Gastrointestinal Flashcards
Which Organs are Located in the Right Upper Quadrant (RUQ)?
- Ascending and transverse colon
- Duodenum
- Gallbladder
- Liver
- Pancreas (head)
- Pylorus (Ileum transverse all Q)
- Right adrenal gland
- Right kidney (upper pole)
- Right Ureter
Which Organs are Located in the Left Upper Quadrant (LUQ)?
- Spleen
- Stomach
- Transverse descending Colon
- Pancreas (body and tail)
- Left adrenal gland
- Left kidney (upper pole)
- Left ureter
Which Organs are Located in the Right Lower Quadrant (RLQ)?
- Appendix
- Ascending colon
- Cecum
- Right kidney (lower pole)
- Right ovary and tube
- Right ureter
- Right Spermatic Cord
Which Organs are Located in the Left Lower Quadrant (LLQ)?
- Sigmoid colon
- Left kidney (lower pole)
- Light ovary and tube
- Left Ureter
- Left Spermatic Cord
Which Organs are Located in the Midline?
- Bladder
- Uterus
- Prostate Gland
What are the 2 types of Digestion?
- Mechanical (chewing)
- Chemical (enzymes that break food down
- Digestion spans from mouth - anus
Where does Absorption Occur?
- Nutrient absorption takes place in the small intestine/bowel
- water absorption takes place in the large intestine/bowel
- Whatever is not absorbed in small bowel moves to large bowel
- Water & some electrolytes are reabsorbed, the rest is waste
When is Water eliminated?
- Water is eliminated 48 hours after food is ingested
What are the 6 Factors Affecting Ingestion, Digestion, and Elimination?
1) Age
- Continence - the ability to withhold food - is developed in childhood
- Peristalsis decreases with age
2) Activity
- Physical activity promotes peristalsis.
- This is why patients should be up and ambulating as soon as possible
3) Nutrition and Fluid Intake
- High Fiber and adequate fluid intake promotes peristalsis and elimination
- Consider food intolerances, such as gluten allergies, and how they impact the digestive system
4) Medications
- Medications side effects can commonly cause either diarrhea or constipation and can also impact a patient’s appetite
5) Pregnancy
- Constipation is common in pregnancy, especially in the third trimester when the fetus is larger and putting pressure on the bowel
6) Dentition
- The ability to chew well and comfortably is impacted by underlying dental issues
Ex. Dentures, if not fitted appropriately can cause mouth lesions
What are the 5 Common GI Complaints?
- Dysphagia - swallowing difficulties
- Nausea and Vomiting - any vomiting with blood (hematemesis) is a big concern
- Indigestion - indigestion can be pain or discomfort in your upper abdomen (dyspepsia) or burning pain behind the breastbone (heartburn)
- Change in Bowel Pattern - could be an increase frequency (diarrhea) or decrease in frequency (constipation)
- Anorexia - someone experiencing ‘anorexia’ lacks an appetite
What are the 3 types of Abdominal Pain?
1) Visceral (organ distention) pain
- characterized as gnawing, burning, cramping, aching
2) Parietal (inflammation of peritoneum)
- pain, localized over involved structure, steady, aching, or sharp especially with movement
3) Referred:
- Pain that is usually located in the cutaneous dermatome, sharing the same spinal cord level as the visceral inputs.
Abdominal Pain: Types and Locations
SEE CHART
History Considerations Related to the Abdominal System
OLDCARTSS
Associated Symptoms
○ consider other symptoms then just the presenting complaint
ie. fever, nausea and vomiting, has appetite or bowel function changed at the same time, any unintended weight loss, travelled anywhere recently, does eating make the symptom better or worse?
Past Medical History
- Does the patient have any other abdominal diagnoses?
- Abdominal surgeries?
- Food allergies or intolerances?
- Have they ever had this symptoms before? If so, what was the diagnosis/treatment?
- Medications?
Family History
- any family history related to the abdominal system in first relatives? (ie. Stomach or Colon cancers, Celiac Disease, Chron’s or Colitis?
Lifestyle
- How much alcohol do they drink in a week?
- Do they smoke?
- Illicit drug use?
- Daily caffeine intake ?
- Activity level?
- diet?
- stressed?
What should you ask a a patient about their bowel movements?
- Frequency
- Consistency
- Amount
- Colour
- Odour
- Presence of mucous or blood (** blood could be present as bright red blood or occult blood that looks like dark, tarry stools - referred to as Melena**)
What is the Bristol Stool Chart?
- the Bristol Stool Chart classifies types of stool
Type 1 - Severe Constipation
- seperate hard lumps
Type 2 - Mild constipation
- Lumpy and sausage like
Type 3 - Normal
- sausage shape with cracks in surface
Type 4 - Normal
- like a smooth, soft sausage
Type 5 - Lacking Fibre
- soft blobs with clear cut edges
Type 6 - Mild Diarrhea
- mushy consistency with ragged edges
Type 7 - Severe Diarrhea
- liquid consistence with no solid pieces
How should a Physical Examination of the Abdomen be done?
- should be performed while your patient is lying flat
- involves all methods of examination in the following order:
1) Inspection
2) Auscultation (Precedes palpation as it may alter bowel sounds)
3) Palpation
4) Percussion (advanced technique not performed by the RN)
When Inspecting the Abdomen, what should the nurse look for?
- Contour of the abdomen: could be scaphoid, flat, or protuberant
- Color of the skin: are there any obvious skin colour deviations not consistent with the patient’s ethnicity? any other areas of redness or bruising?
- Umbilicus: Should be midline
- Any scars or striae?
- Do you notice any visible masses or pulsations?
- Is the abdomen symmetrical on each side?
Look for signs that your patient may be in pain by noticing their positioning and facial expression
- Active bowel signs mean that peristalsis is occurring
- They sound like irregular gurgling, clicking noises with a combination of high and low pitched tones
- Start listening in the RLQ and progress around each of the 4 quadrants of the abdomen listening for 5-20 seconds in each quadrant
- normal “active” bowel sounds occur at 5-35 times a minute (we don’t count them)
- document bowel sounds as present, absent, hyperactive, or hypoactive. (ie. bowel sounds present in all 4 quadrants)
- The optimal time to auscultate for bowel sounds is in between meals
What are the 3 Types of Bowel Sounds?
1) Hyperactive
- Hunger Diarrhea
- > 35/minute
2) Hypoactive
- Common After Surgery
- < 5/minute
3) Absent
- Bowel Obstructions distal to the obstruction
- No bowel sound x 5 minutes
Light Palpitation of the Abdomen
- Light palpation of the abdomen is to feel for tenderness, distention, and superficial masses.
Assess the following while palpating:
- Overall consistency (soft or firm) and associated pain/tenderness.
- abdomen is usually soft upon palpation.
- Note the location of any firmness and any associated pain/tenderness.
- consistency of the abdomen is influenced by the amount of adipose tissue or muscle, but these are symmetrical across the abdomen.
- Presence of masses.
- Describe any masses in terms of location, size (dimensions), shape, consistency (soft or firm), and associated pain/tenderness.
-Presence of swelling.
- Note the location of any swelling.
- Presence of pain.
(If the client feels pain/tenderness upon palpation, note the location and ask them to rate the severity on a scale of 0 to 10) - Presence of rigidity and spasms.
- Rigidity is involuntary firmness/hardness of the abdominal muscles associated with peritoneal inflammation.
- This rigidity is felt over the inflamed area; it is not bilaterally symmetrical and not voluntary
- spasms are muscle contractions that are often painful.
Clinical Tip: if client has indicated pain/tenderness, palpate that area last.
- Palpating the area of abdomen will 1st aggravate the pain and may affect the accuracy of the assessment
