Questions regarding the health of the individual can be answered by simply examining the person’s hands. Clubbing, an enlargement of the ends of the fingers with a downward sloping of the nails (Figure 2), could indicate chronic inflammatory conditions, such as coeliac disease, inflammatory bowel disease or inflammation of the lungs or heart. Koilonychia or spooning of the nails can indicate an iron deficiency (Potter, 2023). A flapping tremor, signs of inflammation to the person’s skin and other external manifestations of liver disease, should all be looked for and noted, as this can indicate advanced stages of liver disease (Weber, 2008).

A thorough assessment of the bowel should take into consideration the anatomy and physiology of the gastrointestinal system and the surrounding organs (Ferguson, 1990; Weber, 2008; Bickley et al, 2020). The peritoneal cavity contains multiple organs, so dysfunction or disease of one can impact directly on other, adjacent organs (Thomas and Monaghan, 2014). For example, abdominal pain can relate to many body systems (Table 1).

With this in mind, it is important to consider some common differential diagnoses in order to decide the next steps, follow-up treatment and additional investigations that may be required. An examination of the respiratory, cardiac system, lymphatic system and a neurological examination should then be considered and carried out if required. Additionally, an advanced nurse should have the knowledge and skills to support a full physical examination if required (Rhoads and Jensen, 2014; Potter, 2023).

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages

Part 2: Procedures for the planning, provision and management of person-centred nursing care

3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

6. Use evidence-based, best practice approaches for meeting needs for care and support with bladder and bowel health, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

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