Abdominal Assessment And Bowel Elimination Flashcards
Anatomy of the GI tract
Mouth, esophagus, stomach, small intestine, large intestine, anus
Know organs in each quadrant of the abdomen
GO LABEL!!!
Subjective bowel assessment
Appetite changes, diet, physical activity, medications, exercise, fluid intake, pattern, characteristics, routines, any pain/discomfort
Signs and symptoms of abdominal disorders
Pain, nausea/vomiting, bowel movements, GI bleeding, abdominal dissension
DysphaGia
Difficulty swallowing any liquid or solid material
Dysphasia
Speech disorders in which there is impairment of the power of expression by speech, writing, or signs of impairment of the power of comprehension of spoken or written language
When assessing the abdomen, do what first….
LOOK AND LISTEN
Auscultate before palpate
Abdominal skin
Color is normal with smooth texture
Yellow = jaundice
NO lesions
NO rashes
NO scars
NO striae (related to pregnancy, rapid growth, cushings, or obesity) NO spider Angioma (one could be normal, more consider liver damage)
Cullens sign
Periumbilical bleeding
NOT NORMAL
Bleeding behind the peritoneum
Turners Sign
Flank bleeding
Bleeding behind the lining of the abdominal cavity
Abdominal contour
Should be flat or rounded
NOT scaphoid (could be malnourishment) or protuberant
Types of localized enlargements
Hernias, tumors, cyst, bowel obstruction
Abdominal Aortic Aneurysm
Visible pulsation
Marked pulsation right above the belly button
Normal bowel sounds
High pitched, gurgling, cascading sounds
Hyperactive sounds
Loud, high pitched, rushing, tinkling sounds (increased motility)
Borborygmus - loud stomach gargling
Hypoactive or active sounds
Decreased motility associated with anticholinergic medications, abdominal surgery, ileum, or inflammation of the peritoneum
Listen for five minutes in each quadrant
Mixed abdominal sounds
Varied sounds based on quadrant and what is happening
Hyperactive ABOVE a mass/impaction
Hypoactive BELOW the mass/impaction
Auscultation of vascular sounds
Use bell to look for bruit
- aorta
- renal artery
- illiac artery
- femoral artery
Abdominal palpation
Can identify areas of tenderness
Empty bladder
Lighter —-> deeper palpations (never go to where it hurts)
Do not palpate an abdominal mass
Rebound tenderness
Press onto the involved area and let go. Pain upon rebound indicates peritoneal tenderness
Common with appendicitis
McBurney’s point
Draw a line from the right anterior superior iliac spine and the umbilicus
This area has discomfort during appendicitis
Characteristics of feces
Color, odor, consistency, frequency, shape, constituents
Bristol Stool Chart
Type 1 ——> Type 7
Tiny, hard lumps ——> long, liquid diarrhea
Common alterations in bowel elimination
Constipation
Diarrhea
Flatulence
Blood in stool
Fecal incontinence
Hemorrhoids
Flatulence
Gas in lumen intestines
Avg individual produces 1/2 liter of gas/day
Needs to be passed or it will cause dissension and pain
Good for post-op patience
Diarrhea
Caused by infection, food poisoning, meds, food intolerance, diseases, and procedures
Dehydration
Treatment with avoiding dehydration, probiotic yogurt, and the BRAT diet
Constipation
Lack of fiber, fluids, exercise
Hard, dry, formed stools with decreased frequency
Types of laxatives
Bulk forming
Emollient/stool softener
Stimulant/irritant
Lubricant
Saline/osmotic
Bulk forming
Increases the fluid, gaseous, or solid bulk in the intestines
May take 12hrs to act, sufficient fluid needed, good for long term use
Emollient/stool softener
Softens and delays the drying of the feces; permits fat and water to penetrate feces
Slow acting, may take several days
Stimulant/irritant
Irritates the intestinal mucosa or stimulates nerve endings in the wall of the intestine, causing rapid propulsion of the contents
Acts more quickly that bulk forming
Fluid is passed with the feces
May cause cramps
Prolonged use may cause fluid and electrolyte imbalance
Lubricant
Lubricates the feces in the colon
Prolonged use inhibits the absorption of some fat-soluble vitamins
Saline/osmotic
Draws water into the intestine by osmosis, distends bowels, and stimulates peristalsis
May be rapid acting
Can cause fluid and electrolyte imbalance
Not used by older patients
Prolonged use inhibits absorption of some fat soluble vitamins
Hemorrhoids
Prolapsed, varicose veins of the rectum
Inc venous pressure r/t constipation, straining, pregnancy, w weightlifting
Bleeding, bright red, pain, itching
Treatment: avoid constipation, warm bath, cortisone cream, sclerotherapy, hemorrhoidectomy
Guaiac Fecal Occult Blood Test
Detects GI bleeding that isn’t seen most commonly
Normal - negative
- no blood detected
Abnormal- positive
-colon or rectal polyps or cancer, hemorrhoids, annal fissures, esophageal or gastric cancer, peptic ulcers, ulcerative colitis, chronic disease, GERD, esophageal varies
False-positive:
- recent dental procedure, bleeding gums, eating red meat, fish, turnips, horseradish, high doses of Vitamin C, NSAID
Valsalva Maneuver
Patient inspires deeply and holds breath while contracting ab muscles and bearing down
- Inc intra abdominal and intra thoracic pressure.
- Dec venous return to heart
- bradycardia, Dec BP, Dec CO
Stoma
Whole opening into a hallow organ
Tracheostomy - a stoma in the trachea
Appendicitis referred pain
Umbilical pain
Rebound tenderness
McBurneys Point ( right)
Cholecystitis referred pain
RUQ pain with radiation to shoulder/back
5 Fs: fat, fair, forty, flatulence, female
Constipation referred pain
Sharp pain mimicking appendicitis
Diffuse tenderness with palpation
Diverticulitis
LLQ
Pain worse after eating
Pancreatitis referred pain
RUQ and epigastric pain
Peptic Ulcer referred pain
Epigastric pain 1-2 hours after meals
Sudden and severe
Right shoulder radiation
Peritonitis referred pain
Abdominal pain
Inc with movement
Rebound tenderness
Abdominal Aortic Aneurism (AAA)
Often asymptomatic
Back/abdominal pain
Pulsatile mass may be palpable
