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GI tract
Health Assessment
| Question | Answer |
|---|---|
| abdomen | large oval cavity from diaphragm to brim of pelvis that is bordered in the back by the vertebral column and on the sides and front by lower rib cage and abdominal muscles |
| The abdomen extends from the _______ to the ______. | diaphragm; symphysis pubis |
| 4 quadrants | RUQ, LUQ, RLQ, LLQ |
| three main sections of 9 regions | epigastric, umbilical, hypogastric/suprapubic |
| Four Layers of Abdominal Muscles | 1. outer= rectus abdominis 2. external abdominal obliques 3. internal abdominal obliques 4. transverse abdominis |
| RUQ includes | liver, gallbladder, right kidney, duodenum |
| LUQ organs | stomach, spleen, pancreas, left kidney, part of transverse and descending colon |
| RLQ organs | cecum, appendix |
| LLQ organs | Part of descending colon, rectum |
| spleen location | from 9th to 11th rib lateral to LMAL, about 7 cm in size |
| should you palpate the LUQ if there is pain in this area? | no because there may be an issue with the spleen and palpating it could cause it to rupture |
| spleen function | filter for purifying blood, aids in removing microbes and damaged RBCs, production of WBCs to fight. infection |
| kidneys location | - retroperitoneal at costovertebral angle - right kidney is slightly lower than left - the right is sometime palpable but left. usually is not unless enlarged |
| organs of alimentary system | Esophagus, Stomach, Small intestine, Large intestine, Rectum, Anal canal |
| Accessory organs | Liver, Gallbladder, Pancreas |
| functions of alimentary system | Digest food, absorb nutrients, electrolytes & water, and eliminate solid waste |
| liver | provides large proteins for blood and detoxifies toxins |
| gallbladder | production of bile that assists in absorption of fatty foods |
| pancreas | contains enzymes that assist in digestion and absorptions |
| urinary tract organs | kidneys, ureters, bladder |
| ureters | connect kidneys to bladder |
| urethra | expels fluid from body |
| developmental changes in aging adult | salivation decreases: dry mouth and decreased sense of taste; esophageal emptying and gastric acid secretion delayed: GERD common constipation |
| history for GI assessment | change in appetite, dysphagia, food intolerance, abdominal pain, nausea/vomiting, bowel habits, medications, HX, family HX, alcohol, drug, tobacco use, nutritional assessment |
| infant subjective data | breast vs bottle, child's willingness to eat, overweight/obesity risk |
| aging adult subjective data | how do you get you groceries? or frequency/consistency/color of stools |
| three causes of pain in GI tract: | distention, ischemia, inflammation, (sometimes pain with ulcers) |
| distention | gas, obstruction |
| ischemia | loss of blood flow |
| inflammation | peritonitis (pain of abdominal wall), appendicitis, cholecystitis(acute/chronic in gallbladder) |
| gastric ulcer | pain on empty stomach |
| duodenal ulcer | pain 2-3 hours after eating |
| peptic ulcer | happens with frequent use of NSAIDs, alcohol, and smoking |
| visceral abdominal pain | from the organs, dull, poorly localized |
| parietal abdominal pain | inflammation of peritoneum, sharp precise location, worse with movement |
| referred abdominal pain | from another place |
| which area of the stomach do you examine last? | any areas in pain |
| black stool | bleeding high in GI tract |
| red stool color | bleeding low in GI tract |
| grey/clay colored stool | gall bladder disease |
| green stool | diarrhea/gastroenteritis or diet, could also be from eating lots of greens |
| anything with bismuth in it (pesto-bismol_ causes what colored stools? | black |
| black stools are often what texture? | tarry |
| what position should you pt. be in for a GI assessment? | supine, knees bent |
| inspection includes | contour, umbilicus, skin, vascular pattern, pulsations, hernias, demeanor (quiet and relaxed vs restless and in pain) |
| Flat contour of abdomen | normal |
| Scaphoid contour of the abdomen | sunken in abdomen and abdomen caves in |
| protuberant abdomen | abdomen is distended and from pregnancy, obesity, ascites, or. obstruction |
| umbilicus should be | midline and inverted |
| everted umbilicus | can be normal but may. be from increased intra-abdominal pressure (mass/ascites) |
| striae | stretch marks from obesity, rapid weight gain, pregnancy, or ascites |
| pulsation in abdomen | - can sometimes be seen in really thin individuals if vigorous and exaggerated may be an abdominal aortic aneurysm (triple A) |
| localized abdominal distention | discrete mass, organ enlargement |
| Generalized abdominal distention | feces(constipation), fetus (pregnancy), flatus (GI), fluid (ascites) |
| abdominal varices | obstruction of vena cava |
| cirrhosis | Chronic disease of the liver |
| surgical scar | alerts you to possible presence of underlying adhesions and excess fibrous tissue |
| candida | yeast infection in. skin folds |
| incarcerated hernia | hernia contents are irreducible but not obstructed or strangulated |
| obstructed hernia | irreducible hernia presenting with intestinal obstruction |
| strangulated hernia | when blood supply to the hernia is cut off because of pressure (emergency bc stopping blood flow) |
| where do you begin listening to bowel sounds? | RLQ, then move clockwise |
| active bowel sounds | normal; 5 to 30 per minute |
| hypoactive bowel sounds | less than 5 per minute |
| absent bowel sounds | no sounds in 5 minutes, must listen for entire 5min |
| hyperactive bowel sounds | borborygmus (hunger) |
| bruits | use bell over vessels to see if you hear blowing/swishing (not normal) aorta, left and right renal arteries, femoral arteries, iliacs |
| peritoneal friction rub | grating sound of friction created by inflammation of organ in contact with peritoneal lining |
| general percussion of abdomen | tympany |
| liver percussion sound | dull |
| gastric detention would sound. like | hyperresonance |
| Liver Span Assessment | - Percuss to map out boundaries of certain organs, Measure height of liver in right midclavicular line, Begin in area of lung resonance, and percuss down interspaces until sound changes to dull, mark spot (around 5th ICS) |
| Liver Span Assessment continuted | Find abdominal tympany, and percuss up in midclavicular line, mark where sound changes from tympany to a dull sound (RCM), measure distance between tow marks (normal adult 6-12 cm) |
| percussing for splenic dullness | stand on R of pt, reach over, percuss over last ICS and should hear tympany- have pt inhale and percuss again and should remain tympanic- if dullness it could be. spleen enlargement |
| fist percussion is used to assess: | for tenderness over the kidneys, liver, and gallbladder |
| shifting dullness test | -in supine position, ascitic fluid settles by gravity into flanks, which displaces the air-filled bowel upward, you will hear tympanic note as you percuss over top of abdomen bc gas filled intestines float over the fluid then percuss down (fluid = dull) |
| shifting dullness test continued | mark this spot, shifting level of dullness by turning pt to right side, so if fluid, it will flow down to right side and displace, lighter bowel upward, percuss upper side and move downward (dullness should be higher = presence of ascites) |
| Fluid wave test for ascites | have the patient or a colleague press one hand along the midline of the patient to prevent vibrations through the abdominal wall. The examiner then taps one flank, while feeling on the other flank for the tap. |
| fluid wave test for ascites continued | The pressure on the midline prevents vibrations through the abdominal wall while the fluid allows the tap to be felt on other side The result is considered positive if tap can be felt on the other side. |
| Light palpation of abdomen | 1-2cm; detect superficial massess, tenderness, rigidity |
| Deep palpation of abdomen | 5-8cm; bimanual if needed. note location, size, consistency, mobility. of any masses, organ enlargement, tenderness |
| bimanual liver palpation | use two hands |
| Hook Technique for Liver Palpation | to palpate liver border |
| Normally not palpable | most of liver, gallbladder, spleen, duodenum, pancreas |
| palpating the aorta | Press firmly deep in upper abdomen, slightly left of the midline, normally 2.5-4 cm wide |
| Rovsing's sign | Pain in RLQ with palpation of LLQ indicative of appendicitis, rebound tenderness |
| Blumberg's sign | rebound tenderness in RLQ |
| Murphy's sign | test for gallbladder inflammation, have pt take deep breath when palpating liver (painful for pt has to stop = positive murphy's sign = potential cholecystitis) |
| iliopsoas muscle test | test for appendicitis. patient supine place your hand over the lower thigh. Ask the patient to raise the leg flexing at the hip, while you push downward against the leg. Pain in the lower quadrant is suspicious of appendicitis. |
| how to describe abdominal masses | location, size, contour, consistency, tenderness, mobility, pulsation |
| gas | curved, hypoactive/absent bowel sounds in lies; hyperactive bowel sounds heard in early bowel obstruction |
| ascites | curved, everted umbilicus, bulging flanks, taught/glistening skin, recent weight gain, tympany over top with dullness to sides |
| tumor | localized distention, dull over mass, may feel borders |
| intestinal obstruction | partial or complete blockage of the small or large intestine caused by a physical obstruction may lead to leak into peritoneum= sepsis Hypovolemic shock... EMERGENCY |
| McBurney's point | Pain in RLQ with appendicitis |
| Four F's of cholecystitis | female, forty, fertile, fat |
| dyspepsia (indigestion) | pain or discomfort in digestion, peptic ulcers or drugs like NSAIDs/ ASA |
| inflammatory bowel disease | inflamed intestines with reoccurring cramps and diarrhea |
| irritable bowel syndrome | disorder of the entire digestive tract that causes recurring abdominal pain and constipation or diarrhea |
| ulcers | lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices |
| gastritis-inflammation of stomach lining | caused by infection, alcohol, stress, injury, drugs, immune system |
| gastroesophageal reflux disease (GERD) | stomach acid and enzymes flow backward from stomach into esophagus, causing inflammation and pain in esophagus |
| functional pain | chronic or recurring (>6mo) with no identified disorder, related to stress, anxiety |
| symptoms requiring immediate evaluation | high fever, loss of appetite/weight, pain that awakens the patient, blood in stool or urine, jaundice, ascites |
Created by:
AV25
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