Gastrointestinal System

Quadrants of the Abdomen

Right Upper Quadrant, Left Upper Quadrant, Right Lower Quadrant, and Left Lower Quadrant

Right Upper Quadrant (RUQ)

Liver, Gallbladder, Duodenum, Head of Pancreas, Right kidney and adrenal, Part of ascending and transverse colon

Left Upper Quadrant (LUQ)

Stomach, spleen, Left lobe of Liver, Body of Pancreas, Left Kidney and Adrenal, and Part of Transverse and Descending colon

Right Lower Quadrant (RLQ)

Cecum, Appendix, Right Ovary and Tube, Right Ureter, Right Spermatic Cord

Left Lower Quadrant (LLQ)

Part of descending colon, Sigmoid colon, Left ovary and tube, Left ureter, and Left spermatic cord

Surface Landmarks for Assessment

Umbilicus (Navel), Xiphoid Process, Pubic Symphysis, McBurney’s Point

Umbilicus (Navel)

Located at the level of L3-L4, it is the central landmark for dividing the abdomen into quadrants.

Xiphoid Process

The inferior end of the sternum, marking the superior boundary of the abdominal quadrants

Pubic Symphysis

A cartilaginous joint uniting the left and right pubic bones, defining the inferior boundary of the abdominal cavity.

McBurney’s Point

Found one-third of the way from the anterior superior iliac spine (ASIS) to the umbilicus on the right, often associated with appendicitis.

Common Pain Sources in RUQ

• Cholecystitis (gallbladder inflammation)

• Hepatitis or liver enlargement

• Right-sided kidney stone pain

Common Pain Sources in LUQ

• Gastritis or gastric ulcer

• Splenic rupture or infarct

• Pancreatitis

Common Pain Sources in RLQ

• Appendicitis (McBurney’s point pain)

• Ovarian torsion or cyst rupture

• Kidney stone tracking into ureter

Common Pain Sources in LLQ

• Diverticulitis

• Constipation

• Ovarian cysts

Common Pain Sources for Midline/Pelvic

• Urinary Tract Infection (UTI)

• Early pregnancy complications

• Hernias

Peristalsis

Movement of contents through the intestines

Borborygmi

Hyperactive, growling sounds made by the movement of gas and fluids through the intestines. Increased GI motility. Possible causes: inflammation, anxiety, diarrhea, bleeding, laxatives, reaction to certain foods.

Factors Influencing Bowel Elimination

Age, Diet, Fluid Intake, Physical Activity, Psychological Factors, Personal Habits, Position During Defecation, Pain, Pregnancy, Surgery and Anesthesia, Medications, Diagnostic Tests

Chief Complaints/Common Bowel Elimination Problems

• Constipation-Impaction → Gas

• Diarrhea-Incontinence → Hemorrhoids

Hemorrhoids

Swollen and enlarged veins in the rectum or around the anus

Hematochezia

The passage of fresh, bright red or maroon blood through the anus, either mixed with the stool, coating it, or visible on the toilet paper

Hematemesis

“vomiting blood”

Melena

Black, tarry, and foul-smelling stool caused by digested bloods, typically a sign of bleeding in the upper GI tract

Emesis

Another word for vomiting. Look for color, contents, frequency, blood (hematemesis/coffee-ground)

Occult Test/Guaiac

Test that detect hidden (occult) blood in the stool that cannot be seen with the naked eye

Stool Culture

A laboratory test used to identify bacteria or other microorganisms in a stool (feces) sample that may be causing a gastrointestinal infection.

Most Common Bacteria in Stool Culture

• Campylocbacter

• Enterococcus faecalis

• Clostridioides difficile

Indications of Bacteria in Stool

Blood, mucus, abnormal looking stool, frequent liquid/diarrhea stools

How to Promote Normal Elimination

Position, Hydration, Comfortable Environment, Nutrition, Digital removal of stool if necessary.

Types of Diets

NPO, Clear Liquid, Full Liquid, Pureed, Mechanical Soft

NPO Diet

• “Nothing by mouth”

• No food or water.

• Before some diagnostic tests and most surgeries

Clear Liquid Diet

• Common post-surgery

• Ok foods: gelatin, hard candy, broth, coffee and tea, popsicles

Full Liquid Diet

• Post-surgery and when patient can tolerate more

• Ok foods: Ice cream, milk, pudding, fruit, and vegetable juice

Pureed Diet

Consists of foods that have been blended, mashed, or processed until they have a smooth, pudding-like consistency with no lumps and little to no chewing required.

Mechanical Soft Diet

Consists of foods that are soft, easy to chew, and easy to swallow, but unlike a pureed diet, the foods do not need to be blended into a smooth consistency.

Bristol Stool Form Scale

• Constipation= 1-2

• Healthy Stool Types= 3-4

• Diarrhea= 5-7

OLDCARTS

• Onset

• Location

• Duration

• Characteristics

• Alleviating and Aggravating Factors

• Radiating Factors

• Timing

• Severity

PQRST Pain Assessment

• Provokes

• Quality

• Radiates

• Severity

• Time

Preparing for the GI Exam

• Good lighting

• Expose abdomen so that it is fully visible

• Empty bladder prior to the exam

• Warm stethoscope with hand, warm hands

• Place pillow under knees or have patient bend knees

• Examine areas identified as painful LAST

Assessment Order for Abdomen ONLY

1. Inspection

2. Auscultation

3. Percussion

4. Palpation

(avoid stirring things up)

Inspection

• Contour

• Symmetry

• Umbilicus

• Skin

• Pulsation or movement

• Demeanor

Perianal Area Inspection Expectations

• Moist, hairless

• Coarse, folded, pigmented skin

• No lesions, rashes, lumps, inflammation, excoriation, scars, hemorrhoids

Abdomen Inspection Findings

• Protuberant Abdomen (chronic bulging)

• Abdominal distention (temporary, gas, etc.)

• Scaphoid abdomen (occurs with malnourishment)

Auscultation for Bowel Sounds

• Air and fluid movement. Begin with RLQ, RUQ, LUQ, LLQ

• Hear 15-30 bowel movements in each quadrant

Vascular Sounds

• Locations: Aorta, Renal Artery, Iliac Artery, Femoral Artery

• Bruits: Indicates turbulent blood flow within an artery caused by unusual narrowing or partial blocking

Costovertebral (CVA) Tenderness

Percuss over kidney at 12th rib posteriorly. Note any discomfort or pain.