Gastrointestinal System Health Assessment

Objectives Upon completion of this lecture , you will be able to: Recall the anatomy and physiology of the abdomen. Identify landmarks that guide assessment of the abdomen. Develop questions to be used when completing the focused interview. Explain client preparation for assessment of the abdomen. Differentiate normal from abnormal findings in physical assessment of the abdomen. Describe the variation in techniques required for assessment of the abdomen. Document findings

General principles of exam: Good light Relaxed patient in Supine position Full exposure of abdomen Empty bladder Arms across chest, not above head. Ask patient where pain is, and examine last. If the patient is ticklish or frightened, initially use the patients hand under yours as you palpate. When patient calms then use your hands to palpate. Watch the patient’s face for discomfort

Abdomen Gastrointestinal system Structures of other body systems

Gastrointestinal System Alimentary canal Mouth Pharynx Esophagus Stomach Small and large intestines Rectum Anus

Gastrointestinal System Accessory organs Teeth Salivary glands Liver Gallbladder Pancreas

Organs of the alimentary canal and related accessory organs. 7

Related Structures Peritoneum Abdominal wall muscles Aorta Kidneys Ureters Bladder Spleen Reproductive organs

Muscles of the abdominal wall. 10

Abdominal vasculature and deep structures. 11

Abdomen Largest cavity of the body Contains structures from the digestive system and other body systems

Abdomen Inferior to the Diaphragm and Superior to the Pelvic Floor

Mapping Dividing the Abdomen Into Four Quadrants and Nine Regions

Four Quadrants Midsternal line from the xiphoid process through the umbilicus to the pubic bone Horizontal line perpendicular to the first line through the umbilicus Two perpendicular lines form four equal quadrants of the abdomen

Four Quadrants Quadrants named Right upper quadrant (RUQ) Right lower quadrant (RLQ) Left upper quadrant (LUQ) Left lower quadrant (LLQ)

Figure 19.4 Mapping of the abdomen into four quadrants. 17

Four-Quadrant Method Gallbladder Kidneys Costovertebral angle Liver Spleen Midline structures Abdominal aorta Urinary bladder Uterus

Mapping of the abdomen into nine regions. 19

Upper torso: Organs of the four abdominal quadrants Upper torso: Organs of the four abdominal quadrants. Lower torso: Organs of the nine abdominal regions. 20

Focused Interview General questions

Focused Interview Specific questions Illness or infection Symptoms Pain Behaviors Infants and children Pregnant female Older adult Environment

Equipment Examination gown and drape Examination gloves Examination light Stethoscope Skin marker Metric ruler Tissues Tape measure

Other Considerations Age Gender Language Culture

Abnormal Abdominal Findings Abnormal sounds Pain Distention Hernias

Abnormal Abdominal Sounds 27

Pain in Common Abdominal Disorders 28

Abnormal Abdominal Sounds Hypo- and hyperactive bowel sounds Vascular sounds of bruits and venous hums Friction rubs

Abdominal Pain Direct Referred

Abdominal Distention Obesity Gas Tumor Ascites

Obesity. 32

Distended abdomen. 33

Abdominal tumor. 34

Ascites. 35

(continued) Ascites. 36

Abdominal Hernias Umbilical Ventral Hiatal

Umbilical hernia. 38

Alterations of the Gastrointestinal Tract Nutritional problems Eating disorders Cancers Ulcers Inflammatory and infectious diseases

Nutritional Disorders Malnutrition Anorexia Obesity

Cancers of the Gastrointestinal Tract Esophagus Stomach Colon

Inflammatory Processes Ulcerative colitis Esophagitis Peritonitis Hepatitis

Physical Assessment of the Abdomen Techniques Inspection Auscultation Percussion Palpation

Areas of the Abdominal Assessment Inspection of the abdomen Auscultation of the abdomen Percussion of the abdomen Percussion of the liver Percussion of the spleen Palpation of the abdomen Palpation of the liver Palpation of the spleen

Areas of the Abdominal Assessment Palpation of the aorta Palpation for rebound tenderness Percussion for ascites

Auscultating the abdomen for bowel sounds. 46

Auscultation Listen for bowel sounds and note their frequency and character Normal sounds consist of clicks and gurgles The frequency of which has been estimated at from 5 to 34 per minute Because bowel sounds are widely transmitted through the abdomen, listening in one spot, such as the right lower quadrant, is usually sufficient.

Auscultation If the patient has high blood pressure, listen in the epigastrium and in each upper quadrant for bruits If you suspect arterial insufficiency in the legs, listen for bruits over the aorta, the iliac arteries, and the femoral arteries

Light palpation of abdomen. 49

Deep palpation of abdomen. 50

Palpating the liver. 51

PALPATION OF LIVER

Palpating the spleen. 53

Percussion pattern for ascites. 54

Percussion pattern for ascites. 55

Rebound tenderness Feel for muscular rigidity. - Early voluntary guarding may be replaced by involuntary muscular rigidity. Check the tender area for rebound tenderness. - Rebound tenderness suggests peritoneal inflammation, as from appendicitis.

Glossary abdomen The largest cavity of the body and contains many organs and structures that belong to various systems of the body. accessory digestive organs The structures connected to the alimentary canal by ducts.—the liver, gallbladder, and pancreas— that contribute to the digestive process of foods. alimentary canal A continuous, hollow, muscular tube, begins at the mouth and terminates at the anus. anorexia nervosa A complex psychosocial problem characterized by a severely restricted intake of nutrients and a low body weight. ascites An abnormal collection of fluid in the peritoneal cavity. bruit A vascular sound; pulsatile and blowing. dysphagia Difficulty swallowing.

Glossary esophagitis Inflammatory process of the esophagus, caused by a variety of irritants. friction rub A rough, grating sound caused by the rubbing together of organs or an organ rubbing on the peritoneum. hernia (Rupture) is a protrusion of an organ or structure through an abnormal opening or weakened area in a body wall. malnutrition An imbalance, whether a deficit or excess, of the required nutrients of a balanced diet. mapping The process of dividing the abdomen into quadrants or regions for the purpose of examination.

Glossary obesity Weight of 20% or more above recommended body weight. overweight A weight of 10% to 20% in excess of recommended body weight. peritoneum A thin, double layer of serous membrane in the abdominal cavity. peritonitis A local or generalized inflammatory process of the peritoneal membrane of the abdomen. referred pain Pain located where the development of structures occurred in the fetus. striae (Stretch Marks) are silvery, shiny, irregular markings on the skin, and are seen in obesity, pregnancy, and ascites.