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Questions and Answers
What is a sign of confusion that may be related to liver dysfunction?
Which symptom is commonly associated with the accumulation of bile salts in the skin?
What is the significance of assessing upper right quadrant pain in liver assessment?
What is the purpose of checking for ascites during a liver assessment?
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Which assessment method might be used to evaluate the liver span?
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What is one of the primary functions of the spleen?
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Which symptom is commonly associated with potential spleen issues?
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Which of the following is an endocrine function of the pancreas?
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What should be noted during the inspection of a patient possibly having a splenic issue?
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What assessment technique is used to identify an abnormal bulge in the spleen?
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What is the primary function of the gall bladder?
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Which symptom is NOT typically associated with gall bladder issues?
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What factor primarily triggers referred pain from gall bladder issues?
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Which of the following is a common complication of cholelithiasis?
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What finding is associated with the absence of bile salts in stool?
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Which symptom may suggest irritation of the abdominal area?
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What sign can indicate severe abdominal conditions through bruising around the umbilicus?
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Decreased bowel sounds may indicate which of the following conditions?
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What is a common assessment step for detecting kidney issues?
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What does the Grey Turner Sign indicate?
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In assessing urinary history, which symptom is significant?
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What is one of the primary functions of the kidneys?
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What condition may result in undernutrition and weight loss?
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What is the primary function of the oral cavity in the gastrointestinal tract?
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Which area may indicate gastric ulcers when experiencing pain?
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Which special test for appendicitis involves increased pain with pressure at a specific point?
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When palpating the left lower quadrant, which symptom can indicate appendicitis?
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What condition is characterized by blood or mucus in stools?
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Which gastrointestinal organ is primarily responsible for the absorption of nutrients?
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Which symptom is NOT typically associated with the early stages of appendicitis?
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Which of the following indicates the presence of bowel sounds during auscultation?
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Study Notes
Gastrointestinal Tract
- The oral cavity is where the initial breakdown of food occurs through mastication, forming a bolus, and the introduction of digestive enzymes.
- The stomach temporarily stores food, further mechanically breaks it down (grinding), and produces enzymes and specialized cells for digestion.
- The small and large intestines are responsible for further/final breakdown, digestion, absorption, and elimination of waste.
Assessment of the GI Tract
-
Pain:
- Right or Left or Mid Upper Quadrants: Gastric ulcers
- Epigastric: Epigastric hernia, heartburn, GERD
- Right Mid Abdomen: Constipation
- Umbilical Region: Early appendicitis, umbilical hernia, bowel pain
- Left Mid: Diverticulitis, inflammatory bowel syndrome
- Right Lower Quadrant: Appendicitis, constipation, inguinal hernia
- Mid Lower: Diverticular disease, inflammatory bowel
- Right Lower: Diverticulitis and inguinal hernia
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Other History:
- Nausea or vomiting
- Appetite
- Heartburn
- Diarrhea or constipation or any changes in bowel function
- Cramping
- Blood/mucous in stools
Inspection
- Contour: Symmetry, discolouration
Auscultation
- Presence of Bowel Sounds in 4 quadrants
Percussion
- Dullness vs. general tympany
Palpation
- Lumps, bumps, masses
Special Tests for Appendicitis
- McBurney’s Point: Right abdomen between the umbilicus and the iliac crest – increased pain with pressure.
- Rovsing’s Sign: Palpation of the LLQ causes pain in the RLQ.
- Rebound Tenderness: Removal of pressure rather than the application of pressure causes pain.
Liver
-
Primary Functions:
- Cognition
- Skin
- Medication toxicities
- S/S of Infection
- Ascites and Third spacing of fluids
- Nutritional Status
- Abnormal Bleeding
Assessment of the Liver
-
Assessments:
- Upper right quadrant pain
- Right shoulder pain (referred pain)
-
Special Tests:
- Inspection: Ascites, spider angioma, contour of abdomen related to ascites
- Auscultation: Of abdomen in general
- Percussion: To find the liver span
- Palpation: Gentle palpation from the umbilicus upwards with a flat hand
Gallbladder
-
Primary Functions:
- Stores and concentrates bile from the liver
- Excretes bile into the duodenum via the cystic duct
- Bile is required for the breakdown and absorption of fats
- Some involvement in the removal of waste from the liver to the intestine.
Assessment of the Gallbladder
-
Common Issues:
- Stones (cholelithiasis)
- Infections (cholecystitis)
-
History Questions:
- Nausea/vomiting
- Fever/chills
- Jaundice
- Changes in colour of stools (usually to grey – no bile salts to colour them)
-
Pain and Referred Pain:
- Upper right or mid abdomen
- Radiation to the right shoulder or mid back, especially after eating a fatty meal
-
Assessment:
- Inspection
- Auscultation
- Percussion
- Palpation: Tenderness to RUQ
-
Special Tests:
- Signs of Peritoneal Irritation
- Guarding
- Rigidity and tenderness
Spleen
-
Primary Functions:
- Production of lymphocytes (B and T cells)
- Removal of old or damaged red blood cells
- Can be a reservoir for blood in trauma or hemorrhage
- Retains iron, which is needed for the production of hemoglobin
Assessment of the Spleen
-
History Questions:
- Left Upper Quadrant abdominal pain
- Bloating or early satiety
- Nausea or vomiting
- Problems with either diarrhea or constipation
-
Inspection:
- Can you see a bulge or is the abdomen misshapen?
-
Auscultation:
- Cannot normally hear anything
-
Percussion:
- Look for abnormal dullness in the ULQ at the costal margin
-
Palpation:
- Palpate laterally to identify an abnormal bulge – follow the edge along until you feel the ledge (normally not palpable)
Pancreas
-
Primary Functions:
- Exocrine Function: Production and release of enzymes that aid in the digestion of food.
- Endocrine Function: Regulation of blood glucose through the production and excretion of insulin and glucagon.
Assessment of the Pancreas
-
History:
- Pain: Upper left or mid abdominal pain with radiation to the mid back or chest, may be reduced by leaning forward and exacerbated by cough, movement, or even deep breathing.
- Nausea/vomiting
- Flatulence, diarrhea, steatorrhea
- Abdominal distention
- Undernutrition, weight loss
- Fatigue
-
Inspection:
- Patient may be diaphoretic, febrile, tachycardic, and tachypneic.
-
Auscultation:
- Decreased bowel sounds.
-
Percussion:
- Not specified
-
Palpation:
- Not specified
-
Special Tests:
- Grey Turner Sign: Bruising to flanks
- Cullen Sign: Bruising around the umbilicus
- These signs are rare and have a poor prognosis.
Kidneys
-
Primary Functions:
- Regulation of electrolyte and fluid balance
- Regulation of blood pH
- Production of hormones important for red blood cell production, calcium regulation, and blood pressure regulation
- Excretion of waste products from the blood
Assessment of the Kidneys
-
History:
- Urinary history: Volume, changes in patterns, hematuria, pyuria, colour and odour, retention or no voiding.
- History of illness related to renal/urinary disease: Infections (including recent strep infections), cancers, BPH, renal calculi.
- Pain assessment: Normally flank pain
- Edema (usually dependent edema)
- Blood pressure changes
-
Physical Assessment:
- Inspection: Flank areas, look for swelling, bruising.
- Auscultation: Listen as CVA for bruits and at upper abdomen for renal arteries.
- Percussion: CVA tenderness.
- Palpation: Kidneys are deep palpation so you don’t have to do this, palpation of the bladder.
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Description
This quiz covers key concepts related to the gastrointestinal tract, including the anatomy and functions of the oral cavity, stomach, and intestines. Additionally, it assesses knowledge on various gastrointestinal pain indicators and their associated conditions. Test your understanding of digestive health and pathologies.
