GI & Renal

Solid Viscera

Liver

Pancreas

Spleen

Kidneys

• dense and dull

Hollow viscera

Stomach

Gallbladder

Small intestine

Colon Bladder

• hollow, higher pitch

Left Upper Quadrant

stomach, spleen, pancreas, transverse colon

Right Upper Quadrant

Liver, Gallbladder, Duodenum, Transverse Colon

Right Lower Quadrant

Ascending Colon, Appendix

Left Lower Quadrant

Descending and sigmoid colon, Bladder

The LLQ contains all of the following structures except:

Spleen

Health History

Appetite

Food Intolerance

Abdominal Pain

Nausea/vomiting

Bowel

Health History- urinary and renal

• suprapubic pain

• dysuria, urgency, or frequency

• hesitancy, decreased stream in males

• polyuria or nocturia

• urinary incontinence

• hematuria

• kidney or flank pain

• ureteral colic

Upper GI

• stomach and up

• acute upper abdominal pain or discomfort (OLDCART)

• Chronic upper abdominal discomfort or pain

  • dyspepsia

  • discomfort, may be non painful, just comfortable

  • heartburn

  • atypical respiratory symptoms

  • alarm symptoms

Lower GI

• right lower quadrant

• acute lower abdominal pain

  • sharp and continuous

  • intermittent and cramping

  • rebound

  • doubled over

Chronic GI Pain

abdominal pain

• change in bowel habits

• alternating diarrhea and constipation

• change in form of stool

• intermittent pain with relief from defecation

Associated Symptoms

nausea, retching, vomiting, regurgitation, odor, vomitus, anorexia

eldery history

pay special attention to diet/nutrition

do not discount possible alcohol use or drug use

may under report pain

Urinary tract- general Qs

• Difficulty passing urine?

• How often do you go?

• Get up at night? How often?

• How much urine do you pass?

• Pain or burning?

• Ever leak urine/wet self involuntarily/trouble getting to restroom in time?

• Know when bladder is full?

Order for GI

• Inspection

• Auscultation

• Percussion

• Palpation

Objective data

Contour, Symmetry, Movement, Umbilicus

Contour

Flat, Rounded, Scaphoid, Protuberant

Auscultation

• warm your stethoscope in your hands

• Always use the diaphragm to listen to bowel

• apply stethoscope lightly to skin and keep contact

• Begin in RLQ and work your way around

Vascular Sounds

Aortic

Left Renal

Right Renal

Left Iliac

Right Iliac

Bruit

aortic aneurysm

auscultation

Normal bowel sounds

5-34/min

Hypoactive bowel sounds

<5/min

Hyperactive bowel sounds

>34/min

Borborygmi

prolonged gurgles of hyperperistalsis

“stomach growling”

Absent

no sound 5 minutes each quadrant

Percussion

• help to determine areas of density, fluid, mass

• Primarily you hear TYMPANY due to air in intestine

• HYERRESONANCE is heard with distention

• DULLNESS is heard over solid organs, mass or full bladder

Costovertebral Angle

CVA

fist percussion

for kidneys

Organomegaly

enlarged organs

Palpation

warm hand

first light palpation- light, gentle dipping motion approx. 1cm depth

then deep palpation 2-3 inches

watch for guarding, rigidity, masses, tenderness, rebound tendernesss

Urinary tract evaluation

types of incontinence

• stress

• urge

• overflow

• functional

assessing rick factors for colorectal cancer

• past colorectal cancer or adenomatous polyp

• history of inflammatory bowel disease

• family history of colorectal cancer or adenomatous polyp

people at average risk for colorectal cancer screening

fecal occult blood test annually

flexible sigmoidoscopy every 5 years

colonoscopy every 10 years

double contrast barium enema every 5 years

Risk Factors for colorectal cancer

diabetes

alcohol use

obesity

smoking

high fat diet

protective factors

diet high in fruits and vegetables

diet high in fiber

regular physical activity

use of aspirin or NSAIDS

important to remember

Remember that all surgery patients who have general anesthesia are at risk for bowel problems

post op care: critical

auscultate for bowel sounds. Usually keep NPO until peristalsis returns- bowel sounds, flatus, or BM

turn pt q 2hr. have pt move as much as possible

patients who have had bowel surgery may have NG tube. Suction should be monitored and set as ordered

post op care

assess level of N/V- both anesthesia and pain med can cause nausea

medicate PRN to avoid undue strain on sutures due to vomiting

document amount and character of emesis (or NG drainage)

monitor electrolytes due to NG or vomiting losses

post op complications

wound dehiscence

wound infections

incisional hernia

hematoma