Gastrointestinal/Genitourinary Systems Flashcards
1
Q
What is the Solid Viscera in the Internal Abdominal Cavity?
A
Liver, pancreas, spleen, adrenal glands, kidneys, ovaries and uterus
2
Q
What is the Hollow Viscera in the Internal Abdominal Cavity?
A
Stomach, gallbladder, small intestine, colon and bladder
3
Q
What is the peritoneum?
A
Membrane that covers and holds organs in place
4
Q
What is peristalsis?
A
the involuntary constriction and relaxation of the muscles of the intestine or another canal, creating wave-like movements that push the contents of the canal forward.
5
Q
Kidneys
A
Remove waste from the blood to form urine
6
Q
Ureters
A
transport urine from the kidneys to the bladder
7
Q
Bladder
A
reservoir for the urine until the urge to urinate develops
8
Q
Urethra
A
Urine travels from the bladder and exits through the urethral meatus
9
Q
Liver
A
Produces and secretes bile to emulsify fat
10
Q
Gall Bladder
A
Stores and concentrates bile
11
Q
Pancreas
A
Secretes insulin and regulates blood glucose levels, secretes digestive enzymes
12
Q
Where are most nutrients absorbed?
A
Most nutrients absorbed in the small intestine
13
Q
Where are most electrolytes absorbed?
A
Electrolytes and water also absorbed through the large intestine
14
Q
What is some subjective data that you need to collect during a GI assessment?
A
- Abdominal History (surgeries, treatment, trauma)
- Family History
- Medications & Allergies
- Nutritional Assessment (appetite, dysphagia, food intolerance)
- Abdominal Pain
- Nausea/vomiting
-Bowel Patterns - Alcohol and/or Drugs
15
Q
What is dysuria?
A
Dysuria is defined as the sensation of pain and/or burning, stinging, or itching of the urethra or urethral meatus associated with urination.
16
Q
Hematuria
A
Blood in your urine
17
Q
Polyuria
A
your body makes more pee than normal. Adults usually make about 3 liters of urine per day. But with polyuria, you could make up to 15 liters per day. It’s a classic sign of diabetes.
18
Q
Melena Stool
A
Melena (black stool) is a symptom of internal bleeding, usually in your upper gastrointestinal (GI) tract.
19
Q
What is a key factor when performing IAPP on the GI system?
A
ALWAYS auscultate before percussion and palpation otherwise, you will increase peristalsis and give a false interpretation of bowel sounds
20
Q
Why do you always begin to auscultate in RLQ?
A
Always begin in the right lower quadrant 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.
21
Q
How many Bowel sounds should you hear per minute?
A
5-30 sounds per minute
22
Q
What happens if you do not hear 5-30 bowel sounds per minute?
A
If you do not hear anything in a minute then you need to listen for 5 minutes.
23
Q
Where do you begin your auscultation of the abdomen?
A
RLQ and work clockwise
24
Q
What do you note when auscultating bowel sounds?
A
- Note the character and the frequency of bowel sounds
- Bowel sounds are usually higher pitched
25
Hypoactive Bowel Sounds
Less than 5 a minute
Reduced (hypoactive) bowel sounds include a reduction in the loudness, tone, or regularity of the sounds.
They are a sign that intestinal activity has slowed.
Hypoactive bowel sounds are normal during sleep.
They also occur normally for a short time after the use of certain medicines and after abdominal surgery.
Constipation, Inflammation (peritonitis), Late bowel obstruction, can occur with pneumonia
26
Hyperactive Bowel Sounds
More than 30 bowel sounds a minute
loud, gurgling sounds (borborygmi) signal
increased motility
Hyperactive bowel sounds mean there is an increase in intestinal activity. This may happen with diarrhea or after eating. Abdominal sounds are always evaluated together with symptoms such as: Gas.
Early Bowel obstruction, gastroenteritis, diarrhea, laxative use
27
What vascular sounds are you auscultating for on the abdomen?
- Aorta
- Renal Artery
- Iliac artery
- Femoral artery
28
Should you hear Bruits when auscultating the vascular sounds of the abdomen?
No sounds should be present
29
What organs are in the RLQ?
appendix
Cecum
Portion of the ascending colon
Right ovary
Right ureter
Right spermatic cord
Lower portion of the kidney
30
What are the organs in the RUQ?
Gallbladder
Duodenum
Right Lobe of the liver
Head of the pancreas
Right adrenal gland
Part of the right kidney
A portion of the ascending colon
A portion of the transverse colon
31
What are the organs in the LUQ?
Spleen
Stomach
Body of the pancreas
Left lobe of the liver
Left adrenal gland
Part of the left kidney
A portion of the transverse colon
A portion of the descending colon
32
What organs are in the LLQ?
Sigmoid Colon
Portion of the Descending colon
left ovary
left ureter
Left spermatic cord
lower portion of the kidney
33
What does light palpation give you an impression of?
Form an overall impression of the skin surface,
tenderness, superficial muscles, swelling, rigidity,
pulsations.
34
How do you palpate the abdomen?
With four fingers close together, depress the skin 1-
2 cm. Make a gentle rotary motion, sliding the
fingers and skin together. Then lift the fingers and
move clockwise to the next location on the
abdomen
35
What should you hear when percussing the abdomen?
General Tympany (A hollow drum-like sound that is produced when a gas-containing cavity is tapped sharply)
Dullness over liver, masses, feces, and fluid
36
When percussing the spleen, what indicates an enlarged spleen (splenomegaly)?
If there is a change from tympany to dullness: indicates enlarged spleen
splenomegaly- accompanied by pain)
37
Where do you percuss for the spleen?
Percuss laterally from the 9th-11th ICS left midaxillary line
38
How do you percuss the kidney?
Right kidney: place hands together in a “duck bill” position on the patient's right flank.
Left Kidney: sits 1 cm higher than the right, normally not palpable. Required deep palpation
39
What is an acute emergent situation?
- Pain
- Tarry Stool
- Bloody Stool
- Hematemesis
- Trauma
- Emesis with fecal odour
- Jaundice
- Inability to void
- Referred cardiac pain
40
What are the 4 types of Urinary Incontinence?
- Urgency Incontinence
- Stress Incontinence
- Functional Incontinence
- Overflow Incontinence
41
What is urgency incontinence?
a. The inability to hold urine long enough to reach a restroom
b. It can be associated with having to urinate often and feeling a strong, sudden urge to urinate
42
What is stress incontinence?
a. This is the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or performing other body movements that put pressure on the bladder.
43
What is functional incontinence?
a. This is urine leakage due to a difficulty reaching a restroom in time because of physical conditions, such as arthritis, injury or other disabilities.
44
What is overflow incontinence?
a. Leakage occurs when the quantity of urine produced exceeds the bladder’s capacity to hold it.
45
What is nocturia?
Nocturia is defined as the need for patients to get up at night on a regular basis to urinate.
46
What are some considerations for the older adult with the GI/GU System?
- Less saliva & stomach acid
* Decreased taste
* Slower peristalsis (Difficulty swallowing & Malabsorption)
* Changes in dentition
* Reduced muscle mass
* Immobility, risk of
dehydration, decreased
thirst sensation
* Prone to constipation
* Fat accumulates in abdomen
* Renal function declines
* IADLs (meal prep)
47
Ascites
Ascites is a condition in which fluid collects in spaces within your abdomen.
48
External Male Genitalia
Penis (Urethral meatus, shaft, glans, prepuce or foreskin)
Scrotum (testes, epididymis, spermatic cord)
49
What subjective data should you collect when conducting a health history for GU?
- Personal History (STI, chronic illness, prostate issues)
- Current concerns/injuries
- Medical and Surgical History
- Medications
- Family History (cancer, infertility)
-Additional risk factors
- Protection during sports
- Self exams
- Age appropriate exams
- Sexual history and satisfaction with sexual activity
50
What are some things you ask when screening for STI's?
-Multiple partners
- New partners
- History of STIs
- Partner with STIs
- Partner has other partners
-Unprotected sex
- Vaginal/oral/anal sex
51
Priapism
Priapism is a disorder in which the penis maintains a prolonged, rigid erection in the absence of appropriate stimulation.
52
What do you do if the patient gets an erection during the exam?
If there is an erection, reassure the patient that
this is a normal response to the touching
involved in the exam.
53
Phimosis
Phimosis is defined as the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. Phimosis may appear as a tight ring or “rubber band” of foreskin around the tip of the penis, preventing full retraction
54
What is paraphimosis
Paraphimosis occurs when the foreskin is retracted behind the corona (or crown) of the penis and cannot be returned to the unretracted position
55
What objective data do you collect on inspection of the male genitalia?
- Groin (Skin, Hair distribution)
- Penis (Colour, lesions)
- Glans (Ask patient to retract foreskin)
- Urethral Meatus (Discharge)
- Scrotum (Skin, lesions, usually asymmetrical)
- Perineum (Spread buttocks inspect)
56
What do you palpate on the male?
- Palpate the anus and the rectum
- Palpate the prostate gland
57
How do you palpate the anus and rectum on a male?
- Using a lubricated gloved index finger, place the pad
of this finger gently against the anal verge.
- When the sphincter relaxes, flex the tip of your
finger and slowly insert it into the anal canal in a
direction toward the umbilicus.
- The canal should feel smooth and even.
- Decreased tone should be investigated
58
How do you palpate the prostate gland?
- On the anterior wall of the anal canal, note the
elastic, bluging prostate gland.
- Press into the gland in a systematic manner- noting
any nodules.
- The surface should feel smooth and muscular.
59
What are some considerations for the older adult male?
- Less testosterone affects sexual function (longer
to obtain erection and longer to ejaculate)
- Pubic alopecia
- Sometimes prostate enlargement
- Scrotum drop lower due to decreased muscle
tone
- Older adults can still get STI
- Assess dribbling, urgency, frequency, inability to
empty bladder
60
External genitalia on women
- Mons pubis
- Labia majora and Labia minora
- Clitoris
- Para-urethral Skene’s glands (clear fluid to aid lubrication) and Bartholin’s glands (clear mucus into vagainal introitus)
- Vaginal introitus (opening into vagina)
- Perineum
61
Internal Female genitalia
- Vagina
- Uterus
- Cervix: posterior portion of uterus protrudes
into vagina
- Fallopian tubes: transport ova to uterus
- Ovaries: provide ova; secrete estrogen &
progesterone
62
What regulates the female hormones?
- Anterior Pituitary
- Hypothalamus
- Ovaries
63
How does the anterior pituitary regulate female hormones?
FSH: growth and maturation of ovarian follicle
Leutenizing: stimulates release of ova which
increases production of progesterone
64
How does the hypothalamus regulate hormones?
Stimulates the release of FSH and LH
65
How do the ovaries regulate hormones?
Estrogen: secondary sex characteristics;
proliferation of endometrial lining
Progesterone: necessary for successful
implantation
66
What are some subjective questions you ask a woman?
- Family history
- Personal history: age
- Menstrual; LMP (day #1); menarche
- Obstetric: pregnancies;
complications
- Menopause
- Infections; surgeries
- Immunizations: HPV
- Screening: PAP - results
- Personal History (contraception, medications and supplements)
- Sexual behaviours (STI's)
67
Inspect the external genitalia
- Mons pubis ( hair distribution, lice, nits)
- Skin (color, redness, swelling, lesions)
- Labia (size, swelling, symmetry, piercings, redness)
- Urethral opening
- Discharge (amount, color, consistency, odor)
- Perineum
- Anus
68
What are some considerations for the older adult female?
- Limited/absent estrogen
- Menopause (1 yr without menses)
- Ovaries and uterus shrink. Uterus may prolapse due to
weakened musculature.
- Risk of endometrial cancers
- All bleeding after menopause must be investigated
- Vaginal dryness: may require artificial lubrication
- Intimacy questions
- Sexual desire continues
- Thinning hair
69
What are factors that influence bowel movements?
- Age
- Diet
- Fluid Intake
- Physical activity increases peristalsis
- Psychological Factors (anxiety and stress lead to diarrhea)
- Personal habits
- Position during defecation
- Pain
- Ability to get to bathroom
- Surgery and anesthetic decrease peristalsis
- Medications
- Diagnostic tests
70
What is the normal adult urine output?
1500-1600 mL/day
71
What does a urine output of less than 30 mL/day indicate?
May indicate renal alterations
72
How much can the adult bladder hold?
approximately 400-600 mL of urine
