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Health Assessment Exam 3 > GI > Flashcards

GI Flashcards

1
Q

PSHx

A
  • EtOH increases risk for esophageal cancer and liver cirrhosis
  • Diet: if someone has unexpected weight gain or loss ⇒ know # and quality of calorie intake
  • Anxiety, depression, stress affects GI tract
  • Sexual Hx: # of partners, gender(s) involved, protection
    • If female of child bearing age and have abdominal pain ⇒ have to think abt pregnancy
    • If men and women have abdominal pain in general ⇒ think of STIs
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2
Q

Abdominal Inspection of…

A
  • Pt position & appearance
    • Position: can pt lie down and keep legs straight?
    • If they have inflammation of peritonitis ⇒ can’t keep leg flat and want to lie on side or bent
  • contour: is abdomen contour concave or convex?
  • color: Pink-purple striae ⇒ found in Cushing syndrome
  • distention: 7 Fs that may explain it…
    • fat, fetus, fluid, flatulence, feces, fibroid tumor, fatal tumor
  • movement:
    • Peristalsis should be happening 24/7 in abdomen unless something is wrong w/ colon, small intestines, etc.
      • Shouldn’t be able to see peristalsis though
    • Pulsations of abdominal aorta can be seen if lying down and can see slight pulsation
      • Bounding pulse abnormal
  • urine, stool, emesis (vomit)
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3
Q

Abdominal Auscultation

A
  • Norm: gurgling sound
  • Abnormal: hearing bruits
  • Auscultation points…
    • aorta, right renal artery, left renal artery, vena cava, right iliac artery, left iliac artery, right femoral artery, left femoral artery
  • Bowel sound interpretations…
    • Norm: high-pitched gurgles or clicks every 5-15 sec
    • Hypoactive/Absent: ↓ of norm sounds
      • Norm during sleep
      • Causes: paralytic ileus, peritonitis, bowel obstruction, constipation
    • Hyperactive (Borborygmi): ↑ of norm sounds
      • Norm during postprandial (after dinner/lunch)
      • Causes: gastroenteritis or diarrhea
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4
Q

Abdominal Percussion

A
  • Norm sound over belly: tympany (hollow sound bc there’s more air under there)
  • Norm sound over organ: dullness
  • Tympany: over-filled viscera (most of abdomen)
  • Hyperresonance: base of left lung
  • Dullness: solid organs, full bladder
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5
Q

Hepatic Percussion

A
  • Goal: get liver size
  • Norm adults: 6 - 12 cm
  • Steps: down from lungs resonance until you hear dullness (mark) + up from from bottom of abdomen’s tympany sound until you hear dullness (mark) + measure distance between those marks
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6
Q

Spleen Percussion

A
  • Steps:
    • Percuss on left lateral side bc that’s where spleen is
    • You’ll hear usual abdominal tympany sound
    • Ask pt to take deep breath → sound should go to dullness ⇒ suggests splenic enlargement (normal)
  • If there’s abnormal splenic enlargement and the percussion sound is still the same dullness that’s normal
    • Causes: mononucleosis or lymphoma
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7
Q

Indirect Kidneys Percussion

A
  • CVA Tenderness Test
  • Steps:
    • Put one hand where kidney is on back
    • Take other fist and pound fist over back of your placed hand
    • If pt feels tenderness ⇒ pyelonephritis or musculoskeletal issue
      • Pyelonephritis can be narrowed if pt has fever + urine dip test shows UTI
      • Pyelonephritis can present w/ flank pain that this indirect percussion can detect
  • Causes of enlarged kidneys: hydronephrosis, cysts, or tumors
  • Left flank mass ⇒ may represent enlarged left kidney or splenomegaly
    - Suspect enlarged kidney if ⇒
    - Normal tympany in LUQ
    - Can probe w/ fingers between mass and costal margin but not deep to its medial and lower border
  • Bilateral enlargement suggests ⇒ polycystic kidney disease
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8
Q

Abdominal Palpation (Goal, Light, Deep, Norm)

A
  • Goal: looking for tenderness and associated signs
  • Going from least (light) to most (deep) invasive palpations
  • Light palpation: general vague pressing of hand over abdominal area
  • Deep palpation: pressing firmer and deeper
  • look at pt’s facial expressions while doing both
  • norm: pt isn’t in any pain and you feel no abnormalities
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9
Q

Liver Palpation (Norm, Abnormal, Steps, etc.)

A
  • Norm liver edge: smooth, rounded
  • Abnormal liver edge: hard, nodules
  • In chronic liver disease ⇒ enlarged palpable liver edge roughly doubles likelihood of cirrhosis
  • Steps: Place one hand behind rib cage and other on belly → Tell pt to take deep breath in and exhale → On exhale → you’re trying to get fingers under rib cage and seeing if you can feel edge of liver → Assess for tenderness, size, and feel of overall liver
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10
Q

Spleen Palpation (Norm, Left Flank Mass Meaning, Steps)

A
  • Norm: no pain or tenderness
  • Left flank mass ⇒ may represent splenomegaly or enlarged left kidney
    • Suspect splenomegaly if ⇒
      • Palpable notch on medial border
      • Edge extends beyond midline
      • Percussion dull
      • Fingers can probe deep to medial and lateral borders
      • No probing between mass and costal margin
  • Steps:
    • Two hands w/ opposing pressure to feel for spleen → Ask pt to take deep breath in and out → Inspect pt’s facials for pain/tenderness
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11
Q

Ascites

A
  • What: excess fluid in peritoneal cavity
    • Ascitic fluid in lowest point of abdomen ⇒ produces building flanks
  • Sound percussed: dull
  • Inspection: Percuss and tap on belly a little ⇒ if wave like movement occurs ⇒ ascites
    • Turn pt to side to detect shift in position of fluid lvl (shifting dullness)
    • Fluid can appear to be either from fat or ascites →
      • If excess mass forms rolls ⇒ abdominal fat
      • If excess mass shifts dullness + pt has abdominal muscle pain + mass had rapid size growth + abdomen skin feels tight ⇒ ascites
  • S&S:
    • Abdominal pain (can also be from fat)
    • Tight abdominal skin
    • Feels like a full balloon
    • Rapid mass size growth over days
  • Tx: tap and drain but underlying cause needs to be treated otherwise fluid returns
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12
Q

Peritonitis (What + S&S)

A
  • What: inflammation of parietal peritoneum
  • S&S:
    • Guarding: voluntary contraction of abdominal wall, accompanied by grimace that may go away if pt is distracted
    • Rigidity: involuntary reflex contraction of abdominal wall from peritoneal inflammation that persists over several exams
    • Rebound tenderness: pain expressed by pt after examiner presses down on area of tenderness and suddenly removes hand
    • Positive cough test
    • Percussion tenderness
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13
Q

What are the Specific Intestine Diseases

A
  • Diverticulitis
  • Small Bowel Obstruction (SBO)
  • Paralytic Ileus
  • Irritable Bowel Syndrome (IBS)
  • Inflammatory Bowel Disease (IBD): Crohn’s Disease and Ulcerative Colitis
  • Pancreatitis: Acute and Chronic
  • Hepatitis
  • Abdominal Aortic Aneurysm (AAA)
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14
Q

Diverticulitis

A
  • What: something got stuck in diverticula pouch ⇒ causes inflammation and infection of diverticulum
  • Usually in LLQ
  • Can have pieces of stool gets caught in diverticula pouch
  • Diagnose w/: CT (computer tomography scan)
  • S&S: LLQ tenderness, Abdominal distention, Pain, Decreased appetite, NV, Fever/Chills
  • Management: Hydration, More Fiber, Avoiding nuts and seeds (easier to get stuck), avoiding constipation
  • Causes: EtOH, inactivity, low fiber, obesity, smoking
  • Common in: > 60 yo adults
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15
Q

Small Bowel Obstruction (SBO)

A
  • Leads to: dilation of proximal intestine
  • Causes:
    • Adhesions: scar tissues that develop bc of surgery can cause obstruction
    • Malignancy: tumor can cause obstruction
    • IBD
    • Hernias: bulge that occurs when internal organ or tissue pushes through weakness in abdominal wall or other surrounding tissue
  • S&S:
    • Abdominal pain and distention
    • ↓ bowel sounds (high-pitched → absent)
    • ↓ flatulence
    • NVD bc you can’t get things down thru system and can’t get things out either
      - Diarrhea bc it might mean that they have rlly small area where liquidy stool can get by even w/ large obstruction
    • Constipation
    • Dehydration
  • Prognosis: 100% mortality rate if undetected
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16
Q

Paralytic Ileus

A
  • What: portion of small intestines (ileus) is paralyzed ⇒ no peristalsis
  • Causes:
    • ↓ K
    • Opioids
    • Post-operation
    • ↓ blood supply to abdomen
    • Infection
  • S&S:
    • Abdominal pain and distention
    • ↓ bowel sounds (high-pitched → absent)
    • ↓ flatulence
    • NVD bc you can’t get things down thru system and can’t get things out either
    • Constipation
    • Dehydration
    • If peristalsis that moves feces thru is stopped ⇒ dangerous and needs to be addressed as emergency immediately 🚩
17
Q

Appendicitis

A
  • What: inflammation of appendix
    • Avoid appendix rupturing bc that increases sepsis and peritonitis risks
  • S&S:
    • Positive McBurney’s Point (specific to palpation of pain when it comes to appendicitis)
    • Positive Rebound Tenderness
    • Visceral periumbilical pain ⇒ suggests acute appendicitis from distention of inflamed appendix
    • Abdominal pain seen in 4-5% emergency pts usually for appendicitis
    • Localized tenderness anywhere in RLQ, even right flank ⇒ suggests appendicitis
    • RLQ pain or pain that migrates from periumbilical region + abdominal wall rigidity on palpation ⇒ appendicitis
      • Pain begins near umbilicus → migrates to RLQ
    • Significant onset of RLQ pain
    • Ill-appearing
    • High WBC count
    • Acute abdominal pain
  • Tx: surgery
18
Q

Irritable Bowel Syndrome (IBS)

A
  • What: functional change in frequency or form of bowel movement w/o known pathology
    • Functional disorder and has no underlying serious cause that can lead to increased morbidity or mortality
    • Syndrome (group of Sxs) ⇒ causing chronic stomach pain/discomfort, diarrhea, constipation, alternation between both
  • Cause: disturbance in how brain and gut interact + aggravated by stress
  • Common in: women
  • S&S:
    • 3 patterns: Diarrhea-predominant, Constipation-predominant, or Mixed
    • Sxs present ≥6 months
    • Abdominal pain ≥3 months
  • Test results shows: no signs on colonoscopy or other diagnostic tests
  • Triggered by: emotional/physical stress, food, meds, gaseous distention, hormonal changes
19
Q

Inflammatory Bowel Disease (IBD)

A
  • What: autoimmune disease, group of diseases which include Crohn’s disease and ulcerative colitis
    • May increase risk of/can lead to colon cancer
    • Impacts quality of life
    • At risk for developing other autoimmune diseases if you just have one autoimmune disease
  • Cause: abnormal response from IS mistaking healthy cells and bacteria in bowel as harmful foreign substances
  • Common in: males and females equally + tends to be genetic
  • S&S:
    • Bloating may occur w/ IBD
    • Hepatomegaly in teens may be from IBD
    • Persistent diarrhea
    • Rectal bleeding
    • Urgent need to move bowels
    • Sensation of incomplete evacuation
    • Constipation ⇒ can lead to bowel obstruction
    • Loss of norm menstrual cycle
  • Tx: courses of steroids (educate pt on side-effects)
  • Test results shows: inflammation of bowel detected by colonoscopy and other diagnostic tests
20
Q

Crohn’s Disease

A
  • What: mostly affects colon/large intestine & portions of small bowel (ileum) but can also affect any part of GI tract from mouth to anus
    • Inflammation of intestine can “skip” and leave normal areas in between patches of diseased intestine
    • Affects entire thickness of bowel wall
  • S&S: chronic diarrhea and hematochezia
21
Q

Ulcerative Colitis

A
  • What: affects only innermost lining of large intestine/colon/large bowel
    • Doesn’t affect all aspects of colon and doesn’t escape colon
    • Inflammation of intestine doesn’t “skip” ⇒ leaves no areas in between patches of diseased large intestine
    • Affects entire thickness of bowel wall
  • S&S: chronic diarrhea and hematochezia
22
Q

Pancreatitis Acute

A
  • Causes:
    • Cholelithiasis
    • EtOH
  • S&S: mild to severe
    • Epigastric pain w/ or w/o radiation to back or other abdominal parts
    • Acute onset, constant dull pain that’s vague and not localized and doesn’t go away
    • Abdominal distention & tenderness
    • ↓ bowel sounds
    • Tachycardia
    • Dyspnea
    • Jaundice
    • Ill-appearing
    • Anorexia
  • Prognosis: resolves in wk usually
  • Aggravated by: lying down
23
Q

Pancreatitis Chronic

A
  • Cause: EtOH
  • S&S: comes and goes
    • Epigastric pain that can radiate to back
    • Constant abdominal pain
    • Weight loss
    • Steatorrhea: fatty stool
    • Malnutrition
  • Prognosis:
    • Low survival rate
    • 80% have 3 yr survival rate
    • 60% have 5 yr survival rate
24
Q

Hepatitis (Increases risk of, Types, Prevention, S&S, Transmission)

A
  • Increases risk of liver failure, liver cancer, cirrhosis
  • Type A: acute infections from contaminated food and water
  • Type B: blood-borne infections
  • Type C: chronic infections
  • Type D: depends on exposure to type B
  • Type E: enteric (ingested/passes thru GI system) infections from contaminated food and water
  • Prevention: vaccines, hygiene, clean water, clean needles, condoms
  • S&S: type dependent
  • Transmission: viral
    • Types A & E: fecal and oral
    • Body Fluids
25
Q

SARS-CoV2 & GI Sxs

A
  • Increase in inflammatory cytokines
  • Changes in intestinal microbes
  • Often early Sxs of COVID-19
  • NVD
26
Q

Abdominal Aortic Aneurysm (AAA)

A
  • Aneurysm: bulging in artery that has potential to rupture
  • What: aorta in abdomen is huge artery ⇒ if ruptures ⇒ pt can bled out
  • At risk pts: heavy smokers
  • S&S:
    • Bruit
    • Thrill
    • Significant pulsation
27
Q

What are the Specific Diseases of the Renal System?

A
  • UTIs
  • Cholelithiasis
  • Renal Insufficiency / Kidney Failure: Acute & Chronic
  • Calculi
28
Q

Urinary Tract Infection (UTI)

A
  • What: infections of the urinary tract which may involve…
    • Bladder ⇒ cystitis
      • S&S: Dysuria, Frequent urination, Urgent urination, Fever, Bacteriuria
    • Urethra ⇒ urethritis
      • S&S: Dysuria, Frequent urination, Urgent urination
    • Renal pelvis ⇒ pyelonephritis
      • S&S: Flank Pain (elicited w/ indirect percussion of kidneys w/ CVA Test), Confusion in older adult pts, Dysuria, Frequent urination, Urgent urination, Fever, Bacteriuria
  • Causes: E. coli, other gram neg bacteria
  • Tx: antibiotics depending on where infection is, how many past UTIs, last Tx of one + Hydration
29
Q

Cholelithiasis

A
  • What: cholelithiasis and cholecystitis are inflammation of gallbladder or gallstones
  • S&S:
    • RUQ pain may radiate to right scapula
    • Epigastric pain may radiate to right scapula
    • Pain is debilitating, intermittent
  • Aggravated by: high fatty foods, dairy products, spice
  • Common in: >40 yo women, overweight/obese pts
  • Tx/Management: diet or removal of gallbladder (cholecystectomy)
30
Q

Renal Insufficiency / Kidney Failure ACUTE

A
  • What: kidneys unable to filter waste products from blood
  • Onset: abrupt and reversible
  • S&S:
    • Weight loss
    • Isolated systolic HTN: BP ≥140/<90
    • Breath odor
31
Q

Renal Insufficiency / Kidney Failure CHRONIC

A
  • What: kidneys unable to filter waste products from blood
  • Onset: progresses slowly over ~3mo ⇒ can lead to permanent renal failure
  • End-stage renal failure pts Tx:
    • Dialysis
    • Kidney transplants (Can survive w/ one kidney if you’re healthy)
  • S&S:
    • Weight loss
    • Isolated systolic HTN: BP ≥140/<90
    • Breath odor
32
Q

Calculi

A
  • What: kidney stones
    • Hard deposits of minerals and salts
  • May cause urgent urination
33
Q

Red Flags GI & Renal

A
  • Ill-appearing: Pt appears unwell, in pain, NV ⇒ take it srsly
  • Severe pain of abdomen
  • Febrile: having or showing Sxs of fever
    • Not a red flag if someone just has fever and basic gastroenteritis
    • Big red flag if presenting w/ severe abdominal pain + fever + no signs of virus ⇒ may be ruptured appendix
  • Dehydration: + NVD + young child ⇒ big red flag
  • Guarding of abdomen: when pt shields abdominal/stomach area w/ arms during exam
  • Rebound tenderness: when pushing on belly and there’s no pain but when letting go pt suddenly feels pain ⇒ means pushing on belly was irritating peritoneal lining of abdomen
  • Unexplained weight loss: often sign of malignancy
  • Abdominal distention: esp if causes doesn’t appear to be one of 7 F’s ⇒ big red flag
  • Peristalsis is stopped
34
Q

GI & Renal Age-Related Considerations

A
  • Infants
    • Norm:
      • Liver takes up more space in abd compared to adult
      • Abdomen protrudes due to underdeveloped abd muscles (not distention)
    • Abnorm: Feeding issues: causes can be GI related or heart problem where they don’t have enough energy to eat, cyanotic, etc.
  • Children:
    • Norm:
      • Abd protrusion continues to increase and will decrease when their muscles develop (Adult proportion not reached until adolescence)
      • Organs more easily palpated than in adults
  • Older Adults
    • Norm:
      • ↓ salivary production
      • ↓ gastric acid production
      • ↓ gastric motility ⇒ can affect swallowing, absorption, digestion + implication for oral health
      • ↓ liver size
      • ↑ fat accumulation in lower abd (women) and around waist (men)
  • Pregnant Women
    • Norm: resolves after fetus delivered/pregnancy over
      • Abd muscles relax
      • Rectus abdominis muscles separate
      • Stomach rises (may impede on diaphragm) (caused by fetal displacement of everything on abdomen)
      • Bowels compressed by uterus ⇒ may ↓ bowel sounds and/or constipation
      • ↑ heartburn
      • Linea nigra and striae
35
Q

Normal Documentation of GI Abdomen

A
  • Abdomen flat, soft, w/o tenderness
  • Active bowel sounds present
  • No bruits
  • No masses or hepatosplenomegaly palpated
  • Tympany percussed throughout
  • Liver span 8 cm in right midclavicular line
  • Liver, spleen, kidneys not palpated
  • No costovertebral angle (CVA) tenderness
36
Q

RUQ (AS DUmb GAllant KIDs LIVE PANdering TRANSactional Universes)

A
  • ascending colon
  • duodenum
  • gallbladder
  • kidney (right)
  • liver
  • pancreas (head)
  • transverse colon
  • ureter (right)
37
Q

LUQ (DESCriptive KIDs PANdering SPLEndid STOcks TRANSactionally URgent)

A
  • descending colon
  • kidney (left)
  • pancreas (body and tail)
  • spleen
  • stomach
  • transverse colon
  • ureter (left)
38
Q

RLQ (APtly SMart BLoomers Can REally OVerreact PROmptly URgent)

A
  • appendix
  • ascending colon
  • small intestine
  • bladder
  • cecum
  • rectum
  • ovary
  • prostate
  • ureter (right)
39
Q

LLQ (BLooming DESCENDants SMudges SInging URgently OVer PROmises)

A
  • bladder
  • descending colon
  • small intestine
  • sigmoid colon
  • ureter (left)
  • ovary
  • prostate

Health Assessment Exam 3 (4 decks)

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