Module 4: Abdominal, Female and Male Genitourinary

In which quadrant of the abdomen would you find the spleen?

Left upper quadrant

In which quadrant would you find the liver?

right upper quadrant

In which quadrant would you find the gallbladder?

right upper quadrant

In which quadrant would you find the appendix?

right lower quadrant

In which quadrant of the abdomen would you find the right kidney?

right upper quadrant

In which quadrant of the abdomen would you find the left kidney?

left upper quadrant

In which quadrant of the abdomen would you find the aorta?

Upper abdomen, just left of the midline

Describe the path of the GI tract from the mouth to the anus.

Mouth > esophagus > stomach > small intestine > large intestine (colon) > rectum > anus

Describe the role of the mouth in the GI tract.

chewing mechanically breaks down food, mixes with saliva that acts on cooked starch to begin its conversion to maltose

Describe the role of the esophagus in the GI tract.

as food enters, it pass the upper esophageal sphincter ( prevents air from entering esophagus and esophageal contents from refluxing back into throat); food travels down with aid of peristalsis, which is contraction that propels the food

Describe the role of the stomach in GI tract.

sphincter prevents reflux of stomach contents back into esophagus

Describe the role of the small intestine in the GI tract.

after stomach, material moves through the small intestine

Describe the role of the large intestine (colon) in the GI tract.

peristalsis move the chyme through the ileocecal valve into large intestine; large intestine is divided into cecum, ascending colon, transverse colon, descending colon, and sigmoid colon; digestive fluid enters the large intestine by waves of peristalsis through the ileocecal valve

Describe the role of the rectum in the Gi tract.

the last 17-20 cm (7-8in) of the intestinal tube; mucosa absorbs water as feces move toward the rectum

Describe the role of the anus in the GI tract.

opening for elimination of feces; feces contain cellulose and similar indigestible substances, sloughed epithelial cells from GI tract, digestive secretions, water, and microbes

What are some age-related changes in the GI system?

Occur, but do not significantly affect function as long as no disease is present.

How is fat redistribution affect with age?

after middle age, fat accumulates in the suprapubic area in females due to decreased estrogen levels

How do male fat deposits change with age?

In the abdominal are, they are accentuated with amore sedentary lifestyle

How is muscle relaxation affected with age?

abdominal musculature relaxes

What are normal physiologic changes in aging adults that directly affect nutritional status?

• poor dentition

• decreased visual acuity

• decreased saliva production

• decreased GI absorption

• slowed GI motility

• diminished olfactory and taste sensitivity

Is constipation a physiologic consequence of aging?

No, but common causes include: dec. physical activity, inadequate water intake, low-fiber diet, side effects of meds (opioids, tricyclic, antidepressants), IBS, bowel obstruction, hypothyroidism

What should you consider about medications and nutrition?

aging adults frequently take multiple medications that have potential for interaction with nutrients and with one another; some meds interfere with nutrient absorption, leading to vitamin deficiencies, while other may require avoiding certain foods, thus limiting nutrient intake

What are some questions you would ask to gather subjective data about appetite?

• changes in appetite - time period and amount

• changes in weight - loss or gain (amount) and time period

What are some questions you would ask to gather subjective data about dysphagia?

• any difficulty in swallowing

• onset and associated symptoms

What are some questions you would ask to gather subjective data about food intolerance?

• type of food reaction that occurs

• use of Rx or OTC medication - amount and frequency

What are some questions you would ask to gather subjective data about abdominal pain?

• onset duration, location, and severity

• characteristics (quality and patter) and associated symptoms

• about eating, pain better or worse

• association with any other clinical symptoms

• alleviating factors and aggravating factors

• treatment methods: Rx and OTC

What are some questions you would ask to gather subjective data about nausea and vomiting?

• onset, frequency, type and amount

• associated symptoms and/or triggers

• recent foods eaten and/or travel habits

What are some questions you would ask to gather subjective data about bowel habits?

• frequency, color, consistency, diarrhea or constipation

• any recent changes

• laxative use - type, amount, and frequency

What are some questions you would ask to gather subjective data about past abdominal history?

• GI disease/pathophysiology

• GI diagnostic procedures

• GI surgeries and clinical response

What are some questions you would ask to gather subjective data about medications?

• Rx and OTC

• alcohol - type, amount, and frequency

• smoking history

What are some questions you would ask to gather subjective data about nutritional assessment?

• dietary history/24 hr recall

• “Is that menu typical for most days?”

• “record intake of caffeine (coffee, tea, soda)

What is the proper order of techniques for abdominal assessment?

inspection > auscultation > percussion > palpation

Define scaphoid.

describes an abdomen that is hollow or sunken; caves inward, creating concave profile instead of flat or rounded (occurs with extreme malnutrition/weight loss)

Define protuberant.

means abdomen is rounded, bulging, and convex; causes include: pregnancy, obesity, ascites, tumor, and gas distention

Define striae.

aka stretch marks, silvery white, linear, jagged marks about 1 to 6cm long; occur when the elastic fibers in the reticular layer of the skin are torn after rapid or prolonged stretching

How do you assess the abdominal aorta and what are the areas you listen to?

auscultate for vascular sounds, specifically bruits (bell is best for this kind of sound); areas to auscultate: aorta, renal arteries, iliac, and femoral arteries

What are the expected finding when percussing each quadrant of the abdomen? What do you hear over the liver and spleen?

primarily tympani due to air in the stomach and intestines; scattered areas of dullness may occur over the liver, spleen, and kidneys, fluid-filled structures, and adipose tissue

Describe the hooking techniques for palpating the liver.

an alternative method for palpating the liver to assess contour, consistency, and tenderness:

• stand at the patient’s right shoulders

• place both hands side by side on right costal margin below border of liver dullness

• push deeply down and under the costal margin

• ask the person to take a deep breath

• the liver edge should bump your fingertips as the person inhales

Describe how to test for Blumberg’s sign.

another name for rebound tenderness:

• choose the location where you suspect tenderness (often lower quadrants)

• press down slowly and deeply over the area

• hold pressure briefly

• lift your hands quickly

What does a positive test for Blumberg’s sign indicate?

pain that occurs when you release pressure; suggests peritoneal inflammation (appendicitis, peritonitis)

How do you test for Murphy’s sign?

tests for cholecystitis (inflammation of gallbladder)

• hook your thumb under the right costal margin at the liver border, in the midclavicular line

• ask the person to take a deep breath

What does a positive test for Murphy’s sign indicate?

a sudden stop in inspiration; suggest cholecystitis