Abdominal and GI System Review

Abdominal Regions and Organs

• Right Hypochondrium: Liver (right lobe), Gallbladder

• Right Iliac Fossa: Appendix, Cecum

• Right Flank: Ascending colon, Right kidney

• Left Hypochondrium: Spleen

• Left Iliac Fossa

• Left Flank: Descending colon, Left kidney

• Epigastric Region, Umbilical Region, Hypogastric Region (suprapubic)

Subjective Data

• Health History: GI conditions, surgeries, meds

• Review of Systems

• Family history

• Functional assessment: substance use, diet

• Focused Assessment: OPQRSTU

Bowel Movements (BM)

• Assessment: frequency, color, consistency

• Abnormalities:

  • Dyschezia: pain/straining

  • Tenesmus: feeling of fullness after emptying

  • Diarrhea

  • Hematochezia: bloody stool (lower GI bleed)

  • Melena: black, tarry stool (upper GI bleed)

  • Steatorrhea: fat malabsorption

Physical Exam: IAPP (Inspection, Auscultation, Percussion, Palpation)

• Preparation: lighting, exposure, empty bladder, supine position

Inspection

• Skin color and condition: Cullen's & Turner's sign (intraabdominal bleeding)

• Umbilicus: midline and inverted

• Symmetry: hernias, masses

• Contour: flat or rounded (normal)

• Movement: aortic pulsation, peristalsis

Auscultation

• Bowel Sounds: RLQ and moving clockwise

  • Normoactive: 5-30 times per minute

  • Hypoactive: <5 sounds/min; decreased motility

  • Absent: no sounds after 5 minutes; obstruction

  • Hyperactive: >30 times/minute; increased motility

• Vascular Sounds: Use bell to listen for bruits over aorta, renal, iliac, and femoral arteries

Percussion

• Tympany: normally predominates

• Dullness: liver, fecal matter, ovarian cyst

• Fist Percussion: CVA tenderness indicates kidney inflammation.

Palpation

• Light palpation: tenderness, surface characteristics

• Deep palpation: advanced technique for organs

• Guarding: voluntary (emotions, pain), involuntary (inflammation, spasm)

Palpating Abdominal Organs

• Liver: RUQ, smooth, firm, nontender, extend no more than 2cm outside right costal margin

• Gallbladder: RUQ, normally not palpable

• Spleen: LUQ, normally not palpable; can rupture easily

Aging Adult Considerations

• Increased abdominal fat

• Risk for nutritional deficits

• Constipation

• Decreased abdominal musculature

• Reduced abdominal rigidity with peritonitis

Disorders of the Abdomen & GI System

GERD

• Stomach contents move into the esophagus.

• Clinical findings: Regurgitation, heartburn (pyrosis), pain worse when lying down.

Peptic Ulcer Disease

• Ulcer in lower esophagus, stomach, or duodenum

• Clinical Findings:

  • Epigastric pain (burning, gnawing)

  • Duodenal: relieved with food

  • Gastric: worse with food

  • Nausea, bloating; melena or hematemesis (bleeding)

Bowel Obstruction

• Mechanical or paralytic ileus

• S/S: abdominal pain/distension, N/V, constipation, lack of flatus, visible peristalsis

Ascites

• Fluid collection in abdominal cavity.

• S/S: Protuberant contour, jaundice (cirrhosis), dyspnea, diminished bowel sounds, shifting dullness.

Appendicitis

• Dull abdominal pain to severe RLQ pain

• McBurney's point tenderness; Rovsing's sign

• Iliopsoas/Psoas sign, Obturator sign

• Rebound tenderness; N/V/D, fever

Cholecystitis

• Bile duct obstruction.

• S/S: RUQ pain radiating to shoulder, worse after fatty meals

• Positive Murphy Sign (inspiratory arrest)

• Fever, steatorrhea, N&V, possible jaundice

Diverticulitis

• Inflammation of diverticula.

• S/S: "Crampy" LLQ pain, fever, chills, localized tenderness, blood-streaked stool.

Inflammatory Bowel Disease

• Ulcerative Colitis (UC): bloody diarrhea with mucus

• Crohn’s: symptoms depend on location of fissures/fistula/ulcer

• Both: abdominal pain, weight loss, diarrhea

Peritonitis

• Bacterial peritoneal inflammation

• S/S: Fever, tachycardia, bloating, pain, rigidity, rebound tenderness, hypoactive BS

Abdominal Aortic Aneurysm (AAA)

• Dilation of abdominal aorta

• Asymptomatic until rupture

• S/S: Impending doom, bruit, abdominal/lower back pain, palpable pulsation

Diabetes Mellitus

• Elevated serum glucose levels.

• S/S: Polyphagia, polydipsia, polyuria, paresthesia, poor wound healing, weight loss.

• Diabetic ketoacidosis (DKA): Kussmaul respirations, fruity breath
  Hypoglycemia: confusion, diaphoresis, shakiness

Urinary Tract Infection (UTI)

• Dysuria, frequency, urgency, fever, suprapubic pain, malodorous urine, CVA tenderness. Labs: WBC count, (+) Urine culture. Treatment: Abx, Cystoscopy