Abdomen and Gastrointestinal System

what are the organs in the GI system

• stomach

• large intestine

  • sigmoid colon

• small intestine

• rectum - anus

what is the function of the small intestine

where most of the food is digested and absorbed

what is the structure of the small intestine, what parts

three segments: duodenum, jejunum, ileum

• duodenum - first part coming off the stomach, makes a c shaped curve

• jejunum - second, middle section, provides absorption through intestinal villi

• ileum - last part, provides absorption through intestinal villi

what is the ileocecal valve

between the ileum and large intestine, prevents backward flow of fecal material

what is the main function of the large intestine

• absorbs water and electrolytes

• feces is formed in the large intestine and held until defacation

the large intestine is also the colon

what are the three parts of the colon?

1. ascending

2. transverse

3. descending

• turns into S- shape to make sigmoid colon and leads to rectum

what organs are associated with the GU system

• kidney

• ureter

• bladder

• prostate

• urethra

problem based questions: abdominal pain

pain = OLDCARTS

• change in location?

• worse when stomach empty?

• other symptoms? fever, stress, constipation

• Women- associated with period?

1. hematochezia

2. melena

3. hematemesis

REPORT IMMEDIATELY

1. bloody stools

2. dark, tarry stools

3. vomiting of blood

problem based questions: nausea and vomiting

• quantity/frequency

• color and consistency

• duration

• diet - ate in last 24 hrs

• other symptoms?

problem based questions: dyspepsia

Dyspepsia is defined as indigestion, characterized by discomfort or pain in the upper abdomen, often occurring after eating or drinking.

• issues with: nausea, food intolerance, heartburn, ulcers, change in weight

• stress?

• other symptoms: belching, bloating, flatulence (fart)

problem based questions: dysphagia

difficulty swallowing foods or liquids

• describe

• stroke history?

• dental issues? dentures

can lead to aspiration pneumonia or unintended weight loss

GU subjective data

ask them about:

• dysuria - pain or discomfort when urinating

• urinary frequency

• urinary urgency - a strong urge that makes it difficult to reach the bathroom

• urinary incontinence - leak when you cough, sneeze, jump

what is the order in assessing the GI tract: between percussion and ect

1. inspection

2. auscultate

3. percussion

4. palpation

palpate LAST, it can cause a change in bowel sounds 

• have pt use bathroom FIRST

what are you inspecting for when looking at the abdomen

• contour/shape

• symmetry - any masses?

• umbilicus - is it inverted? midline?

• skin - color, smooth, lesions?

• movement/pulsations

abdominal contour: rounded vs convex/distended

round- slightly extended

convex- more distended or protuberant

• both could be from pregnancy, water retention, cancer

• normal in kids under 4

abdominal contour: concave

sunken in

• could be normal if skinny

GI : auscultation

• use diaphragm to listen to bowel sounds

  • usually high pitched, irregular 

• all 4 quadrants, clockwise motion starting at RLQ

• more important to listen than count sounds

Bowel sound: borborygmi

increases due to hunger

true or false: you should not hear vascular sounds when auscultating the bowel sounds

true

• if you do report to the HCP

how do you auscultate the GI vascular system

this include the aorta, renal artery, iliac artery, and femoral artery

• use the BELL

How do you palpate the abdomen (GI)

1. ask pt to bend knees while in supine position - enhances relaxation

2. perform in all 4Q

light vs deep palpation

1. light palpation (1cm) - assess muscle resistance, masses, tenderness

2. deep palpation (4+ cm) - assess for enlarged organs

how do you palpate the GU

1. have pt use bathroom

2. palpate in the suprapubic area for distention

• note any pain, guarding, rebound tenderness

how to test rebound tendeness

maintain pressure in an area, if pain occurs when the pressure is lifted then the test is positive

How much should someone pee in an hour

30ml/hr

• less than that is a sign of dehydration

how to assess GI of newborns and infants

follow the same assessment

• if umbilical cord is connected look for 2 arteries and 1 vein

• may hear more tympany in percussion

• palpate with feet elevated and knees flexed

how to assess GI of older adults

follow same assessment

• abdominal wall usually thinner from loss in muscle tone

• contour is usually rouded 

• constipation may increase

what does jaundice indicate - how does the GI/GU change

• indicated elevated serum bilirubin

• urine changes from amber to brown

• stool goes from brown to tan

what causes jaundice

• liver disease

• gallstones

• pancreatitis

• medications

has a cephalocaudal progression

what causes diarrhea

acute = dehydration

what are interventions for constipation

• high fiber and fluid diet

• decrease sugar and milk

• stool softeners, laxatives