Module 9- GI Assessment Flashcards
Function of the abdomen
- Digestion
- Absorption of food
- Storage
- Abdominal muscles assist in respiratory
- Protect inner organs
Structures of the abdomen
- Stomach
- Liver
- Kidneys
- Spleen
- Pancreas
- Gallbladder
- Small intestine
- Large intestine
Function of the anus
- Excretes stool by two anal sphincters (internal and external)
- Contains rectal contents
Structure of the anus
- Connected to the Sigmoid colon
- Rectum
- Stool pass through valves of Houston
- Rectal Ampulla (stores) before elimination
- Anal canal (column, valve and crypt)
- Anorectal junction
- Internal sphincter
- External sphincter
Function of the rectum
- Stool stops here before elimination through the anus
- Electrolyte absorption (Na, K, Cl)
- In-digestive food are broken down by bacteria
- Water and mucus thickens stool
Structure of rectum
- Continuation of sigmoid colon
- Contains the Valves of Houston before the Peritoneum (connection to the anus)
- Stops at Rectal ampulla (stored feces)
Health history Questions for Abdomen
1) Change in Appetite
2) Dysphagia
3) Abdominal pain
4) Nausea/Vomiting
5) Bowel habits
6) Past Abdominal history
7) Medications
8) Food intolerance
9) Alcohol and Tobacco
10) Nutritional Assessment
Organs in the RLQ
- Appendix
- Cecum
- Right ovary/Fallopian tube
- Right ureter
- Right spermatic cord
Organs in the RUQ
- Liver
- Gallbladder
- Duodenum
- Head of pancreas
- Right kidney/adrenal
- Hepatic flexure of colon
- Part of ascending and transverse colon
Organs in the LUQ
- Stomach
- Spleen
- Left lobe of liver
- Body of pancreas
- Left kidney/adrenal
- Splenic flexure of colon
- Part of transverse and descending colon
Organs in the LLQ
- Part of descending colon
- Sigmoid colon
- Left ovary and Fallopian tube
- Left ureter
- Left spermatic cord
Why is auscultation done before palpation of the abdomen?
- Palpation’s can increase peristalsis which can give a false interpretation of bowel sounds
- Can identify bruits and if bruits are identified do not palpate! Could indicate an aortic aneurysm
7 Steps to Inspection of Abdomen
1) Contour
2) Symmetry
3) Umbilicus
4) Skin
5) Pulsation/Movement
6) Hair distribution
7) Facial expression
Inspection- Contour
- Done at eye level
- Describe contour as flat, rounded, scaphoid and protuberant
Inspection - Symmetry
- Should be symmetrical bilaterally
- Look for bulges/masses/hernia
- Client to take a breath and highlight change
Inspection - Umbilicus
- Inverted/Everted
- Normally umbilicus is mid-line and inverted
- Assess for inflammation, discoloration, bleeding and hernias
Inspection - Skin
- Surface should be smooth and even tone
- Assess for inflammation, jaundice, stretch marks (striae), Cushing’s Syndrome, adhesion’s and scar tissue
Inspection - Pulsation/Movement
- Muscle relaxation
- Peristalsis and rippling movement can be identified
- Assess for distention
- Abdominal obstruction can be identified with peristalsis and abdominal distension
Inspections - Hair distribution
- Assess normal hair growth
- Abnormal hair growth can indicate blood flow issues/Hirutisim/endocrine issues
Inspections - Facial Expressions
- Should be comfortable and relaxed
- Look for any signs of distress
- Distress can be sign of obstructed bowels, discomfort and peritonitis/infections
Auscultation assessment - Normal Bowel Sounds
- Diaphragm of stethoscope listen to all 4 quadrants
- Start RLQ at the ileocecal valve
- Note character/Frequency
Normal sounds: High-pitched gurgling - Stomach growling (borborygmus)
Auscultation assessment - Abnormal findings
- Hyperactive sounds (loud/rushing) - Bowel obstruction
- Absent sounds (inflammation)
Auscultation assessment - Vascular Sounds
- Bell of stethoscope
- Assessing aorta, renal, iliac and femoral arteries
- Absent sound normal
- Assess for bruits
Palpation Assessment - Light Palpation technique
- Keep hand low to abdomen
- Use of four fingers depressing skin 1 cm
- Rotation motion and lifting fingers to next section
- Checking skin surface, temperature, swelling, rigidness, moisture, pulsations, tenderness, pain and superficial muscles
Normal findings of Abdomen assessment
- Smooth even skin tone
- Flat contour
- Equal bilateral symmetry
- Inverted umbilicus
- Consistent hair growth
- High pitched gurgling sounds
- Stomach growling
- No discomfort when palpating
- Absent sounds when assessing vascular arteries
Abnormal Findings - Abdominal Distention
- Obesity (rounded contour)
- Air/Gas
- Ascites (bulging sides in supine)
- Ovarian cyst
- Pregnancy
- Feces (localized distention)
- Tumour
- Bulges/Masses
Factors of Intestinal Obstruction
- History of previous abdominal surgery
- Vomiting
- Absence of stool/gas
- Distended abdomen
- X-ray findings of obstruction
- Hyperactive bowel sounds
- Dehydration/fluid loss
- Accumulation of fluid
- Colic pain
- Fever
- Pressure from excess fluid
- Hypovolemic shock (Low BP, High HR)
Abnormalities on Inspection - Hernia’s
- Umbilical Hernia - incomplete closure
- Epigastric hernia - fatty nodule at midline (palpate when standing)
- Incision Hernia
- Diastasis Recti (partial/complete separation of the abdominal recti’s - six pack)
Abnormal Bowl Sounds
- Succussion Splash- Loud splash when infant is rocked side to side - increased air/fluid in stomach
- Hypo-active bowel sounds (Diminished/absence) - indicates inflammation/late bowel obstruction
- Hyperactive bowel sounds (Loud/gurgling) - indicates early bowel obstruction
- Bruits
Abnormal Abdominal Friction rub and Vascular sounds
- Peritoneal Friction rub (Liver/Spleen)- rough/grating sounds - indications peritoneal inflammation or tumour
- Vascular Sounds (Arterial/Venous hums/murmurs)
- 3 conditions:
1) Abdominal Aortic Aneurysm
2) Renal artery stenosis
3) Partial occlusion of femoral arteries (heard in inguinal region)
Abnormalities detected on Palpation
- Enlarged liver - cirrhosis/acute hepatitis
- Enlarged nodular liver - cancer
- Enlarged gallbladder - gallstones
- Enlarged spleen - infections
- Enlarged kidney - cysts/cancer
- Aortic aneurysm - high risk for rupture/life threatening
Referred pain common sites
- Liver, RUQ/ epigastrium - Nausea
- Esophagus: midepigastrium/lower sternum- GERD
- Gallbladder: right/left scapula
- Pancreas: midepigastric, radiating to back
- Duodenum: does not radiate
- Stomach: epigastric, radiates to back/substernal
- Appendix: periumbilical, shifts to RUQ
- Kidney: flak or lower abdominal
- Small intestine: diffuse abdominal
- Colon: Lower abdomen
7 Health History Questions for Anus/Rectum
1) Usual bowl routine
2) Change in bowel habits
3) Rectal bleeding/blood in stool
4) Medications
5) Rectal Conditions
6) Family history
7) Self-care behaviour
Abnormalities of Anal regions
- Pilonidal cyst or sinus - contains hair
- Anorectal fistula - inflamed gastro-intestinal tract and creates an abnormal passed from anus to skin
- Fissure - tear occurred from trauma
- Hemorrhoids - varicose veins- results from pressure/strain
- Rectal prolapse - rectal membrane protrudes from anus - weakened
- Pruritus Ani (Itching/burning)- infection
Abnormalities of Rectum
- Abscess - infections
- Rectal polyp - common nodule
- Fecal impaction (Colon block) - Constipation
- Carcinoma - Rectal cancer
