WEEK 8 - ABDOMEN, GI, URINARY SYS, & NUTRITION

ASYNCH AND LECTURE

Gastro-

Stomach

Entero-

intestine

colo-

large intestine/colon

procto-

Anus/rectum

Hepato-

liver

Nephro-

Kidney

cysto-/vesical 

bladder

uro-

related to urine/urinary

chole-

gallbladder

-itis

inflammation

-lithiasis

formation of calculi

-ostomy

artifical opening made into the organ through surgery

-ectomy 

to surgically remove 

-scopy

to look or examine

-fisiula

an abnormal connection between an organ and another structure

-rrhea

flow or discharge 

uria 

in the urine 

cachexia

highly catabolic state with accelerated muscle loss

distended

swollen abdomen usually due to pressure from the inside 

scaphoid

sunken or hollow appearance

hypoactive

bowel sounds that are less than expected

normoactive

bowel sounds that are expected 

borborgymi

bowel sounds that are more active than expected

venus hum

soft pitched humming w/ systolic and dystolic components due to partial obstruction of artery.

ascites 

collection of fluid in the abdomen 

visceral pain

pain that occurs when hollow organs are distended, stretched, or contracted forcefully

parietal pain

pain that occurs due to inflammed peritoneum

reffered pain 

pain occuring at a distant site innervated at the same spinal level as the disordered structure. 

peritoneum

serous membrane forming protective cover over the abdominal cavity

2 layers: parietal and visceral

parietal peritoneum

lines the abdmonial wall

visceral peritoneum 

covers the abominal wall

peritoneal cavity

contains serous fluid to prevent friction rubs

space between parietal and visceral pleura

retroperitoneum

behind the peritoneum: contains kidenys/adrenal glands, spleen and vasculature

Vasculature of the abdomen

inferior vena cava

left and right renal artery

aorta

left and right ureter

left and right common illiac artery

Alimentary tract 

27 feet long 

functions: ingest, digest, absorb nutrients, absorb electrolytes, absorbs water, rid of waste 

composed of: mouth, esophagous, stomach, small intestine (DJI), Large intestine (ICC), rectum

Acessory Organs

Liver, Gallbladder, Pancrease (Unencapsulated), Spleen.

Organs in the Right upper quadrant

liver

gallbladder

Pylorus

Duodenum

head of pancrease

right kidney

right adrenal gland

hepatic flexure of colon

portions of ascending and transverse colon

Left Upper Quadrant 

stomach 

spleen 

left lobe of liver 

body of pancrease 

left kidney 

left adrenal gland 

splenic flexure of colon 

portions of transverse and descending colon 

Right Lower quadrant

cecum

appendix

right ovary

right ureter

right spermatic cord

bladder if distended

uterus if enlarged

left lower quadrant

potrion of descending colon

sigmoid colon

left ureter

left ovary

left spermatic cord

bladder if distended

uterus if enlarged

Macronutrients - carbohydrates

the main source of energy 

55-70% of total calories

Macronutrients - Protein

essential in helping grow and heal tissue

12-20% of calories

fats

essential for normal growth and development

synthesis and regulation of hormones

tissue structure

nerve impulse transmission

insulation and protection of organs

less than 7% of total carbs

micronutrients

vitamins and minerals needed for growth, development and metabolic processes.

mouth fxn

turns food into bolus

chewing and salivary glands 

esophagus fxn

propels food from mouth to stomach

stomach fxn 

churns bolus

releases hydrochloric acid activates pepsinogin

small intestine fxn - duodenum

where most digestion occurs 

bile from gall bladder to emulsify

bush border cells to break down proteins and carbs

pancrease releases enzymes to breakdown proteins, carbs and fats

Jejunum 

where most absorption occurs 

sends to liver 

illeum - how it works

bile salts reabsorbed and sent back to liver

fats absorbed

Large intestine - what it does

reabsorbs water sodium and potassium

mircrorganisms help w/ digestion

rectum/anus 

expels stool 

Urinary tract - Kidneys

located in the posterior abdominal cavity by the T12 and L3

the right is lower than the left due to the liver

functions:

detects and disposes of waste in the body

erythropoitein secretions

activates Vitamin D

electrolyte balancing

regulation of fluids

regulation of BP

urinary tract - ureters 

connect the kidneys to the bladder 

approximately 12 inch long 

urinary tract - bladder

sac of smooth muscle fibers behiond the symphus pubis on the anterior side of the pelvis

contains internal sphincter, helps ___ relax

300 mL = moderate distention felt

450mL = casues discomforty

Older adults - the GI/GU

slowing of GI motility

inc. liklehood of regurgitation - less esophageal pressure

loss of subQ fat in face and neck, redistributed to arms, abdomen and hips

bacterial flora less active, inc. food intolerance and impaired digestion

dec internal sphincter tone and sensation

bladder dec in size and muscle tone

older adults - nutritional changes 

decreased taste and appetite 

become more salt sensitive 

physical limitation, social isolations, income 

Nutritional assessment - 24 hour recall

recall the last 24hrs of their eating from memory

Nutritional Assessment - 3 day food diary

best if written immediately after eating

can cause concious or subconscious change in dietN

Nutritional Assessment - Food Frequency Questionnnares 

asks patient how often they eat something, then patient tells you how often they eat that 

Abdominal Asessement order

inspect, auscultate, percuss, palpate

Ausculation - bruits

siwshing sounds that indicate turbulent blood flow due to constriction or dilation of a tortuous vessel

Auscultation - Bowel sounds: normal 

5 to 30 gurgles in 1 minute with sounds every 5-15 seconds 

Auscultation - Bowel sounds: hypoactive

5 sounds in 5-15 seconds 

Auscultation - Bowel sounds: hyperactive

30 sounds in 5-15 seconds

due to things like diarrhea or GI upset

Auscultation - Bowel sounds: absent

no sounds heard

cause for listening in each quadrant for 5 minutes each

Percussion findings

Normal - tympanny

organs - dull especially over liver

fluid filled/massess - dull

also monitor for pain

Plapation - Light palpations 

fingertps .5 to 1inch deep 

normal - nontender signs of pain 

reboundtenderness - more painful when releasing hands than when plapating - indictive or perietal inflammation 

Palpations - Deep Palpations

1.5 to 2.5 inch deep

looking fro organs masses tenderness

dipping motion with hands P

Palpations - Safety

DONT PALPATE IF:

organ transplant

child with wilms tumor

spleen trauma

suspected aortic aneurysm

Complete metabolic panel 

Albumin - serum protein in blood 

ALP - reflect liver fxn 

ALT - reflect liver fxn 

AST - reflect liver fxn 

billirubin - too much indicates jaundice 

Other labs to consider for GI

lipase, amylase - pancreas fxn

ammonia - indicates liver issues, too much = toxic

prealbumin - protein intake

stool samples

CBC

BMP

ABG

Intake - what to track

track:

% of meals eaten

any fluids taken orally or enterally

ice (recored as half the vol of the container)

amount of IV fluids

Output - what to track 

urine output:

adequate ~ 0.

normal ~ 1500 mL/day

oliguria ~ 100 - 400 mL 

Anuria - no urination 

draingage from tubes 

emesis 

liquid stool 

BMI

weight in lbs/height in inches squared x 703

below 18.5 = underweight

18.5-24.9 = normal weight

25-29.9 = overweight

30-34.9 = obesity class 1

35-39.9 = obesity class 2

40 or greater = morbid obesity

BMI not considered

less than 5 ft tall

high muscle percentile

fluid overload conditions

Ostemies and Stomas - assess this on patient 

good - appeare red and beefy 

applicance should fit good but not too tight 

assess output 

assess pts rxn to stoma and body image perception 

Ostemies and stomas - ileostomy

site - right lower quadrant

output - 500 -1300 mL/day

stool - liquid and mushy

ostemies/stomas - colostomy

site - left lower quadrant

output - 200-700 mL/day

stool -semi formed

Assessing urinary catheters and nephrostomy tubes 

assess for necessity every shift 

check urine output, color and consistency 

check lines for kinks and obstructions 

bag should always be lower than pt 

check skin integrity 

check signs of infxn - UTI = ALOC, cloudy urine, fever 

BPH - recognize/analyze cues

dec. urine stream, dec starting and stopping

hesitency

frequency

nocturia

hemturia

urinary retention

BPH - generate solutions

monitor for s/s UTI or impaired kidney fxn 

bladder scan 

potential straight cath or indwelling cath 

urinary retention medications - admin urination meds 

Malnutrition - Skin, hair nails

dull, pasty, scally, dry, bruised

eyes dull, conjunctiva pale

hair brittle and dull

mucus membrane pull, gums boggy and bleeding

tongue dark, red, swollen

Malnutrition - GI

nasuea/vommitting

diarrhea/constipation

loss of appetite

over or underweight

Malnutrition - other signs and symptoms 

loss of appetite 

withdrawn, easily fatigued, stooped posture 

inattentive, irritable 

flaccid muscles, cachexia, parasthesia 

Ascites - recognize/analyze cues

• fluid collection in the periotneal or abdominal cavity

Data: high AST/ALT, low albumin

asymmetrical contour

weight gain

everted umbilicus

abdominal distention

SOB when lying flat

fluid wave

dull percussion tones

jaundice

hard plapable liver

Ascites - generate solutions

fluid collection in peritoneal or abdominal cavity

elevate HOB, SOB

monitor/treat for dehydration

oxygen if needed

diuretics

replace albumin

I & Os

paracentesis

UTI - recognize/analyzing cues 

Data collection: UA, WBC w/ left shift,RBC positive for leukocyte esterase and nitrites, inc. BUN, Creatine 

hesitency, urgency, dysuria 

CVA tenderness

chills 

fever

confusion

hematuria

cloudy, foul smelling urine

urethral discharge 

urethriitis

prostatic tenderness 

UTI - generate solutions

monitor for s/s of urosepsis

cetheter care

R/O STI

sitz bath

warm compress

inc fluid intake

ABX

teach: empty bladder frequently, urinate before/after sex, wipe front to back, avoid citrus or caffine until infx solved

Diverticulitis - signs

• outpouching in the rectum due to poo/food getting stuck causing inflammation and infxn

data collection: elevated WBC w/ left shift

LLQ pain made worse with lifting, coughing or straining

nausea

diarrhea or intermitnent constipation

fever

Diverticulitis - generate solutions 

monitor for s/s of peritonitis - abdominal x-ray 

IV ABX 

mild-clear liquids for 2-3 days 

bowel rest/ NG suction 

high fiber diet and inc. fluids once infxn resolved 

cholecystitis with cholethiasis - signs

• Inflammation of the gallbladder due to gall stones

data collection - INC WBC, ALP, bilirubin, US, or MRI

RUQ pain made worse after eating

N/V

clay colored stool

may radiate to shoulder or back

murpheys sign

jaundice

fever

tachycardia

cholecystitis with cholelithiasis - solutions

monitor for s/s of peritonitis

pain management

IV ABX

ERCP - Endoscopic Retrograde Cholangiopancreatography

cholecysectomy

acute: NPO

low fat diet

pancreatitis - signs 

• when digestive enzymes become active while still in the ___ causing inflammation

data collection - inc. amylase, lipase, WBC, C-reative protein 

N/V

mid epigastric to LUQ pain that can radiate to back 

worse w/ eating fatty foods or drinking alc 

hypoactive bowel sounds 

fever tachycardia 

abdomen tenderness adn distention 

pancreatitis - solutions

monitor for s/s of hemmorragh or peritonitis

pain management

acute: NPO

low fat, low protien diet

alcohol cessation

IV ABX

Appendicitis - signs 

• inflammation of the ___

data collection - WBC w/ left shift, CT, ultrasound, MRI 

anorexia

N/V

low grade fever, diaphoresis, chills 

tachycardia 

normoactive bowel sounds with possible constipation or diarrhea 

mcburneys point in RUQ

rebound tenderness 

Rosvings sign

psoas sign 

orbutrar sign 

Appendicitis - solutions

Acute - NPO

once infxn resolved or after surgery, return to regular diet

IV fluids

pain interventions

antibiotics

appendectomy

fowlers position

monitor for s/s of peritonitis

GI bleed - signs

data collection - decresed RBC, HGB, HCT, increased BUN, positive occult stool

abdominal distention

melena (upper GI)

hematochezia - blood in the stool (lower GI) 

coffee ground emesis (Upper GI) 

GI bleed solutions 

NPO 

monitor for s/s of decreased perfusion 

blood transfusion if needed

EGD 

colonoscopy 

alcohol cessation 

stop anticoagulants 

avoid NSAIDS, aspirin, corticosteroids