Lecture 4: GI Flashcards
Structure and Function of the Abdomen
Abdomen wall divided into four quadrants
- Right upper quadrant (RUQ)
- Left upper quadrant (LUQ)
- Right lower quadrant (RLQ)
- Left lower quadrant (LLQ)
Developmental Considerations: Infants and children
- Prominence of umbilical cord
- Abdominal wall less muscular
- Risk for GI illness and dehydration related to diarrhea and vomiting
Developmental Considerations: Pregnant women
- Morning sickness
- Heartburn
- Constipation and decreased bowel sounds
Developmental Considerations: Older adults
- Suprapubic fat accumulation in women, abdominal accumulation in men
- Decreased salivation, gastric acid secretion, delayed esophageal emptying (risk of aspiration)
- More susceptible to dehydration
- Decreased liver size and increased gallstones
- Decreased renal function (adverse or toxic drug effects)
- Constipation
Cultural and Social Considerations
- Prevalence of lactose intolerance
- Rates of celiac disease
- Gastroesophageal reflux disease (GERD) and modifiable risk factors
- Peptic ulcer disease
- Inflammatory bowel disease
- Relationship of hep A and GI illnesses to socioeconomic factors
Subjective Data: Health History
- Appetite
- Dysphagia
- Food intolerance
- Abdominal pain
- Nausea/vomiting
- Bowel habits
- Past abdominal history (med/surg)
- Meds
- Alc or tobacco
- Nutritional assessment
- Diet
- Weight change
Additional Health History Questions: Infants and children
- Infant feeding
- Table foods
- Eating patterns
- Constipation
- Abdominal pain
- Height/weight: growth
Additional Health History Questions: Adolescents
- Schedule and content
- Exercise
Additional Health History Questions: Older Adults
- Food access
- Emotional characteristics
- Recall
- Bowel movements
GI Concerns
Stool
- Black and tarry - occult blood (melena)
- Grey – hepatitis (liver not working)
- Red – localized bleeding, frank bleeding (something wrong closer to the GI tract)
Objective data: Physical Exam
IAPP!!!
- This is the body system where we change order of assessment
- Inspection, Auscultation, Percussion, Palpation
What position is the patient in?
- Supine, arms at side
- Relaxed
- Empty bladder prior to exam
- Warm room (so no muscle tensing)
- Lower pants (no need to get undressed)
- Examine painful areas last
Physical Exam of Abdomen: Inspect
- Contour
- Symmetry
- Umbilicus
- Skin
- Pulsation or movement
- Hair distribution
- Demeanour
Physical Exam of Abdomen: Auscultate
- Bowel sounds
- Vascular sounds (bruits – aortic, renal, iliac, femoral)
- Start RLQ, auscultate all 4 quads
Physical Exam of Abdomen: Percuss
- General tympany
