Abdominal Assessment, GI, Hepatic, and Pancreatic Systems(unit 4 lecture)

Overview

This section covers abdominal assessment, including the GI, hepatic, and pancreatic systems, their functions, assessment techniques, and therapeutic measures.

Digestive Process Overview

• Digestion begins in the oral cavity.

• Absorption occurs primarily in the small intestine.

• Water reabsorption happens in the large intestine.

• Key processes in digestion:

  • Teeth chew food.

  • Saliva dissolves and moistens food.

  • Salivary glands secrete amylase, converting starch to maltose.

  • Peristalsis propels food through the esophagus to the stomach.

Stomach Functions

• Uses gastric acids to break food into a liquid called chyme.

• Pyloric sphincter regulates chyme movement into the duodenum.

• Nutrient absorption order:

  1. Carbohydrates (most readily absorbed)

  2. Proteins

  3. Fats

• Pepsin converts proteins to polypeptides.

• Hydrochloric acid (HCl) maintains a pH of 1-2, helping destroy pathogens and assist in digestion.

Small Intestine

• Duodenum (First 10 inches): Entry point for the common bile duct and pancreatic duct.

• Jejunum (~8 feet): Major site of digestion and absorption.

• Ileum (~11 feet): Nutrient absorption.

Large Intestine

• ~5 feet long.

• Functions: Stores and eliminates indigestible material.

Accessory Organs

Liver

• Largest internal organ, located in the right upper quadrant (RUQ), protected by the rib cage.

• Functions:

  • Produces bile to emulsify fats.

  • Stores vitamins and minerals.

  • Detoxifies chemicals and filters blood.

  • Stores glycogen, releases it as needed.

  • Produces clotting factors.

  • Regulates blood nutrients.

  • Blood supply:

    • Hepatic artery brings oxygen-rich blood.

    • Hepatic portal vein carries nutrient-rich blood from the GI tract.

Gallbladder

• Small organ beneath the liver.

• Stores bile produced by the liver and releases it into the duodenum in response to fatty foods.

• Cholecystokinin (CCK) stimulates bile release.

Pancreas

• Location: Behind the stomach, in the upper left quadrant (LUQ).

• Functions:

  • Exocrine: Releases digestive enzymes:

    • Amylase (starch digestion)

    • Lipase (fat digestion)

    • Trypsin (protein digestion)

  • Endocrine: Secretes insulin and glucagon to regulate blood sugar.

Spleen

• Located in the LUQ, near the liver.

• Functions:

  • Filters red blood cells.

  • Produces white blood cells (lymphocytes) to fight infections.

Aging and the GI System

• Slower metabolism of drugs, increasing toxicity risk.

• Increased risk of gallstones.

• Tooth enamel hardens, increasing difficulty in chewing.

• Decreased saliva production, increasing periodontal disease risk.

• Esophageal motility declines, increasing risk of aspiration.

• Slower stomach emptying, leading to early satiety.

• Decreased hydrochloric acid affects digestion.

• Fat absorption slows down.

• Weakening of rectal elasticity, contributing to constipation.

Abdominal Assessment

History Taking

• Present health: Any chronic conditions?

• Symptoms: Pain, bloating, nausea, vomiting, heartburn, indigestion.

• Bowel habits: Frequency, color, consistency, recent changes.

• Dietary habits: Appetite changes, weight loss/gain.

• Risk factors: Travel, smoking, alcohol use.

• Family history: GI diseases, hepatitis, cancer.

Physical Examination

1. Inspection

   • Normal: Smooth, even tone, symmetrical.

   • Unexpected: Lesions, bruising, jaundice, distension.

   • Striae:

     • Pink/purple: Recent stretching (weight gain, ascites).

     • Silver/white: Older scarring.

2. Auscultation

   • Normoactive: 5-34 sounds/min.

   • Hyperactive (>34/min): Associated with diarrhea.

   • Hypoactive (<5/min): Associated with constipation or post-op.

   • Absent sounds (5 mins of listening): Possible obstruction or ileus.

   • Bruits: Swishing sounds indicating vascular abnormalities.

3. Palpation

   • Light palpation (~1 inch deep).

   • Expected: Non-tender, relaxed.

   • Unexpected:

     • Rigidity or guarding → Possible inflammation.

     • Tenderness or masses → Further evaluation needed.

Health Promotion

• Exercise: At least 30 minutes/day to improve peristalsis and reduce stress.

• High-fiber diet: Promotes GI health.

• Adequate hydration: 8-10 glasses of water daily.

• Routine screening:

  • Colonoscopy starting at age 45, then every 10 years.

  • Fecal occult blood test (FOBT) to detect hidden blood.

Diagnostic Tests

• CBC: Checks for infection or anemia.

• Electrolytes: Imbalances from vomiting/diarrhea.

• Liver function tests (LFTs):

  • ALT, AST, albumin, bilirubin.

• Stool tests:

  • FOBT (blood in stool).

  • Steatorrhea (fat in stool).

• Imaging:

  • X-rays, CT scans, endoscopy, colonoscopy.

  • Barium swallow (NPO before, white stool after).

Enteral Nutrition

• Used when oral intake is insufficient.

• Methods:

  • NG tube, OG tube, PEG tube.

• Nursing Considerations:

  • Keep HOB elevated (30-45°) to reduce aspiration risk.

  • Check placement before use.

  • Flush with water before and after feedings/medications.

  • Monitor for complications: Obstruction, bloating, aspiration.

Nasogastric (NG) Tube Uses

• Decompression (removing gas/fluid).

• Lavage (removing toxins).

• Diagnostics (gastric fluid sampling).

• Nutrition/hydration.

• Medication administration.

• Post-surgical healing.