Physical Assessment: Upper Gastrointestinal Tract

Question 1

Upper Gastrointestinal Tract

Answer 1

• mouth
• pharynx
• esophagus
• stomach

Question 2

Small Intestine

Answer 2

-folded, twisted, and coiled tube that connects the stomach and the large intestine
-occupies most of the abdominal cavity
-most digestion + absorption of food
-peristalsis halts periodically to allow for absorption
Contains 3 Segments:
>duodenum
>jejunum
>ileum

Question 3

Large Intestine

Answer 3

"colon"
-extends from ileum to anus
Contains 7 Segments:
>cecum
>ascending colon
>transverse colon
>descending colon
>sigmoid colon
>rectum
>anus

Question 4

Rectum

Answer 4

• continuous with anus
• last 2.5 cm of colon
• highly vascular
• free of waste products until just before defecation

Question 5

How to Assess Tissue Perfusion to the Abdominal Organs?

Answer 5

apical rate + BP
>Indicators of Normal:
-appetite
-bowel sounds WNL
>Absence of:
-pain
-N/V (nausea/ vomiting)
-malabsorption deficiencies
-distention
-constipation
-diarrhea
-excessive thirst

Question 6

Bowel Continence

Answer 6

control of passage of stool from the bowel

Question 7

Normal Indicators of Bowel Continence

Answer 7

• recognizes urge to defecate
• maintains predictable bowel pattern
• maintains control of stool passage
• evacuates stool at least q 3 days (varies)
• sphincter tone adequate to control defecation
• sphincter innervation functional

Question 8

Indicators of Abnormal Bowel Continence

Answer 8

• inability to control evacuation of BM
• change in frequency, color, consistency, amount, shape, or odor of BM
• blood tinged or black, tarry stools
• frequent loose or watery stools
• absence of BM for more than 3 days
• pain in abdomen, rectum or with defecation

Question 9

Factors that Affect Bowel Elimination

Answer 9

• medications
• surgery and procedures; clients undergoing anesthesia
• stress

Question 10

Common Causes Of Bowel Incontinence

Answer 10

• chronic constipation
• diarrhea
• reduced rectal capacity
• pelvic floor damage
• sphincter damage
• prolapsed rectum
• nerve damage (pudendal nerve)

Question 11

Gastrointestinal Changes of Aging

Answer 11

• decreased peristalsis resulting in constipation and indigestion
• decreased production of digestive juices
• decreased nutrient absorption
• malnutrition and anemia more common
• anus darker in color + hemorrhoids common
• decreased hunger + thirst drive

Question 12

Basic Assessments: Abdomen

Answer 12

• Inspect
• Auscultate
• Percuss
• Palpate

Question 13

Organs Contained in the Abdomen

Answer 13

• esophagus
• liver
• stomach
• pancreas
• gallbladder
• large intestine
• small intestine
• appendix

Question 14

Bowel Sounds

Answer 14

method most commonly used to identify the location of assessment findings in the four quadrant method, which divided the abdomen into 4 sections
-by drawing a line vertically from the xiphoid process to the symphysis pubis and a horizontal line at the level of the umbilicus

Question 15

Subjective Info Obtained in an Abdominal Assessment

Answer 15

• abdominal pain, indigestion, nausea or vomiting (N/V)
• appetite, usual meal pattern, food allergies, or lactose intolerance
• usual bowel + bladder elimination patterns
• constipation, diarrhea, incontinence
• problems of gastrointestinal (GI) system
• problems or urinary tract disorders
• past surgeries or trauma
• OTC medications, herbal remedies, alcohol ingestion
• menstrual history and other reproductive problems

Question 16

Auscultation for Normal Bowel Sounds

Answer 16

clicks and gurgles that occur every 3 to 20 seconds and absence of pulsations (bruits)

• 5-35 sounds per minute
• if absent –> must listen for 5 minutes before concluding

Question 17

Increased Bowel Sounds can Indicate?

Answer 17

• diarrhea

- early bowel obstruction

Question 18

Decreased bowel sounds can be heard…

Answer 18

• after abdominal surgery

- in later bowel obstruction

Question 19

Absent bowel sounds can indicate?

Answer 19

• peritonitis

- paralytic ileus

Question 20

High-pitched bowel sounds can indicate?

Answer 20

a bowel obstruction

Question 21

Percussion on Abdomen

Answer 21

• use indirect percussion to assess for fluid, air, organs, or masses
• generally tympany over bowels (due to presence of gas)
• abdomen is non-tender, soft, and without masses or fluids

Question 22

Tympany

Answer 22

hollow drum-like sound that is produced when a gas-containing cavity is tapped sharply
-what you hear over the bowels

Question 23

What are we assessing when palpating the Abdomen?

Answer 23

observe for non-verbal cues of pain and assess areas of pain last
>Normal Findings:
-abdomen soft, relaxed, free of tenderness
>Abnormal Findings:
-involuntary rigidity, spasms, masses and pain