GI Assessment

what is the alimentary canal

• the route from the mouth to the anus

function of GI system

• digestion and elimination of food

what does the GI tract consist of

• oral cavity

• esophagus

• stomach

• pancreas

• liver and gallbladder

• small intestine

• large intestine

BOX

physiologic changes w aging

• atrophy of gastric mucosa leads to decrease hydrochloric acid levels

• peristalsis decreases, nerve impluses dulled

• distension and dilation of pancreatic ducts change. calcification of pancreatic vessels occurs w a decrease in lipase production

• decrease in number and size of hepatic cells which increases fibrous tissue that leads to decreased protein synthesis and changes in liver enzymes. Decreased enzyme activity and cholesterol synthesis

• intestinal microbiota abnormalities

BOX

disorders r/t physiologic changes in older adults

• decreased absorption of iron, b12, proliferation of bacteria, atrophic gastritis occurs from bacterial overgrowth

• decreased sensation to defecate can postpone BM leading to constipation and impaction

• decreased lipase causes decreased fat absorption and digestion, steatorrhea occurs bc of this

• decreased enzyme activity depresses drug metabolism causing accumulation and toxicity

• dysfunction microbiota causes anorexia and undernutrition

questions to ask during GI hx

• What is your typical daily food intake?

• What medications are you taking? (Obtain name, dose, and frequency)

• Do you take any vitamins, minerals, or herbal supplements? If so, what are they?

• How is your appetite? Has there been a recent change?

• Have you lost or gained weight recently? If so, was the weight loss or gain intentional?

• Are you on a special diet? If so, what kind, and for what purpose?

• Do you have difficulty chewing or swallowing?

• Do you wear dentures? If so, how well do they fit?

• Do you experience indigestion or “heartburn”? If so, how often? What seems to cause it? What helps it?

• Have you had GI disorders or surgeries in the past? If so, what are they and when did they occur?

• Is there a family history of GI health problems?

• Do you smoke (or vape), or have you ever smoked (vaped) in the past?

• Do you chew or have you ever chewed tobacco?

• Do you drink alcoholic beverages? If so, what kind, how much, and how many each week?

• Do you have pain, diarrhea, constipation, or gas? Do any specific foods accompany the problem?

• Have you traveled out of the country recently? If so, where and when?

• What is your usual bowel elimination pattern? Frequency? Character?

• Do you use laxatives to produce a bowel movement? If so, how frequently?

• Do you have any pain or bleeding associated with bowel movements?

• Have you experienced changes in your usual bowel pattern or stool

• Have you ever had an endoscopy or a colonoscopy? If so, which one, and when?

what should you not do if you see a buldging mass during abdominal inspection

• do not touch w hands or stethoscope

• may be aortic aneurysm

• notify HCP immediately

when asking about precipitating or palliative factors

• what were you doing when pain started

• what caused it

• what makes it better or worse

• what triggers it

when asking about quality/quantity

• describe feeling

• sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting, stretching

when asking about region/radiation

• where is it located

• does it radiate

• does it feel as if it travels or moves around

• did it start in one place and is now localized to one spot

when asking about severity

• 0-10 pain scale

• does it interfere w activities

• how bad is it at its worst

• does it force you to sit down, lie down, slow down

• how long does an episode last

when asking about timing

• When or at what time did the pain start?

• How long did it last?

• How often does it occur (e.g., hourly, daily, weekly, monthly)?

• Is it sudden or gradual?

• What were you doing when you first experienced it?

• When do you usually experience it (e.g., daytime, night, early morning)?

• Are you ever awakened by it?

• Does it lead to anything else?

• Is it accompanied by other signs and symptoms?

• Does it ever occur before, during, or after meals?

• Does it occur seasonally?

order of assessment of GI tract

• inspection

• auscultation

• palpation

ACTION ALERT

peristaltic movements

• rarely seen unless pt is thin and has increased peristalsis

• if observed, note quadrant of origin and direction of peristaltic flow

• report to HCP bc may indicate intestinal obstruction

cologuard test

• is a screening

• inspects DNA from colon lining w BM

• if abnormal need colonoscopy

colonoscopy is a

diagnostic test

imaging assessment

• xrays

• ct

• MRI

other diagnostic assessments

• endoscopy

• EGD

• ERCP

• small bowel capsule endoscopy

• colonoscopy

• sigmoidoscopy

• ultrasonography

• endoscopic ultrasonography

• liver spleen scan

what is EGD

• esophagigastriduodenoscopy

• isual exam of esophagus, stomach, and duodenum

ACTION ALERT

EGD

• priority care after EGD is to prevent aspiration

• do not offer fluids PO until you are sure gag reflex is intact

• monitor for signs of perforation like pain, bleeding, or fever

what is ERCP

• endoscopic retrograde cholangiopancreatography

• visual exam of liver, gallbladder, bile ducts, and pancreas

ACTION ALERT

ERCP

• teach about importance of monitoring for postop comps like cholecystitis, pancreatitis, infection, bleeding, perforation, biloma

• pt will have severe pain if these occur

• fever is present in sepsis

• dont occur right after procedure, may take several hours to 2 days to develop

when to start getting colonoscopy

45 for men & women

screenings after 75

• benefits decline after 75

• little evidence to support continuing screening after age 85

care of pt after a colonoscopy

• do not allow anything po until sedation wears off

• take vitals q15-30min until pt is alert

• keep side rails up until alert

• assess for rectal bleeding and severe pain

• remind pt that fullness and mild abdominal cramping are expected for several hours

• assess for s/s of perforation: severe abd pain and guarding, fever may occur later

• assess for s/s hypovolemic shock: dizziness, lightheadedness, decreased bp, tachycardia, pallor/ash gray skin, altered mental status (may be 1st sign in older adults)

• if in ambulatory setting, another person drives the pt home

• teach pt to refrain from driving, making legal decisions, or carrying out other work that requires focus the rest of the day

highest risk for colorectal cancer

• black, american indian, alaskan natives

• advocate for regular screenings for all pts so it can be detected early

considerations when asking complete nutrition hx

• cultural and spiritual observations are important to understand when completing nurtition hx

• ask about preferred foods

  • spices or hot peppers can aggravate indigestion, fasting or abstinence may have impact on pts nutrition health and s/s that are occurring

organs in RUQ

• most of liver

• gallbladder

• head of pancreas

• hepatic flexure of colon

• part of ascending and transverse colin

organs in LUQ

• left lobe of liver

• stomach

• spleen

• body and tail of pancreas

• splenic flexure of colon

• part of transverse and descending colon

organs in RLQ

• cecum

• appendix

• r ureter

• r ovary and fallopian tube

• r spermatic cord

organs in LLQ

• part of the descending colon

• sigmoid colon

• L ureter

• L ovary and fallopian tube

• L spermatic cord