Genitourinary/Gastrointestinal Systems

Elimination

The mechanisms that facilitate the secretion and excretion of body waste products from the kidneys and intestines.

Nutrition

Governs food and fluid intake affecting waste production.

Fluids & Electrolytes / Acid-Base Balance

Impaired elimination disrupts fluid, electrolyte, and acid-base homeostasis.

Hormonal Regulation

Controls digestion and urine formation processes.

Liver

Largest organ (~3.5 lbs), located in the RUQ spanning 5th intercostal space to costal margin; functions include bile production/secretion, protein/carbohydrate/fat metabolism, glucose storage, and clotting factor production.

Gallbladder

Concentrates and stores bile.

Pancreas

Located in LUQ behind stomach. Endocrine: secretes insulin, glucagon, somatostatin, and gastrin. Exocrine: secretes bicarbonate and digestive enzymes (lipase, amylase, protease) into the duodenum.

Kidneys

Located retroperitoneally at T12–L3. Right kidney is slightly lower than the left due to liver displacement. Functions include filtering water-soluble waste, regulating fluids/electrolytes via nephrons, producing erythropoietin (RBC stimulation), and activating vitamin D.

OLD CARTS

Mnemonic for symptom analysis: Onset, Location, Duration, Characteristics, Aggravating factors, Related symptoms, Treatment, Severity.

Smoking (Risk Factor)

Risk factor for peptic ulcer disease and cancers of the colon, pancreas, liver, kidney, and bladder.

Alcohol (Risk Factor)

Associated with acute/chronic pancreatitis and liver cirrhosis.

Family History (Risk Factor)

Family history of colorectal, prostate, or testicular cancer significantly increases patient risk.

Opioid Use

Causes severe constipation and hemorrhoids.

Dysuria

Painful urination.

Polyuria / Frequency

Voiding frequently, greater than every 2 hours.

Urgency

Sudden, intense desire to void.

Nocturia

Waking up at night to urinate.

Hematuria

Blood in the urine.

Stress Incontinence

Involuntary loss with increased intra-abdominal pressure (coughing, sneezing, laughing).

Urge Incontinence

Sudden, intense desire to void.

Overflow Incontinence

Involuntary leakage from an overdistended bladder (common with enlarged prostate).

Functional Incontinence

Inability to reach toilet due to physical or cognitive impairments (e.g., severe arthritis).

Male Prostate / Voiding Issues

Hesitancy, weak stream, dribbling, sensation of incomplete emptying.

The 7 Fs of Distention

Fat, Fetus, Fluid (ascites), Flatulence, Feces, Fibroid tumor, Fatal tumor.

Abdominal Assessment Sequence

Inspection, Auscultation, Percussion, Palpation. (Auscultate before percussion/palpation to avoid altering bowel sounds).

Palpation Contraindications

DO NOT palpate over marked pulsations or suspected AAA, organ transplants, or suspected Wilms tumor. Discontinue if enlarged spleen is suspected to prevent rupture.

Urine Abnormalities

Dark yellow/amber, cloudy/sediment, hematuria, cola-colored. Post-void residual > 200 mL indicates urinary retention.

Stool - Bright Red

Lower GI bleed or hemorrhoids.

Stool - Tarry Black (Melena)

Upper GI bleed, iron, or bismuth.

Stool - Light Tan/Gray/Clay

Biliary tract obstruction (lack of bile).

Stool - Pale Yellow

Malabsorption.

Emesis Inspection

Bilious (green-yellow), coffee-ground (digested blood), or frank blood.

Skin & Contour Abnormalities

Striae, erythema, jaundice, glistening/taut skin (ascites), caput medusae (dilated radiating veins from portal hypertension).

Surface Movements Abnormalities

Visible peristalsis indicates obstruction; marked abdominal aortic pulsations indicate suspected AAA (do not palpate!).

Normoactive Bowel Sounds

High-pitched gurgles/clicks every 5–15 seconds (5–30/min).

Hyperactive Bowel Sounds (Borborygmi)

Loud, prolonged rumbling/tinkling (>30/min).

Hypoactive or Absent Bowel Sounds

Must listen for several minutes (up to 4–5 min) before documenting true absence (indicates ileus, peritonitis, obstruction).

Vascular Sounds - Bruits

Swishing systolic sounds indicating turbulent flow (aortic bruit suggests aneurysm).

Vascular Sounds - Venous Hum

Soft low-pitched continuous tone (portal hypertension/cirrhosis).

Percussion General Findings

Tympany predominates over gas-filled intestines; dullness over liver/spleen/full bladder/ascites.

Light Palpation Findings

Depress 1 cm using finger pads; normal is soft, relaxed wall, no pain. Abnormalities include rigidity/involuntary guarding (peritoneal irritation).

Deep Palpation Findings

Depress 4–6 cm; normal is no pain or masses. Abnormalities include guarding, facial grimacing, fixed masses, lateral pulsatile mass (AAA).

Liver Span Percussion

Normal span is 6–12 cm at right midclavicular line; descends 2–3 cm on inspiration. Hepatomegaly: lower border > 2–3 cm below right costal margin.

Murphy Sign

Sharp pain and abrupt halting of inspiration during deep RUQ palpation; indicates cholecystitis.

CVA (Costovertebral Angle) Percussion

Direct or indirect fist percussion at 12th rib posterior flank; tenderness/pain indicates pyelonephritis, glomerulonephritis, or kidney stones.

Rebound Tenderness (Blumberg Sign)

Press at 90-degree angle and release rapidly; increased pain on release indicates peritoneal inflammation.

Iliopsoas Muscle Test

Downward pressure against a raised/flexed right leg; RLQ pain indicates appendicitis.

Obturator Muscle Test

Flex right hip/knee at 90 degrees and rotate leg internally/externally; hypogastric pain indicates ruptured appendix or pelvic abscess.

Sacrococcygeal Inspection

Smooth; a dimple with a tuft of hair or tender cyst suggests a pilonidal cyst.

Perianal Inspection

Inspect for lesions, external hemorrhoids (shiny blue/purple masses), or anorectal fissures (midline posterior tears).

Normal Prostate (DRE)

Walnut-sized, smooth, heart-shaped, non-tender, projects < 1 cm into rectum.

Benign Prostatic Hyperplasia (BPH)

Smooth, symmetrically enlarged, firm, non-tender gland projecting into rectum.

Prostatitis

Swollen, tender, warm, boggy prostate gland.

Prostate Cancer

Hard, irregular, nodular prostate gland.

Infant Considerations

Umbilical cord has 2 arteries and 1 vein, falls off in 7–14 days. First stool is meconium. Scaphoid abdomen suggests diaphragmatic hernia.

Toddler Considerations

Normal rounded "potbelly" until ~13 years old. Abdominal breathers until about age 7. Umbilical hernias are common and usually resolve spontaneously.

Pregnancy Considerations

Linea nigra, striae gravidarum. Quickening felt at ~20 weeks. Fetal heart rate 120–160 bpm after 10–12 weeks. Fundal height in cm equals gestational age in weeks (plus or minus 2 cm) from 20–36 weeks.

Older Adult Considerations

Reduced GI motility, decreased lower esophageal sphincter pressure, decreased internal anal sphincter tone. Decreased bladder capacity and muscle tone. Increased abdominal fat deposition.

GERD & Hiatal Hernia

Heartburn, regurgitation, dysphagia; exacerbated by lying down.

Peptic Ulcer Disease

Midepigastric burning/gnawing pain.

Crohn's Disease

Affects mouth to anus (most commonly terminal ileum/colon); skip lesions, cobblestone mucosa, deep fissures/fistulas; severe cramping, diarrhea, weight loss.

Ulcerative Colitis

Starts in rectum and progresses continuously through colon; severe constant abdominal pain, fever, profuse watery diarrhea with blood, mucus, and pus.

Cirrhosis

Liver cell necrosis with fibrotic scarring; portal hypertension, ascites, jaundice, dark urine, clay-colored stool, spider angiomas, and splenomegaly.

Cholecystitis

Gallbladder inflammation/gallstones; RUQ pain radiating to right shoulder/scapula after fatty meals, positive Murphy sign.

Pancreatitis

Sudden onset severe, steady, sharp epigastric pain radiating to the back; eased by knee-chest position; nausea, vomiting, fever, absent/hypoactive bowel sounds.

Cystitis

Causes dysuria, frequency, urgency, and suprapubic pain.

Pyelonephritis

Causes fever, chills, flank pain, and CVA tenderness.

Nephrolithiasis (Kidney Stones)

Sudden severe colicky flank/back/lower abdominal pain, nausea, vomiting, and hematuria.