Gastrointestinal Assessment and Bowel Function: Key Concepts for Healthcare

Appetite changes

Ask about appetite, weight changes, diet, food types, preparation, pain with eating, and fluid intake.

Low fluid intake results in... Constipation.

Dysphagia

Difficulty swallowing caused by neurologic, neuromuscular, or obstruction issues.

Food intolerance

Foods that cause nausea, heartburn, or diarrhea.

Abdominal pain assessment

Type, location, duration, aggravating and relieving factors.

Nausea/Vomiting assessment

Frequency, amount, contents, and triggers.

Constipation assessment

Ask about frequency of BMs and the date of the last BM.

Fecal impaction

Hardened stool stuck in rectum causing inability to pass stool.

Diarrhea cause

Often due to infection or bowel irritation.

Fecal incontinence

Involuntary defecation.

Flatulence Gas

increased by high-fiber diets.

Distention

Fullness caused by gas or stool.

Hemorrhoids

Dilated rectal veins; may resolve or require surgery.

Past abdominal history

Includes surgeries, anesthesia history, and contrast dye allergies.

Medications causing constipation

Narcotics and iron.

Medication causing loose stools

Antibiotics.

Nutrition assessment Includes fluid and fiber intake.

Contour of abdomen

Flat, rounded, scaphoid, or protuberant.

Symmetry assessment

Look for bulging, masses, bruising, and hair distribution.

Umbilicus assessment

Should be midline; bulging may indicate hernia.

Skin assessment

Look for striae, rashes, discoloration, scars, lesions.

Visible aortic pulsation

May indicate aneurysm.

Auscultation order

RUQ → LUQ → LLQ → RLQ.

Normal bowel sounds

5-30 gurgles per minute.

Hypoactive bowel sounds

Less than 5 sounds per minute.

Hyperactive bowel sounds

More than 30 sounds per minute.

Absent bowel sounds

No sounds heard; most concerning.

Bruit sound

Faint blowing sound indicating turbulent blood flow.

Percussion finding

Tympany expected due to air in intestines.

Light palpation

depth 1-2 cm.

Deep palpation

depth 5-8 cm.

Light palpation purpose

Assess tenderness and masses.

Deep palpation purpose

Assess organs.

CVA tenderness

Pain indicates kidney inflammation.

Organs not normally palpable

Liver, spleen, kidneys.

Infant umbilical hernia

Common and occurs with crying; usually resolves.

Infant diastasis recti

Midline bulge from muscle separation.

Meconium timing

Passed within first 24-48 hours.

Child protuberant abdomen

Normal; should flatten by school age.

Child bowel control

Spinal cord maturity around 18 months.

Pregnancy abdominal considerations

Constipation, diastasis recti, displaced bowel sounds.

Older adult bowel concerns

Increased risk for constipation.

Normal stool composition

75% water, 25% bacteria and undigested food.

Normal stool color

Brown.

Normal stool consistency

Soft and formed.

Normal stool frequency

1-2 times/day, individualized.

Hemoccult test

Detects hidden blood in stool.

Endoscopy

Visualization of upper GI tract.

Colonoscopy

Visualization of large intestine.

Promote healthy elimination

Increase fluids and fiber, exercise, monitor bowel habits.

Skin integrity interventions

Use barrier creams and moisture-wicking pads.

Comfort interventions

Gentle cleaning and frequent assessment.

Promote positive body image

Provide privacy and emotional support.

Medications for bowel function

Stool softeners and laxatives.

Additional bowel interventions

Enemas, manual impaction removal, bowel training programs.

Poisoning prevention (children)

Lock away household chemicals.

Choking prevention (children)

Avoid small and hard foods.

Small intestine ostomy

Liquid stool output; stoma protrudes more.

Large intestine ostomy

Solid or formed stool output.

Healthy stoma appearance

Pink, red, moist, and shiny.

Ostomy bag care

Clean with warm water; replace every ~3 days.

When to empty ostomy bag

When 1/3 to 1/2 full.

Best time to change ostomy appliance

Before meals.

Ostomy procedure technique

Clean technique; use clean gloves, not sterile.

Ostomy documentation

Document output every time the bag is emptied.