Learning Objectives
By the end of this section, you will be able to:
- Examine the common causes for abdominal distention
- Recognize the common causes for abdominal bulges
- Remember the cause of enlarged abdominal organs
Patients may experience a multitude of symptoms when experiencing an abdominal disorder. Symptoms include increased gassiness, diarrhea, constipation, or pain. Abdominal disorders can be distinguished by general fullness or swelling called distention and or localized swelling referred to as bulges. Using a detailed patient interview to guide the physical exam, a nurse not only will be able to perform a complete abdominal assessment but also help identify causes of common abdominal disorders from distention to abdominal hernias and enlarged organs.
Common Causes of Abdominal Distention
It is important to assess for abdominal distention because it is a manifestation of numerous diseases. Assessing the abdomen when the patient is in the supine position is needed to see the abdomen in a relaxed state and the contour of the abdomen. Remembering to assess the abdomen in a look, listen, feel order. If the patient is sitting up during an abdominal exam, it is difficult to see if the abdomen is flat, concave, rounded, or distended. This positioning allows the nurse to assess for distention or bulges. The most common causes of abdominal distention are the “5 Fs” (Cleveland Clinic, 2021):
- Fat: Excess amounts of fat may be in the abdominal area due to obesity or a manifestation of certain diseases, such as Cushing syndrome. Excess visceral (abdominal) fat is associated with an increased risk for cardiovascular disease and insulin resistance.
- Flatus: Increased gas in the intestines can be caused by numerous conditions, such as aerophagia (swallowing air), food intolerance, carbonated beverages, irritable bowel syndrome, constipation, ulcerative colitis, and certain medications.
- Feces: Constipation can cause a buildup of feces in the intestines, in turn causing abdominal distention.
- Fluid: Ascites is a buildup of fluid in the peritoneal space (the layer of tissue that surrounds the abdomen) resulting from congestion within the liver, creating distention.
- Fetus: Abdominal distention during pregnancy occurs due to the growing uterus, which is housed in the lower abdomen. Different hormones during pregnancy allow the abdominal muscles to relax to allow for this expansion.
Life-Stage Context
Age-Related Changes with Bowel Elimination: Age Is Not Just a Number
Getting older is a normal and healthy part of life. As one grows older, one of the benefits is that one may get wiser and develop life skills. Likewise, one must also make adjustments in their life to accommodate the changes related to the GI tract. When an individual ages, the following occur:
- Changes in diet and physical activity: As a person ages, they may become less active and lead a sedentary lifestyle, which contributes to constipation. Furthermore, an older person may need more fiber in the diet to account for the slowing of the intestines.
- Decreased muscle tone: Muscles lose tone over time and may cause stool to move more slowly through the intestines.
- Medications: As a person ages, they may need to take multiple medications. Often, a side effect of these medications is impaired bowel function leading to constipation.
- Slower digestion: When a person ages, the gut motility (how food moves through the gut) slows down. This can result in constipation.
- To account for these changes, the older adult should maintain a balanced diet full of fiber, stay well hydrated, engage in regular physical activity, and communicate with their provider about changes in their bowel patterns.
Common Causes of Abdominal Bulges
Common causes of abdominal bulges are hernias. Abdominal bulging may be differentiated from abdominal distention such that abdominal bulging may be localized to a specific area of the abdomen and not the entire abdomen. Abdominal bulges may be from hernias, tumors or masses, or enlargement of organs.
Hernias
Hernias are a common cause of abdominal bulges. A hernia occurs when an abdominal organ pushes through a weakness in the abdominal wall. There are different types of hernias; they are named for their location on the body (Figure 27.9), and include:
- epigastric hernia, involves the upper part of the stomach
- femoral hernia, similar to the inguinal hernia but lower in the groin; most commonly found in females
- incisional hernia, results from a surgical incision (healed or not fully healed)
- inguinal hernia (direct or indirect), the most common type of hernia that occurs in the groin or scrotum
- umbilical hernia, found at the belly button
Cause of Enlarged Abdominal Organs
The term visceromegaly refers to the abnormal enlargement of abdominal organs, such as the liver, stomach spleen, pancreas, or kidneys. This enlargement can be caused by a variety of diseases and conditions.
Enlarged Liver
The most common causes of hepatomegaly (enlarged liver) are:
- alcoholic liver disease. Excess consumption of alcohol can lead to liver inflammation and enlargement.
- cirrhosis: chronic liver damage, often from drug or alcohol use, that forms scar tissue in the liver, causing liver enlargement
- congestive heart failure. If the heart is unable to pump blood to the rest of the body, liver congestion may result, causing enlargement, in turn
- diseases: hematochromatosis, an excess of iron in the liver; Wilson’s disease, an excess of copper in the liver; both cause liver enlargement
- hepatitis: viral infection (types A, B, and C) that causes swelling and inflammation of the liver
- infections: parasitic or bacterial that cause the inflammation and organ enlargement
- liver cancer
- nonalcoholic fatty liver disease: caused by an accumulation of fat either from obesity or metabolic syndrome
Enlarged Spleen
An enlarged spleen is called splenomegaly. Splenomegaly can cause an increased risk of rupture and subsequent hemorrhage. Therefore, the nurse must educate the patient that there should be no contact sports and physical limitations are needed. Splenomegaly can be caused by multiple conditions, including:
- autoimmune diseases (e.g., lupus, rheumatoid arthritis)
- blood disorders: diseases that affect the blood cells (e.g., lymphoma, leukemia, anemias)
- infections (e.g., viral and bacterial infections, malaria)
- inflammatory disorders (e.g., sarcoidosis)
- liver disease
- metabolic disorders(e.g., Gaucher disease, Niemann–Pick disease)
- traumatic injury
Aortic Aneurysm
An aortic aneurysm is a localized enlargement of the abdomen at the level of the abdominal aorta. A person may not have symptoms, but the danger is that if the aortic aneurysm bursts, it can be life threatening and require emergency medical attention. Risk factors that may contribute to an abdominal aortic aneurysm are increased age, smoking, high blood pressure, and a family history of abdominal aortic aneurysm.
Link to Learning
When a patient is experiencing an aortic aneurysm, conducting the physical exam is important to recognize the signs of this critical issue. This video demonstrates what signs to look for during the exam if an aortic aneurysm is present.
Enlarged Kidney
The enlargement of a kidney is called nephromegaly. Common causes of nephromegaly include:
- congenital (from birth) abnormalities: occur when the kidney is larger than normal from birth
- glomerulonephritis: inflammation of the kidney’s filtering system, which causes enlargement
- hydronephrosis: occurs when there is a backup of urine from the kidney that causes swelling; often caused by kidney stones, tumors, or structural abnormalities
- infections of the kidney: cause inflammation and swelling of the kidney
- polycystic kidney disease: genetic disorder in which multiple fluid-filled cysts grow on the kidney, causing enlargement
A healthcare provider may request a urinalysis and culture to test for infection, blood in the urine, or for different proteins and glucose.
Enlarged Gallbladder
An enlarged gallbladder can be caused by various conditions, including:
- biliary obstruction: tumors or structures in the bile ducts
- cholecystitis: inflamed gallbladder from infection
- gallstones: hardened deposits of the gallbladder that obstruct the bile flow of bile
- heart failure: often associated with liver enlargement, which leads to gallbladder distention
- pancreatitis: inflammation of the pancreas that leads to swelling of the surrounding areas, including the gall bladder
Stomach Cancer
Stomach cancer, or gastric cancer, occurs when abnormal cells grow rapidly in the lining of the stomach. The most common causes of stomach cancer are:
- age and sex: older adults and males are more prone to stomach cancer.
- chronic gastritis: inflammation of the stomach lining associated with Helicobacter pylori
- diet: diets high in salt, pickled foods, and smoked foods, and diets low in fruit and vegetables may increase risk of stomach cancer
- family history: familial history of stomach cancers
- H. pylori infections: long-term infection by this bacterium increases risk of stomach cancer
- previous stomach surgeries
- tobacco and alcohol use