Elimination: Gastrointestinal Flashcards
Esophagus
- Peristalsis
* Mediastinal location
Stomach
- Upper left quadrant
- Stores food
- Digestive enzymes
- Pyloric sphincter connects small intestine
Small Intestine
- Largest segment of GI tract
- Secrets/absorbs nutrients
- Duodenum (proximal), Jejunum (middle), Ileum (distal)
- Ileocecal valve/sphincter control flow of food to large intestine/prevent back flow of bacteria
- Common tile duct empties into duodenum
Large Intestine
- Ascending (right), Transverse (right to left), Descending (left)
- Terminal portion= sigmoid colon, rectum, anus
Primary Functions of GI Tract
- Breakdown
- Absorption
- Elimination
Chewing/Swallowing Function
- Breaks down food (mastication [mechanical])
- Digestive enzymes
- Epiglottis covers trachea to prevent aspiration
Gastic Function
- Digestive enzymes breakdown food and destroy ingested bacteria
- Chyme= partially digested food mixed with secretions
Small Intestine Function
- Starting at jejunum, absorption is main function
* Digestive enzymes (amylase, lipase, bile)
Large Intestine
- Bacteria helps breakdown food
* Slow peristalsis allows for REABSORPTION of WATER and ELECTROLYTES as main function
Waste Removal
- Feces= food, bacteria, water, inorganic substances
* Elimination begins with distention of rectum, contractions of rectum, relaxation of internal anal sphincter
Factors Affecting Defecation: Diet↑↓
• Constipation from refined foods (no bulk/fiber)
• Lack of bulk= less pressure= ↓ peristalsis
*Longer food sits in colon–> harder/drier stool
• Irregular eating patterns
Factors Affecting Defecation: Fluid
- 1500-2000 ml/day for normal bowel movements
* ↓ fluid intake= harder/drier stool
Factors Affecting Defecation: Exercise
• Promotes peristalsis
Factors Affecting Defecation: Stress
• Diarrhea
Factors Affecting Defecation: Lifestyle
• Postponing, embarrassed, change in environment
Factors Affecting Defecation: Medications
• Diarrhea (antibiotics), constipation (opioids)
Abdominal Assessment
- Inspection
- Auscultation
- Percussion
- Palpation
Contraindications for Physical Exam (percussion/palpation specifically)
- Appendicitis
- Abdominal Aortic Aneurysm
- Tumors
Physical Assessment of Oral Cavity: Contour
- Uvula= smooth
* Hard palate= dome-shaped, firm
Physical Assessment of Oral Cavity: Color
- Red/smooth/beefy= Vitamin B12 deficiency (pernicious anemia)
- Hard palate: white
- Soft palate: pink
Physical Assessment of Oral Cavity: Texture
- Oral Mucosa: smooth, shiny, no cracks
* Tongue: rough from papillae
Physical Assessment of Oral Cavity: Growths
• Note any white, ulcerations, masses, nodes
Physical Assessment of Oral Cavity: Teeth
- Dentures, partial, own teeth
- Location, size, how many missing
- Gums: color, retraction, bleeding, swelling
Physical Assessment of Oral Cavity: Gag Reflex
- Stimulate gently
* Tests cranial nerves IX and X (glossopharyngeal and vagus)
Abdominal Assessment: Inspection
• Empty bladder, supine position, arms at side, knees slightly flexed, drape, curtains
Abdominal Assessment: Inspection: Shape
- Flat: WD/WN; young, athletes, thin adults
- Slighting Rounded: slightly convexity; young children
- Protuberance: increased convexity from fat, less muscle tone, pregnancy; more than young child
- Scaphoid: lean people
- Distended: Fat, Flatus, Feces, Fatal growth, Fluid, Fetus
Abdominal Assessment: Inspection: Other Characteristics
- Symmetry: asymmetry could mean obstruction, hernia, tumor, spinal curvature
- Visible Peristalsis: strong contractions= obstruction
- Scars
- Masses: hernia, tumor, cyst, severe constipation
Abdominal Assessment: Auscultation
- Location, character, frequency of bowel sounds
- Vascular sounds (bruits)
- Listen to all 4 quadrants, diaphragm of stethoscope pressed lightly
Abdominal Assessment: Auscultation: Frequency
- Normal: 4-12/minute
- Hyperactive: >5-10 in 30 seconds or less
- Hypoactive: 1-2 in 2 minutes
- Must listen for FIVE minutes before documenting absent bowel sounds
Abdominal Assessment: Auscultation: Characteristics↑↓
• Normal: bubbling, soft
• Hyperactive: loud, gurgling
• Obstruction: “rushing,” tinkering, high-pitched
• Borborygmi: ↑ frequency/intensity
• Absent/Hypoactive: post surgery
*can take up to 72 hours for sounds to return
*BEST assessment is to ask about passed gas
• Bell of stethoscope for bruits (aortic, femoral, iliac, renal arteries)
Abdominal Assessment: Percussion
- Size/density
- Tympanic: hollow, drum like; gaseous distention
- Tympani is NORMAL (air in stomach/SI)
- Dullness: solid
Abdominal Assessment: Palpation
- Pain
* Rebound Tenderness: press at 90 degree angle away from tender area; tenderness felt on release
Assessment of Feces: Pattern
• Frequency
• Time
*Baseline
Assessment of Feces: Color
- Brown= normal
- Green/Orange= infection, malabsorption
- Red= tarry/blood
- Clay= barium, bile
- Foods
Assessment of Feces: Consistency and Shape
- Normal= soft and formed
* Abnormal= ribbon-like (obstruction, mass); pellets (constipation)
Assessment of Feces: Odor
- Foods
* Blood
Assessment of Feces: Abnormal Constituents
• Blood, pus, excess mucus/fat, parasites
Diagnostic Tests for GI System
- Abdominal Xray
* Stool: occult blood (OB; Guaiac test), parasites, cultures
