Abdomen Assessment Flashcards
Explain red flags for gastrointestinal problems
- mouth, oesphaguys and stomach
- (mouth ulcers(indicate crowns, cancer or coeliac disease)
- **swallowing problems **(can indicate oesophageal cancer)
- reflux
- indigestion (heroism stomach ulcers or cancers)
- nausea and vomiting (bowel disease obstruction, ileus, cancer, liver disease),
- **blood in vomit **(oesophageal varies often associated with alcohol, stomach ulcers, gastritis, cancers)
- blood in stool
State red Flags of liver and gall bladder problems
- jaundice (gallstones, alcoholic liver disease, pancreatitis or hepatitis, cancer), - bloating
- pain (gallstones, tumours, pancreatitis, hepatitis.
-
ascribes (heart failure, cirrhosis of liver cancer
- pale faeces/dark urine
State red Flags of intestinal problems
- **pain,
- bloating,
- nausea,
- vomiting,
- melena/blood in stool,
- anorexia
- not passing wind**
State red flags for kidney and bladder problems
- unable to pass urine (cancer, neurological, enlarged prostate, bladder stones)
- No urine output or large urine output – acute or chronic renal failure
- blood in urine (cancer/infection)
- ** frequency (infection) **
- unable to empty bladder fully (tumour/blaster stones, neurological problems)
- pain on passing urine (infection or tumours)
- incontinence (neurological problems, pregnancy, obesity, constipation, infections and tumours)
State red flags so renal problems
- incontinence
- frequency
- pain
- blood in urine
- retention or change in urine output
State three causes of acute kidney injury
- Prerenal (insuffient blood flow to kidneys)
- Intrarenal (damge to kidney itself)
- Postrenal (Obstruction in ureters, bladder or urethra
Signs and symptoms of acute kidney injury.
- reduced urine output
- raised urea and creatinine
- changes of electrolytes
- fatigue
- SOB
- confusion
- nausea and fluid retention
Specific causes and symptoms of different types of acute kidney injury
Prerenal - haemorrhage, severe dehydration, reduced cardiac output, sepsis and shock - low blood pressure
Intrarenal - glomerulonephritis – hypertension – chemicals/drugs
Post renal - stones, prostatic hyperplasia, urethral stricture
Whats the normal urine output?
0.5-1ml per kg per hour
Explain pathophysiology of appendicitis
- obstruction of lumen (hard stool, tumour, foreign body or torsion - twisting)
- Increased pressure as secretions of mucous and bacteria produces
- Impairs venous and lympatic drainage
- decreased mucosal blood flow, hypoxia, ischaemic and necrosis
- damage to wall leads bacteria and toxins leaking causing abscess or local peritonitis
- If perforates and empties into peritoneal cavily causing generalised periotonitis
Signs and symptoms of appendicitis
- Pain starting around belly button then migrates to right lower quadrant (over 24-48 hours)
- Fever, malaise, anorexia
- Nausea/ vomiting
- Diarrhoea or no passing of stool
- No passing of wind
State some complications of appendicitis
- Perforation
- Peritonitis – inflammation of peritoneum
- Sepsis
- Abscess formation
- Intra abdominal adhesions
- Bowel obstruction
State two type sof inflammtory bowel disease
Crohns disease
Ulcerative colitis
What is inflammatory bowel disease
- genetic
- inflammation and ulceration due to excessive immune response
Signs of symptoms of inflammatory bowel disease
- Pain
- diarrhoea and mucus
- fatigue
- fever
- mouth ulcers (crohns only)
- anemia
- appetite and weight loss
- blood in stool
- nausea and vomiting
What are some investigations done for inflammatory bowel disease?
- Sigmoidoscopy/colonoscopy (looking for ulceration)
- Barium enema – identify structures or ulcerations
- Stool samples – to rule out infection
- Bloods to look for anemia.white cell counts and indicator of infection
- X-ray and ultra sounds
Whats the plan for treatment of inflammatory bowel disease?
- Reduce inflammation
- Manage pain
- Manage fluid balance
- Manage symptoms – nausea and vomiting, diarrhoea
- Consider nutrition – eg. Electrolyte imbalances and dehydration
- Monitor deterioration
State some possible complications of inflammatory bowel disease
- Perforations, peritonitis, obstruction
How can inflammatory bowel disease lead to surgical intervention?
- Removal of large bowel and formation of stoma
- Resection and or stoma due to performation or obstruction
State pathophysiology of crohns disease
Inflammation of whole digestive system from mouth to anus
- Inflammation causes lesions and leads to fibrosis so lumen narrows and obstructs bowel causing reduced surface arease
State pathophysiology of ulcerative colitis
Inflammation and ulceration of large powel only (need remove colon and have stoma)
- Inflmmation spread to colon and lesions cause activation of cytokines and macrophages damaging muscosa epithelial
- can lead to swelling, oedema and bleeding
- Defacate increases damage and wall thickens becoming fibrous so narrows and obstructs leading to dehydration and electrolyte imbalances
Define - perfortion
Break in integrity of bowel wall leading to faecal matter and digestive fluids leaking into peritoneal cloth can causing peritonitis
What is peritonistis?
- inflammation
- infection of peritoneum leads to:
Peristalsos stopping, dehydration and electrolyte imbalances, organ failiure and sepsis
What are some signs and symptoms of peritonitis?
- Pain and tenderness
- Bloating
- Fever
- Nausea/vomiting/diarrhoea
- Dehydrations and severe electrolyte imbalance
What is the plan when facing peritonitis?
- Close monitoring of vital signs – pick up worsening signs of infection
- Pain management
- Management of nausea and vomiting
- Maintain hydration and electrolytes
- NG tubes may be needed to decompress stomach
- ASAP surgical intervention
- Manage infection – antibiotics
What is a stoma and what are the two types?
Part of bowel taken out onto surface of abdomen
- colostomy - any part of large intestine
- ileostomy - any part of small intestine (more bits of food)
How should you assess stool?
- Consistence
- Colour
- Quaintly
- Small
- Undigested food
What are you inspecting in the assessment of a stoma?
- Check skin around stoma site
- Flush with skin or it has a spout
- Signs of prolapse/retraction
- Note of colin – pink is normal but dusk blow or black is abnormal
What should be explained when prepaing for an abdomen assessment?
- Get patient to empty their bladder
- Exposure to abdoment while maintaining privacy and dignity
- Warm, private environment
- Warm hands a and stethoscope
What should be focused on when taking a history during an adbomen assessmnet?
- signs of acute renal failure
- eg. urine output, fatigue, confusion, nausea, fluid retention - Signs of changes
- Bowel habits, wieght loss, blood, appetite, anxiety
What to look for in an intial inspection for abdonmen assessment?
CDSNHF
- **Skin colour **– pallow, jaundice or dry itchy skin
- **General demeanour **– restless (renal colic, obstruction) – lying very still – peritonitis – pain – confusion/drowsiness (renal failure raised UandEs – sepsis)
- General overview – nausea, sickness, dehydration, oedema
- Shape of abdomen - protrusions – eg. Hernias – distended eg. Bloated IBS, constipation, infection, tumours – ascites – pregnancy
- Nutritious – obesity/eating disorders
- Hands – clubbing – cirrhosis, inflammatory bowel disease or coeliac disease – moles/scars – spider naevi – more than 6 liver disease but can also indicate preganan
- Face – spider naevia, eyes eg. Conjunctiva pallow, anaemia, yellowing sclera – liver problems – mouth and tongue – hydration, ulceration, dental enamel
How would you do an abdomen inspection?
- Patient lying flat with 1 pillow to inspet from side and front at eye level
- Look for protrusions eg. Hernia
- Look for contours – 5Fs (fat, flats, fluid, faeces and grotius)
- Check symmetry
- Umbilicus – hernias/bruising
- Hair distribution eg. Men with liver disease loose hair on belly
- Skin – scare, striae (stretchamarks)
- Palpations - temperature?, moisture of skin? capillary refill? normal less than 2s - hard or soft?, guarding/rododoty and tenderness
- Auscultate for bowel sounds - use diaphragm starting right lower quadrant losten for 5 minutes (if sounds found then stop normal 5-30 sounds per minute)
Whats the normal number of bowel sounds every minute?
5-30 sounds per minute
What are some additional tests often used in abdomen assessment?
- Stool samples
- Bladder scan
- Urinalysis
State what is being inspected in urinalysis
- Leukocytes – white blood cells in urine – indicate UTI
- Nitrites – suggest bacterial infection
- Urobilinogen – normal in small quantities but large may indicate liver disease
- Protein – early signs of kidney disease - Injury to urinary tract, bladder, urethra, - inflammation and malignancies
- Haematuria – blood in urine – suggest trauma, smoking, infection – kidney disease or tumour
