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Assessment of Gastrointestinal System Prepared By Dr. Samah El Garhy Masry Medical Surgical Nursing Faculty of Nursing Menoufia University 08/02/24 After completing lecture , the stude...

Assessment of Gastrointestinal System Prepared By Dr. Samah El Garhy Masry Medical Surgical Nursing Faculty of Nursing Menoufia University 08/02/24 After completing lecture , the student will be able to: 1. Identify the anatomical structure of gastrointestinal system. 2. Verbalize the steps used in performing selected examination procedures in assessing the gastro intestinal tract 4. Discuss variations in examination techniques appropriate for clients of different ages. 5. Demonstrate appropriate documentation and reporting of health assessment. 08/02/24 2  Anatomy of Gastrointestinal system 08/02/24  Abdominal quadrants and their structures LUQ Right lobeRUQ of the liver Left lobe of the liver Gallbladder Spleen Pylorus Stomach Duodenum Body and tail of the Head of the pancreas pancreas Hepatic flexure of the Splenic flexure of the colon colon Portions of the transverse and ascending colon Portions of the transverse and descending colon LLQ Sigmoid colon RLQ Portion of the descending Cecum and appendix colon Portion of the ascending colon 08/02/24  Assessing the abdomen Although I may be the heaviest organ in the body, I only weigh about 3 lb in an adult. 08/02/24  Components of health assessment: Health assessment Health history Physical examination History of present illness, Inspection Past, present Auscultation medical history Percussion Family history Palpation Social history  Feeding (type of feed/ patterns/ difficulties) e.g. TPN, formula feeds, breastfeeding, any allergies / intolerances of feed. Elimination (frequency, consistency, color, any bleeding). Pain, cramping, nausea, vomiting (frequency, color, bleeding, consistency). Previous GI interventions/concerns such as stoma, bowel obstruction etc. Previous gastrointestinal tubes. tubes 08/02/24 1. Inspect the abdomen for skin integrity. 2. Inspect the abdomen for contour and symmetry. Observe abdominal contour ( profile line from ribs margin to the pubic bone ) while standing at the client side when the client is supine. Normally, flat, rounded ( convex ) or scaphoid ( concave ) Ask the client to take a deep breath and hold it. 08/02/24  Assess the symmetry of contour while standing at the foot of the bed. If distention is present, measure the abdominal girth by placing the tape around the abdomen at the level of umbilicus. 08/02/24 3- Observe abdominal movements associated with respiration, peristalsis or aortic pulsations. 4- Observe the vascular pattern Normally , no visible vascular pattern 5- Umbilicus (bulging, scars, piercings). In neonates observe for redness, inflammation, discharge, presence of cord stump. Inguinal area (bulging, herniation) 6- Stoma site (dressing regimen/frequency and consistency of output). 08/02/24  Auscultation of The Abdomen 08/02/24  Auscultation Lightly place the diaphragm of the stethoscope in the RLQ, slightly below and to the right of the umbilicus. Auscultate in a clockwise fashion in each of the four quadrants. Note the character and quality of bowel sounds in each quadrant. 08/02/24  Percussion of The Abdomen Percuss in the 4-quadrant started in the left lower quadrant proceed to the right lower quadrant. 08/02/24  Percussing and measuring the liver Percuss the liver to determine its size ( 6 to 12 cm) at mid- clavicular line or (4 to 8 cm) at the mid-sternal line. 08/02/24 Don’t percuss if the patient has an abdominal aortic aneurysm or a transplanted abdominal organ. Doing so can precipitate a rupture or organ rejection. 08/02/24  Percussing the spleen 08/02/24  Percussing the spleen 08/02/24 08/02/24  Perform deep palpation over all 4 quadrant Press the distal half of the palmer surface of fingers of one hand into abdominal wall. Depress the abdominal wall about 4 to 5 cm. Normally, Normally tenderness may be present near xiphoid process, over cecum and over sigmoid colon. 08/02/24  Standard Hooking 08/02/24 Method 1: Standard palpation Method 2: Hooking the liver 08/02/24  Palpating the spleen 08/02/24  Checking for ascites 08/02/24  Eliciting abdominal pain Rebound tenderness To minimize the risk of rupturing an inflamed appendix, don’t repeat the maneuver for assessing rebound tenderness. 08/02/24 08/02/24 Palpation of the rectum and anus 08/02/24  Abdominal Distention Distensi on Distention may result from gas, a tumor, or colon filled with feces. It may also be caused by an incisional Hernia hernia, which may protrude when the patient lifts his head and shoulders. Tumor ??? 08/02/24 prof. Wafaa Hassan 08/02/24 prof. Wafaa Hassan 28