Abdominal/Gastrointestinal assessment Flashcards
What are the different landmarks for the GI system?
Pubic symphysic, ziphoid process, costal margins
How many quadrants is the GI system typically divided into?
4
What is the most common issue for the RLQ?
appendix issues (gynecological as well)
What are the LLQ issues mostly related to?
colon
Patients mostly come in complaining of what related to GI?
How do kids describe GI pain?
Most patients complain of pain
Kids will point to belly button, regardless of issue
Hematemesis
Vomitting blood
Difficulty swallowing
Dysphagia
Pain when swallowing
Odynophagia
Liver issue causing yellowing of the skin
Jaundice
How is heart burn affected when a person lies down?
Gets worse since gravity is no longer assisting them
What are some common descriptors of heart burn?
Burning sensation
metallic taste in mouth
increased amount of burping
Pain associated with organs.
visceral pain
Type of pain that is well localized over the involved structure (e.g. appendicitis)
Parietal pain
What is an example of a GI issue that will have radiating pain?
Gallbladder attack – back pain, nausea
Why do many patients engage in the fetal position when having GI distress?
reduced irritation and distension of the peritoneum
If eating makes the pain lesser, what is most likely the GI issues?
Peptic ulcer (stomach)
If eating makes the pain worse, what is most likely the GI issue?
Esophageal reflux
Where does appendix pain usually start, before moving to the RLQ?
Belly button
Why can dentures cause pain to older adults?
As we get older, our facial structure and mouth changes size - dentures may not fit well and start to rub
What are the cranial nerves to keep in mind for GI?
CN 9 and 11 - for swallowing
What may be the only symptom of GERD (gastric esophageal reflux disease)?
coughing
How may LOC impact GI?
may be an issue for swallowing
Who are at most risk for dehydration related to vomiting?
Children and the elderly
When vomit looks like it has coffee grinds, what does this mean?
Dry blood is present
What is frank hematemesis?
Bright red blood in vomit
Why is it important to ask where a person has eaten if they have had food poisoning?
We track this information for public health
What are the questions we ask for stool?
Nature, consistency, frequency, amount, odour, colour.
What is the biggest red flag for colour in bowel movements?
Black, tarry stools - digested blood called melena
Melena occurs due to what?
Issues in the SI or lower - often related to colon cancer
Why is it more concerning if people have diarrhea at night?
Bowels are usually inactive at night - will be worried of inflammatory bowel disease if there is not a GI bug
What is important to also note if a patient is having diarrhea?
any weight loss
What is the cutoff for constipation?
10 days without a bowel movement (esp. children) is constipation
What is the likely cause of the inability to fully evacuate the bowels?
Obstruction - either due to cancer or decreased in colon peristalsis
What is steatorrhea?
Increased amount of fat in stools related to pancreatitis
How is peristalsis affected as we age?
Decreases
What is the meme about fiber in the diet?
Need to also have fluids or else this won’t help at all
What is the BPG for fluid intake?
6-8 glasses per day
What is important regarding patients post-surgery?
Ambulate them to stimulate peristalsis
What is one of the number one reasons children get constipated?
Not going to the bathroom out of embarrassment (may be an issue in hospitals)
How do personal habits come into play when a person is constipated?
Nurse can help implement a bowel routine - ex: going to the bathroom after eating to promote peristalsis
Why do health professionals try to avoid the use of laxatives for treatment of constipation?
The bowel can get trained to be reliant on them
What is the best position for evacuating the bowels?
Raising the knees
left side, fetal position
What is encopresis? Why does it happen?
Involuntary loss of control of the bowel.
Happens to children when they hold in their bowel movement.
How do anesthetics affect bowel movements?
stops bowel movements, then slows them down
What are some medications that cause constipation?
Opioids and narcotics
iron supplements
Meds affecting urination: diuretics, anti-cholinergics, SSRIs
(pretty much any medication)
How can diagnostic tests affect the GI system?
some diagnostic tests can reduce peristalsis
What is the order of techniques for GI assessment?
Inspection, auscultation, palpation, percussion.
Where does inspection begin?
Upper GI - ex: teeth
What is Hutchinson’s teeth related to?
(congenital syphilis)
acid erosion pathology
How does vitamin B deficiency manifest itself in the GI system?
angular stomatitis (sides of lips get roasted)
How do many medications affect the gums?
Cause gingival hypertrophy
Pigmentation of the gums is often due to what?
Cancer
What is scrotal tongue?
Benign, non-pathological condition causing fissures in the tongue
What causes strawberry tongue?
Scarlet fever
What is a classic stance that GI patients will adopt?
Guarding stance
What are some things we inspect for for the GI assessment?
Skin colour
symmetry, size, shape, distension
facial expression and posture
general behaviour
What are striae
stretch marks
Accumulation of fluid in the abdomen causes what? What is done for it?
ascites - drain it
What is the purpose of auscultation for GI assessment?
Listen for bowel sounds/peristalsis
What is the normal rate of bowel sounds?
5-35 sounds per minute
Auscultation of the GI system is not really important unless what?
there is pain
How long does one have to listen for before one can say bowel sounds are absent?
5 minutes (each quadrant)
What could cause hyperactive bowel sounds?
irritable bowel syndrome, diarrhea
What could cause hypoactive bowel sounds?
post-surgery, immobility, constipation
When is the optimal time to listen for bowel sounds?
after eating
Are bowel sounds heard even if there is an obstruction?
yes, still can hear some
When is the bell used for abdominal assessment?
to listen for bruits
Percussion.
What kind of sounds should be heard over organs?
Everywhere else?
Constipation?
dullness
tympanic - air filled
dullness
What is the purpose of palpation of the abdomen?
Detect areas of tenderness, unexpected distension, or masses
How can the stethoscope be used for palpation?
Press gently to make sure patient actually feels pain in those areas
What is rebound tenderness, and what is it a sign of?
pain on the rebound after pushing the hand down
associated with appendicitis
What is palpated last for the abdomen?
the area of tenderness
CVA - costal vertebral tenderness is associated with what?
Kidney issues
What is the abdominal shape of children?
Protuberant
How may the umbilicus be affected in pregnant women?
may pop out
For older people, why is it easier to palpate?
less muscle tone
Why is a CBC done for GI asesssment?
asses infection, anemia with Celiac, etc.
What is the purpose of an occult blood test?
Determine if there is blood in the stool that cannot be seen
What is endoscopy? Colonoscopy?
Mouth to stomach
rectum to stomach
Endoscopy going into the biliary tree of the liver into the pancreatic system
ERCP
