Abdominal Assessment Techniques Quiz

Gastrointestinal Assessment

• Mouth: Examine for dryness, gingivitis, tonsil inflammation, number of teeth, presence of dentures, gag reflex, swallowing ability, and taste and odor sensitivity.
• Esophagus: Evaluate for difficulties swallowing and gag reflex.
• Abdomen:
  • Inspection: Observe the abdomen's appearance.
  • Auscultation: Listen to bowel sounds, starting in the right lower quadrant and following the colon's anatomy.
  • Percussion: Tap the abdomen to detect any abnormalities, particularly tympany indicating excess air.
  • Palpation: Feel the abdomen, starting with areas of least pain and palpating the painful area last to minimize discomfort.
• Anus: Inspect for bleeding, hemorrhoids, fissures, cracks, and abscesses.

Rapid Influx of Stomach Contents

• Symptoms: Nausea and vomiting, abdominal fullness, cramping, palpitations, and diaphoresis.
• Hypertonic food bolus draws fluid from blood vessels to dilute high concentrations of carbohydrates and electrolytes.
• This leads to hyperglycemia, stimulating insulin secretion.
• Subsequently, hypoglycemia occurs.
• Later symptoms: Drowsiness, weakness, and dizziness.

Management of Rapid Influx of Stomach Contents

• Octreotide (Sandostatin) for severe cases: Slows stomach emptying and blocks insulin release.
• Nursing interventions:
  • Low-carbohydrate diet.
  • Small, frequent meals with more dry items.
  • Avoid fluids with meals.
  • Lie down after meals.
  • Administer anti-spasmodic medications to delay gastric emptying.

Pernicious Anemia

• Condition resulting from stomach damage or dysfunction leading to vitamin B12 deficiency.
• Causes:
  • Autoimmune destruction of parietal cells.
  • Lack of intrinsic factor.
  • Total destruction or removal of the stomach.

Assessment of Pernicious Anemia

• Severe pallor.
• Fatigue.
• Weight loss.
• Smooth, beefy-red tongue.
• Mild jaundice.
• Paresthesia of extremities.
• Balance disturbances.

Nursing Interventions for Pernicious Anemia

• Lifetime vitamin B12 injections: Initially 12 times weekly, then monthly.

Acid Suppression

• For acute upper GI bleeding, proton pump inhibitors (PPIs) or H2 blockers are typically administered.
• IV PPI is usually given every 12 hours or as a continuous infusion.
• Common dosage: 80mg IV PPI bolus followed by a continuous infusion of 8mg/hour for 72 hours.

Endoscopic Clipping or Sewing Techniques

• Used to oversew bleeding vessels in the stomach or duodenum (usually identified by endoscopy).
• Treatment for non-variceal upper GI bleeding.
• Clips are passed out with stools, some within 1-3 weeks.

Sengstaken-Blakemore Tube

• Inserted through the nose or mouth to control bleeding, particularly from esophageal varicosities.
• Remains in place for 24 hours.
• Three lumens:
  • One lumen to inflate gastric balloon.
  • Second lumen to inflate esophageal balloon.
  • Third lumen to aspirate gastric contents.
• Gastric balloon inflated initially with 50 ml (followed by X-ray), adding 200 ml more air.
• Esophageal balloon inflated to 30 mmHg initially, increasing to 45 mmHg if bleeding persists.
• Gastric balloon inflated and placed on traction first.
• Esophageal balloon inflated only if bleeding is not controlled.
• Pressure in balloons released after 24-48 hours to prevent necrosis, deflated in reverse order of inflation.

Nursing Management for Bleeding

• Maintain NPO status.
• Administer intravenous fluids and medications.
• Monitor hydration status, hematocrit, and hemoglobin.
• Assist with saline lavage.
• Insert nasogastric tube for decompression and lavage.
• Prepare for blood transfusion.
• Prepare to administer vasopressin to induce vasoconstriction and reduce bleeding.
• Prepare the patient for surgery if warranted, including: total gastrectomy, vagotomy, gastric resection, Billroth I and II, pyloroplasty, and antrectomy.

Nursing Management After Surgery

• Monitor vital signs.
• Maintain Fowler's position.
• NPO until peristalsis returns.
• Monitor for bowel sounds.
• Monitor for complications.
• Monitor intake and output, intravenous fluids.
• Maintain nasogastric tube.
• Diet progression: clear liquid > full liquid > six bland meals.
• Manage dumping syndrome.

Gastric Ulcer vs. Duodenal Ulcer

• Gastric ulcer: Older patients, normal acidity, pain early after eating, worsens with food and relieved by vomiting, bleeding, weight loss, and vomiting, risk for cancer.
• Duodenal ulcer: Younger patients, increased acidity, pain late after eating (2-4 hours), relieved by food, less likely to bleed and vomit, no risk for cancer.

Liver Functions

• Liver produces bile, helps metabolize carbohydrates, proteins, and fats, synthesizes clotting factors, detoxifies harmful substances, and stores vitamins and minerals.

Common Manifestations of Liver Diseases

• Elevated liver enzymes (LFTs):
  • May be abnormal only after 70% of the liver parenchyma is damaged.
  • Normal values:
    • AST: 10-40 units.
    • ALT: 5-35 units.
    • GGT/GGTP: 10-40 IU/L.
    • LDH: 100-200 units (for biliary cholestasis).
• Ascites: Usually results from portal hypertension, leading to increased capillary pressure and obstructed venous blood flow.
• Jaundice: Elevated blood bilirubin levels causing yellow or greenish-yellow discoloration of tissues.
  • Clinically evident when serum bilirubin levels reach >2.5 mg/dL.
  • Types of jaundice:
    • Hemolytic: Increased destruction of red blood cells overwhelms the liver's ability to excrete bilirubin.
    • Hepatocellular: Damaged liver cells cannot clear normal amounts of bilirubin.
    • Obstructive: Biliary obstruction from factors such as gallstones, inflammation, tumors, or pressure from enlarged organs.

Hepatotoxic Drugs

• Phenothiazines.
• Antithyroid drugs.
• Erythromycin.
• Amoxicillin.
• Androgens.

Fulminant Hepatic Failure

• Sudden and severe impairment of liver function in a previously healthy person.
• Develops within weeks.
• Common causes: Viral hepatitis, toxic medications and chemicals, metabolic disturbances.
• Initial symptom: Jaundice, progressing to encephalopathy.

Categories of Liver Failure

• Acute: Sudden onset and usually reversible.
• Chronic: Gradual progression and often irreversible.
• Fulminant: Rapid and life-threatening.