(f) Discoloration (including jaundice) or blue or yellow color around the
umbilicus--may indicated hemorrhaging.
(g) Visible peristaltic waves--indicative of intestinal obstructions.
Abnormal hair distribution.
(i) Scars--may indicate past surgery. Note the exact location and
description of scars.
(5) Auscultation. Perform auscultation before percussing or palpating the
abdomen. The reason is that two forms of examination may alter the frequency of
bowel sounds. When auscultating the stomach, listen in all four quadrants and the
epigastrium. Note the frequency and character of the clicks and gurgles, the bowel
sounds. Hypoactive sounds (softer than normal sounds) occur less than five times per
minutes. Normal sounds occur five to 34 times per minute, and hyperactive sounds
(louder than normal sounds) occur 34 or more times per minute. Hyperactive sounds
are the sounds of gastritis or gastroenteritis. No sounds for five minutes may indicate
peritonitis or paralytic ileus.
(6) Palpation. Palpate each quadrant with the suspicious area being
palpated last. This type of examination is useful for general orientation to the abdomen
and for identifying air in the stomach and the bowel. Superficial or light palpation may
disclose rigidity or guarding (involuntary or voluntary) of the abdominal wall. Use
extreme caution and do not palpate patients who are extremely aware of this type of
examination. In other patients, apply firm pressure indenting the skin about one half
inch to locate organs and determine their size. Note any tenderness found during
palpation. Rebound (during withdrawal) is done last. Tenderness could suggest
peritonitis. When using firm pressure to palpate, note any masses--the amount of
tenderness, size, shape, consistency, pulsations, and motility.
(7) Percussion. Percussion is useful for general orientation to the abdomen.
In all four quadrants, percuss the abdomen lightly. Do this to assess the general
proportions and distribution of tympany and dullness. Generally, tympany
predominates. The organs which should be percussed include the liver, the epigastric
bubble, the spleen, and the bladder.
c. Anus and Rectum. Examine the anus and the rectum last. When you are
conducting a physical assessment of the rectal area, you are concerned with inspection
and palpation only. Inspect for hemorrhoids, rectal prolapse, and masses. Palpate
after you have inspected visually. A rectal examination of the prostrate is concerned
with discharge, shape and size, consistency, and tenderness. Laboratory and other
studies indicate whether ova and parasites or occult blood exist in the stools.