Need to finish!! Exam 3: Abdominal assessment and bowel elimination Flashcards
Gastrointestinal tract anatomy
Mouth Esophagus Stomach Small intestine Large intestine Anus
Natural contour of abdomen
Flat -> rounded (convex)
Abdominal distention
Fat, Flatus, Fluid, Fetus, Feces, Fibroid
Scaphoid (concave) abdomen
Malnourishment
Localized enlargements
hernias (bulge), tumor, cyst, bowel obstruction
Visible pulsations
may be normal in epigastric area in some individuals; marked pulsation may indicate AAA
Normal abdominal skin
homogeneous color is normal with smooth texture
Straie
Stretch marks related to pregnancies, rapid growth, Cushing’s, obesity
Cullens sign
periumbilical bleeding
Turner’s sign
Flank bleeding
Bowel sounds
Movement of air and fluid through the small intestine
Bowel sounds are
high pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute
How to judge bowel sounds
normal, hypoactive, or hyperactive
Hyperactive bowel sounds
Loud, high-pitched, rushing, tinkling sounds signal increased motili
One type that is fairly common in hyperactive sounds
the hyperperistalsis (increased motility) when you feel your “stomach growling,” termed “borborygmus”; loud, easily audible
Hypoactive or absent sounds
Decreased motility associated with abdominal surgery, ileus, or with inflammation of the peritoneum
A silent abdoment is
UNCOMMON! you must listen for 5 minutes before deciding if they are silent
Mixed abdominal sounds
Varied sounds based on quadrant and what is happening. Can by hyperactive ABOVE a mass/impaction and be absent below the blockage/stoppage.
Rebound tenderness:
press onto the involved area and let go. Pain upon rebound indicates peritoneal tenderness common with appendicitis or peritoneal injury.
what should you not do with pulsating abdominal mass
DO NOT palpate
Abdominal pain: broad categories
Inflammatory (e.g. appendicitis) Mechanical (e.g. bowel obstruction) Neoplastic (e.g. tumor pressing on a nerve) Vascular (e.g. clot, aneurysm) Congenital (e.g. hernia) Traumatic (e.g. blunt trauma)
DysphaGIa
defined as difficulty swallowing any liquid (including saliva) or solid material
DysphaSia
defined as Speech disorders in which there is impairment of the power of expression by speech, writing, or signs or impairment of the power of comprehension of spoken or written language.
Significant alterations in bowel elimination
Constipation/Impaction Diarrhea Flatulence Blood in stool (frank +/or occult) Diseases of GI tract (e.g. irritable bowel syndrome; diverticulitis; colon CA) Fecal incontinence Hemorrhoids
Most common S/S of abdominal disorders
Pain Nausea/vomiting Change in bowel movements Rectal bleeding Abdominal distention Ask about: change in appetite, change in weight, food intolerance, dysphagia, current medications
Diarrhea reflects
increased water content of the stool, whether due to impaired water absorption &/or active water secretion by the bowel
Severe infectious diarrhea
: number of stools may reach 20 or more per day, with defecation occurring every 20 or 30 minutes -> the total daily volume of stool may exceed two liters, with resultant electrolyte imbalances, especially VOLUME DEPLETION AND HYPOKALEMIA
Etiology of constipation
Improper diet (lack of fiber) Lack of fluids Lack of exercise Medications (opioids, anti-cholinergics, iron, calcium channel blockers, diuretics) Disease states (e.g. diabetic gastroparesis; IBS) Emotional stress Pregnancy Surgery Spinal cord injury
Common symptoms of constipation
Decreased frequency of stools Hard, dry, formed stools Straining while stooling; painful defecations Reports of rectal fullness or pressure Reports of incomplete bowel evacuations Abdominal pain, cramps, or distensions Anorexia, nausea Headache
