Gastrointestinal and Genitourinary Flashcards
1
Q
Inside the abdominal cavity, all the internal organs are called
A
viscera
2
Q
where is the spleen
A
in the upper left side of your abdomen, next to your stomach and behind your left ribs
2
Q
Where is the stomach
A
upper abdomen on the left side of your body.
3
Q
Where is the small intestine
A
connects the stomach and the large intestine. It is about 20 feet long and folds many times to fit inside the abdomen.
4
Q
Descending colon
A
on the right side of the abdomen
5
Q
Where is the gallbladder
A
on the right side of your abdomen, just beneath your liver.
6
Q
what organs are in the upper right quadrant
A
liver, right kidney, colon, pancreas, gallbladder
7
Q
What organs are in the lower right quadrant
A
right kidney, colon, small intestine, major artery and vein to right leg, appendix
8
Q
What is in the left upper quadrant
A
liver, spleen, left kidney, stomach, colon, pancreas
9
Q
Where is the hypochondriac region
A
upper left and right
10
Q
where ss the epigastric region
A
upper middle
11
Q
Where is the lumbar region
A
the middle
12
Q
Where is the iliac region
A
Left and right lower
13
Q
Where is the hypogastric region
A
lower middle
14
Q
Order of assessment
A
assess, inspect, auscultate, percuss, palpate
15
Q
What position does the patient lie in during assessment
A
Spine with head and knees bent on pillow arms at side
16
Q
Inspection includes
A
contour
symmetry
umbilicus
skin
pulsation
hair distribution & demeanor
17
Q
Subjective data
A
Appetite
Dysphagia
Food intolerance
Abdominal pain
Nausea/vomiting
Bowel habits
Past abdominal history
Medications
Alcohol and tobacco
Nutritional assessment
Family history (IBD, celiac, ca)
18
Q
contour includes
A
rounded
protuberant (very large)
scaphoid (Skinn)
flat
18
Q
Striae
A
stretch marks
19
Q
Pulsations and movement in the abdomen
A
aorta
respiratory movement
Peristalsis
20
Q
What do bowel sounds sound like e
A
High pitched gurgling – irregular – should hear 5-30 times
21
Q
Hyperactive bowel sounds mean??
A
tingling, loud, high pitched - heard in diarrhea, constipation
21
Q
Hypoactive bowel sounds mean??
A
bowel obstruction, following surgery, peritonitis, torsion of bowel (decrease in peristalsis)
22
If the patient has hypertension what might you hear
a bruit—a vascular sound similar to a heart murmur—caused by turbulent blood flow through a narrowed artery
23
how long do you listen before deciding there is no bowel sounds
5 minutes
24
What may cause a bruit
plaque build up
25
Tympany
normal sound – d/t air in the intestines which rise to the surface when pt is supine
26
Dullness could indicate
distended bladder, fluid, mass, adipose tissue
27
Light palpation
depress skin about 1 cm
- use rotary motion
- move clockwise around the abdomen
27
If you do feel a mass, document
Location
Size
Shape
Consistency (soft, firm, hard)
Surface (smooth or nodular)
Mobility
Pulse felt
Tenderness
28
Why are seniors GI tracts lower
Decreased salivation[leads to decreased sense of taste], gastric acid secretion, delayed esophageal emptying
29
Social Determinant of Health & Health Promotion
Risk for obesity
Lactose intolerance due to lower level of lactase
Celiac disease
Gastrointestinal ulcers (peptic ulcer and duodenal ulcer)
Inflammatory bowel disease
Infectious disease such as hepatitis A
Health promotion –preventing damage to the liver
30
What are common causes of constipation in older adults?
Decreased mobility, adverse reaction of medications, poor dietary habits (decreased fluid intake)
31
When the patient reports that a certain abdominal spot is tender, it is best to:
palpate that spot last to prevent pain from interfering with the rest of the examination.
32
causes for abdominal destension
fluid, flatus, follicles
33
when doing a male genitalia exam
use hard strokes - if erection – reassure that it not unusual & continue with exam or leave room and com back in a few minutes
34
When preparing for GU assessment consider
Modesty
Fear of pain
Negative judgments
Invasion of privacy
35
Structure of penis
Glans
Corona
Urethra
Foreskin
36
Corona
refers to the circumference of the base of the glans penis which forms a rounded projecting border
37
male infants/child development
Descent of testes
Foreskin easily retracted around age 6
38
Male Adolescents Development
Signs of puberty
Tanner’s sexual maturity rating
39
male Adults and older adults development
Sperm production begins to decrease at 40 years
Testosterone declines gradually after age 55 years
Scrotal sac pendulous
Slower and less intense sexual response
Sexual expression in later life
Physical changes do not interfere with libido
40
stage one of tanners male development
10 and younger
-no pubic hair testes and penis are small they are prepubertal
41
Stage 2 of tanners male development
10-13
sparse thin hair id at base of penis, tests enlarge scrotal skin becomes courser and redder
42
Stage 3 tanners male development
12-14 scrotum and testies continue to grow. penis lengthens with diameter increasing slowly. Pubic hair will become darker, coarse, curly, extending laterally
43
Stage 4 tanners male development
13-15
-penis and testes continue to grow pubic hair extends across public squares the medial thigh
44
stage 5 tanners male development
15-17 penis is at full size pubiv hair is diamonds appearance with adult colour tenure extends surface of medial thighs
45
Subjective Data
Groin - hernias
Frequency, urgency, nocturia
Dysuria – burning with voiding
Hesitancy and straining
Hx of UTI’s
Colour
Past history – any kidney disease, flank pain, kidney stones
Penis
Scrotum – lumps, swelling, self-care behaviours
Sexual activity - # of partners in past 6 months, any issues with erections
STI contact - condoms
45
Comprehensive physical assessment:
penis
Scrotum
Inguinal region and femoral areas
46
Warning signs of STI
urethral discharge, bloody or purulent
Scrotal or testicular pain
Burning or pain during urination
Penile erosion
47
Paraphimosis
a common urologic emergency that occurs in uncircumcised males when the foreskin becomes trapped behind the corona of the glans penis
48
Smegma
whitish cheesy material) – sebaceous secretions that collect under the prepuce*
49
Penis should appear
hairless, wrinkled, without lesions.
50
Phimosis
unable to retract the foreskin
51
indirect inguinal hernia
-most common Indirect inguinal hernias occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal
51
Direct inguinal hernia
protrusion of abdominal contents through the transversalis fascia within Hesselbach's triangle.
52
Testicular self-examination tips
TSE is best performed after a warm shower or bath.
Examine each testicle one at a time with both hands.
Cancerous lumps usually are on the sides of the testicle but can show up on the front.
Make an appointment with a physician, preferably a urologist
53
most common age for testitcular cancer
15-49
54
Warning signs to watch out for with self testicular exams
Enlargement of the testes
Pain or discomfort
Heaviness in the scrotum
A dull ache in the groin
Significant loss of size of one testicle
Sudden collection of fluid in the scrotum
55
Sexual maturity in girls stage 1
preadolescent no pibic hair. Mons and labia covered with sine villus hair as on the abdomen
56
sexual maturity in girls stage 2
growth of sparse hair mostly on labs, long downy hair slightly pigmented only slightly curly
57
sexual maturity in girls stage 3
growth sparse and spreading over the pubis hair is getting dark and curly
58
stage 4 of sexual maturity in girls
hair is adult in type but a smaller area non medial thigh
59
stage 5 of sexual maturity in girls
adult in type and growing down to thighs
60
Questions to ask about pregnancy
of pregnancy, lives births, living children, complications, misscarages, abortions
61
Personal history questions
menstruation (consistency), Menopause, urinary issue, disscharge, immunizations
62
External genitalia
for a female
Mons pubis
Labia majora and Labia minora
urethra
Clitoris
Vestibule
Vaginal introitus
Perineum
Anus
63
Skene’s glands
surround urethral meatus
Bartholin’s glands – on either side of the vaginal orifice
64
External inspection: wear gloves
skin color
- hair distribution
- labia majora – symmetrical & plump (before having children)
- slightly shrunken & less defined (after having children)
- lesions
Separate the majora to inspect:
- labia minora
- urethra
- vaginal opening
- perineum
- anus
65
Common genital or rectal symptoms
Pelvic pain
Vaginal discharge, burning, or itching
Menstrual disorders
Structural problems
Hemorrhoids
66
Different in older women genitalia
Labia and clitoris smaller and paler
Epithelial layers thinner & flatter – cervix pale.
Thinning & drying of vaginal mucosa
Uterus & ovaries decrease in size
Ovarian follicles disappear
Ligaments & connective tissue lose muscle tone & elasticity
67
Cervix
The lower, narrow end of the uterus (womb) that connects the uterus to the vagina (birth canal).
68
Primary health promotion for cervical cancer
modify risk factors (safer sex, limiting partners, & HPV vaccine)
69
Secondary health promotion for cervical cancer
earlier diagnosis and treatment ( Accessible Pap smears, HPV viral screening, )
70
Teritary health promotion for cervical cancer
: Seeking to limit disability caused by the condition (early and effective treatment of precancerous legions)
71
When should cervical cancer screening begin
Should begin at age 21 or approx. 3 years after first intimate sexual activity *which ever occurs LATER.
72
How often should cervical screening occur
If results are normal, the person should be screened every 2 years until 3 consecutive normal results. AFTER receiving 3 consecutive normal results screening can be spaced every 3 years
73
Increased risk or past cervical disease-
these individuals need to be screened annually
Included confirmed biopsy of high-grade squamous intraepithelial lesion or Adenocarcinoma in situ
On immunosuppression who have ever been sexually active (ie: AIDS/HIV, organ transplant, long term corticosteroids).
Women with invasive cervical cancer- after hysterectomy continue with vault smears.
74
when can you stop getting screening
Can discontinue screening when older then 69 years old and 3 consecutive satisfactory and negative pap test in the last 10 years and are not immunocompromised.
75
Transgender Men and Cervical Cancer Screening- What Do We Know?
No consensus on screening rates for transgender, genderqueer, or gender non binary people related to cervical cancer
No consensus on HPV vaccination rates for transgender people
Some research suggest that transgender men may have increase rates of unsatisfactory results (not necessarily abnormal but the cytologist is unable to read the results).
