Exam 3 GI Flashcards
Anatomic Locations of 4 Quadrants
What includes? Right upper (RUQ)
liver, gall bladder,head of pancreas, right kidney
hepatic flexure of colon, part of ascending and transverse colon
Anatomic Locations of 4 Quadrants
What includes? Left upper (LUQ)
Stomach, spleen, left lobe of liver, body of pancreas, left kidney
splenic flexure of colon, part of transverse and descending colon
Anatomic Locations of 4 Quadrants
What includes? Right lower (RLQ)
Cecum, appendix
Right ovary and tube, right ureter, right spermatic cord
Anatomic Locations of 4 Quadrants
What includes? Left lower (LLQ)
Part of descending colon, sigmoid colon
left ovary and tube, left spermatic cord
Kidneys location
Posterior or retroperitoneal to abdominal content
Right kidney rests 1-2 cm lower than left b/c of placement of liver
Lower edge of liver and right kidney ?
Small intestine ?
Pancreas?
Lower edge of liver and right kidney may normally be palpable.
Small intestine is located in all 4 quadrants
Pancreas soft, lobulated gland behind stomach
Spleen
location and function
Soft mass of lymphatic tissue
Post wall of abdominal cavity, below diaphragm
Fights invading germs in the blood (contains white blood cells)
Controls the level of blood cells (WBCa,RBcs,platelets)
Filters the blood and removes any old or damaged red blood cells
How to assist abdominal pain?
Acute upper and lower pain or discomfort
Dysphagia
Difficulty swallowing
Taking more time and effort to move food or liquid from your mouth to your stomach.
Chronic upper discomfort or pain, most reason?
Functional dyspepsia
You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient:
flex his or her knees
Proper Order of the Examination
Inspection
Auscultation
Percussion
Palpation
It is believed that percussion and or palpation can change the intestinal motility
Chronic lower pain
Ask about changes in bowel habits
(Diarrhea? constipation?)
What subjective dates we want to get? 10
Appetite
Dysphagia
Abdominal pain
Nausea and vomiting
Bowel habits
Past abdominal history
Medications
Recent stressful life events
Possibility of Pregnancy
Nutritional assessment
Tips for the Examination
Patient should have an empty bladder
Bend the patient’s legs
Be on patient Right side
Supine position w/ hands by side
Painful area examined last
Inspection first!
Look at the contour of the abdomen
If not FLAT, think of 7Fs
Fat
Fibroids
Flatus
Fluid
Fetus
Feces
Fatal Tumor
Inspection/Contour
What it look for?
Flat, Rounded or Scaphoid
Flat is common in well-muscled athletic adults
Rounded—young children—or in an adult is fat or poor muscle tone
Scaphoid—Thin adults
Spider Angiomas
Often alcoholic cirrhosis
but also pregnancy, collagen vascular disorders
Striae
Stress marks consistent with weight loss
Could be pregnancy, tumors or ascites
ascites/Excess abdominal fluid, caused most often related to liver disease
adhesion/癒着
Presence of scars not explained before could lead to history information
Auscultate the abdomen
Begin in RLQ at ileocecal valve
Ileocecal valve
Muscular sphincter that allows contents to move from the ileum of the small intestine to the cecum of the large intestine
“Silent abdomen” is uncommon
What we are going to do?
Must listen for 5 minutes before deciding bowel sounds are completely absent
vascular sounds
How are we gonna listen?
Listen all 4 quadrants
Begin in RLQ at ileocecal valve
Bowel sounds
Increase?
Decrease?
Auscultation=Bowel motility
Increased
-diarrhea or early intestinal obstruction
Decreased
-Adynamic ileus and peritonitis
Peritonitis?
Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.
Usually infectious and often life-threatening.
Adynamic ileus
When food or drink does not pass through the bowel
Commonly occurs for 24 to 72 hours after abdominal surgery
Percussion helps what?
Listen for what sounds?
The amount and distribution of gas in the abdomen
Tympanic
Resonance
Dullness
What are resonance, tympani and suprapubic sounds?
Resonance and Tympanic sound the same
Resonance hollow sounds heard over normal lung tissue
- *Tympani**
- drum-like sounds heard over air filled structures
- *Gas presence** in the stomach, small bowel and colon
Suprapubic area may sound dull if bladder is distended or uterus is enlarged in a women
Palpation
What looking for?
Light palpation detect abnormal tenderness, muscular resistance
Developmental Competence
During early childhood
Abdominal wall is less muscular, so organ may be easier to palpate
Developmental Competence
Teenagers
Ask:
nutritional assessment
activity & exercise patterns
recent wt. loss or gain
Developmental Competence
Pregnant Woman
High incidence of nausea and vomiting(r/t hormones) and
“heartburn (pyrosis)” or esophageal reflux
Decrease in gastric motility which leads to constipation
Increase venous pressure in lower pelvis may lead to hemorrhoids
Skin changes on abdomen include striae and linea nigra
Developmental Competence
Aging Adult
Aging should not affect GI function!!
Decreased salivation, leading to a dry mouth and decreased sense of taste
Decreased gastric acid secretion and esophageal emptying
Decreased liver size
Increased deposit of fat on abdomen and hips
Increased report of constipation
Common Causes of Constipation
in Older Adult
Decreased physical activity
Inadequate intake of water
Low fiber diet
Side effects of medications
Irritable bowel syndrome
Bowel obstruction
Hypothyroidism
Inadequate toilet facilities
Difficulty ambulating to toilet
Focused Health History
ASK Older Adults
How do you get your groceries?
Prepare your meals?
Do you have any trouble swallowing?
How often do your bowels move?
How often do you take anything for constipation (OTC/ herbs)?
What meds do you take?
Referred pain
location of pain is not necessarily where the involved organ is!
Pain may be felt where the organ was located in fetal development
ex: spleen= L shoulder pain/ kidney= groin pain
Rebound Tenderness
Rebound Tenderness= appendicitis
Pain upon removal of pressure rather than application
of pressure to the abdomen
Pain in the RLQ when pressure is released from the LLQ
Murphy’s Sign
Hold fingers under the liver border
Ask the pt to take a deep breath
A normal response is to complete the deep breath without pain
Positive Murphy sign
Pain occurs on inspiration
Stop in inspiration
“inspiratory arrest” = cholecystitis
Obturator Test
lift the right leg straight up, then rotate at 90 degrees= muscle is irritated by appendicitis
Pain= acute appendicitis
Iliopsoas Muscle Test
Lift the right leg straight up,
Then push over the right thigh as the person tries to hold the leg up
appendicitis pain is felt in the RLQ
The nurse is planning to assess the abdomen of an adult male client. Before the nurse begins the assessment, the nurse should
ask the client to empty his bladder
A client comes to the emergency department complaining of pain in the right lower quadrant. Rebound tenderness is present and the nurse assesses the client for referred rebound experiences. The client experiences pain the right lower quadrant. The nurse interprets this as which of the following?
Positive Rovsing’s sign
The nurse is palpating in the right upper abdominal quadrant and feels and enlarged area. The nurse recognizes that she is most likely feeling what organ?
Liver
The nurse is assessing a client with a bladder disorder. Where would the nurse expect the pain to be?
Suprapubic
The nurse correctly identifies the gallbladder is located where?
RUQ
While auscultating a client’s abdomen, the student notes sounds that are both high-pitched and rushing. The student demonstrates an understanding of abnormal bowel sounds when proposing what to be the cause of these sounds?
Partial intestinal obstruction
A client is complaining of pain in the right upper quadrant and also in the right shoulder. Which organ would the nurse suspect as being involved?
Gallbladder
Assessment of a client’s abdomen reveals a positive Murphy’s sign. Which of the following would the nurse suspect?
Cholecystitis
Inflammation of the gallbladder,
The nurse assess for kidney tenderness at what location?
Costovertebral angle
To palpate the spleen of an adult client, the nurse should begin the abdominal assessment of the client at the
left upper quadrant.
A nurse determines that the liver span of an older adult male client measures 6 cm at the MCL. How would the nurse would interpret this finding?
Normal Liver size.
The normal liver span is 6 to 12 cm, so this is a normal finding.
The nurse is evaluating a new nursing graduate’s ability to perform a rebound tenderness test for suspected appendicitis. The nurse determines correct technique when the new graduate is observed pressing deeply at which anatomic location?
- Right lower quadrant
The appendix is located in the right lower quadrant. If the client has appendicitis, pressing deeply in this location with a sudden release of pressure will elicit a sharp, stabbing pain, which is called “rebound tenderness.”
The nurse is percussing a client’s abdomen. What predominant sound should the nurse expect to hear over the majority of the abdomen?
Tympany
The pancreas of an adult client is located
deep in the upper abdomen and is not normally palpable
What additional history questions you might inquire about for young (teenage) adults?
nutrition
activity and exercises
recent weight loss and gain
Pyrosis
heartburn
Eructation
belching
commonly known as burping
- Food Intolerance
a negative reaction to food that doesn’t involve the immune system
Hematemesis
vomiting blood
Black stools vs. gray stools vs. red stools
Blck-blood in upper GI tract or iron supplements
Gray-hepatitis
red-lower GI bleed
Hepatomegaly
enlargement of the liver
- What is the rationale to initiate the abdominal auscultation in the right lower quadrant (RLQ)?
because this is the location of the ileocecal valve, which is a muscular sphincter that allows contents to move from the ileum of the small intestine to the cecum of the large intestine.
Where is the aorta locate?
The let of midline in upper part of abdomen.
What is the hypoactive?
No Bowl Sound within 30 seconds for each quadrant
Peritonitis
What is the hyperactive?
Borborygmi often can be heard w/o a stethoscope
gastroenteritis
What is the gastroenteritis?
An intestinal infection marked by diarrhea, cramps, nausea, vomiting, and fever
How often should you hear bowel sounds?
5-30 per minute
