Gastrointestinal System Health Assessment

1. Gastrointestinal System Health Assessment

2. 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

3. 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

4. Abdomen • Gastrointestinal system • Structures of other body systems

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

6. Gastrointestinal System • Accessory organs • Teeth • Salivary glands • Liver • Gallbladder • Pancreas

7. Organs of the alimentary canal and related accessory organs.

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

10. Muscles of the abdominal wall.

11. Abdominal vasculature and deep structures.

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

13. Abdomen • Inferior to the Diaphragm and Superior to the Pelvic Floor

14. Mapping • Dividing the Abdomen Into Four Quadrants and Nine Regions

15. 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

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

17. Figure 19.4 Mapping of the abdomen into four quadrants.

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

19. Mapping of the abdomen into nine regions.

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

22. Focused Interview • General questions

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

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

25. Other Considerations • Age • Gender • Language • Culture

26. Abnormal Abdominal Findings • Abnormal sounds • Pain • Distention • Hernias

27. Abnormal Abdominal Sounds

28. Pain in Common Abdominal Disorders

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

30. Abdominal Pain • Direct • Referred

31. Abdominal Distention • Obesity • Gas • Tumor • Ascites

32. Obesity.

33. Distended abdomen.

34. Abdominal tumor.

35. Ascites.

36. (continued) Ascites.

37. Abdominal Hernias • Umbilical • Ventral • Hiatal

38. Umbilical hernia.

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

40. Nutritional Disorders • Malnutrition • Anorexia • Obesity

41. Cancers of the Gastrointestinal Tract • Esophagus • Stomach • Colon

42. Inflammatory Processes • Ulcerative colitis • Esophagitis • Peritonitis • Hepatitis

43. Physical Assessment of the Abdomen • Techniques • Inspection • Auscultation • Percussion • Palpation

44. 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

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

46. Auscultating the abdomen for bowel sounds.

47. 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.

48. 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

49. Light palpation of abdomen.

50. Deep palpation of abdomen.