Lecture 4: GI Flashcards
(23 cards)
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
Physical Exam of Abdomen: Palpation
Surface and deep areas
- Measures to enhance muscle relaxation
- Light palpation (1 cm): Voluntary guarding
- Deep palpation
If you identity mass, note:
- Location, size, and shape
- Consistency and surface
- Mobility
- Pulsatility
- Tenderness
Abnormal Findings: Abnormal Distension
- Obesity
- Air or gas
- Ascites
- Ovarian cyst
- Pregnancy
- Feces
- Tumour
Abnormal Findings: On inspection
- Umbilical hernia
- Epigastric hernia
- Incisional hernia
- Diastasis recti
Abnormal Findings: Bowel Sounds
- Hypoactive bowel sounds
- Hyperactive bowel sounds
Abnormal Findings: Detected upon palpation
- Enlarged liver
- Enlarged nodular liver
- Enlarged gallbladder
- Enlarged spleen
- Enlarged kidney
- Aortic aneurysm
Preventive Care
- Everyone over the age of 50 is sent a stool sample care : screening for fecal occult blood, every 2 years
- High risk individuals (i.e. family history colon cancer) have colonoscopy starting age 40 or at age consistent with 10 years prior to family member’s age of cancer onset
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
Which of the following is not part of the list of common causes for abdominal distension?
a. Flatus
b. Fetus
c. Fluid
d. Follicles
D
