GIT Assessment PDF

ABDOMINAL EXAMINATION PROFESSOR: SIR CJ  Assessment of Clients with Gastrointestinal Disorders  History  Demographic data, religion, personal and family history:  General health status.  Previous G.I. disorders and surgery.  Change in bowel habits, G.I. b...

ABDOMINAL EXAMINATION PROFESSOR: SIR CJ  Assessment of Clients with Gastrointestinal Disorders  History  Demographic data, religion, personal and family history:  General health status.  Previous G.I. disorders and surgery.  Change in bowel habits, G.I. bleeding, jaundice, weight loss.  Any medications taken routinely.  Long term use of laxatives.  Family history of G.I. disorders  Diet History  Usual foods and fluids that are typically consumed.  Quality and quantity of foods ingested.  Relationship of food intake and G.I. symptoms  Usual and current appetite.  Symptoms such as nausea and vomiting,  Difficulty of swallowing.  Chief Complaint The nurse should ask the following questions:  Onset  Duration  Quality and characteristics  Severity  Location  Precipitating factors  Relieving factors  Associated symptoms  Medical History  Major illnesses and hospitalizations  Use of medications  Allergies to foods and other substances  GASTROINTESTINAL EXAMINATION  General examination  General inspection  Hands and arms  Face, eyes and mouth  Abdominal examination  Neck  Inspection  Auscultation  Palpation  Percussion  Auscultation  GENERAL INSPECTION  Nutritional state (wasting)  Pallor  Jaundice (liver disease)  Pigmentation (hemochromatosis: inc. iron)  Mental state (encephalopathy)  ASSESSING THE ORAL CAVITY Inspection  Lips - for abnormal color, lesions, nodules, symmetry  Oral mucosa- redness, pallor, swelling, Ulcers or leukoplakia.  Gums - redness, pallor, ulcers, bleeding.  Teeth - dental caries, dentures, missing/ broken teeth.  ASSESSING THE ORAL CAVITY  tongue- color, ulcers, abnormal coating, swelling or deviation to one side, movement  Pharynx-tonsil abnormalities, lesions, ulcers, uvular deviation, unusual mouth odor.  Palpation: lips, gingival, buccal, mucosa, tongue  Area is checked for masses, swelling, tenderness  … AND MOUTH  Breath (fetor hepaticus)  Lips  Angular stomatitis- physical maceration at the angular commissures due to overexposure to saliva  Cheilitis- inflammation of the lips  Ulceration  Peutz-Jeghers syndrome- are mucocutaneous pigment macules and hamartomatous GI polyps (genetics)  … AND MOUTH  Gums  Gingivitis, bleeding  Candida albicans  Pigmentation  Tongue  Atrophic glossitis  Leicoplakia  Furring Atrophic glossitis Thrush  HANDS  Nails  Clubbing  Koilonychia- central portion of the nail is depressed (iron deficiency)  Leukonychia- White spots on your nails (fungal  Palmar erythema- They may also feel warm but will not be swollen, painful, or itchy. Possible causes of palmar erythema include pregnancy and liver cirrhosis.  HANDS  Dupuytren’s contractures- an abnormal thickening of tissues in the palm of the hand. (UNKNOWN CAUSE)  Hepatic flap (STERIXIS) Flapping hand tremor is associated with some liver conditions and may also be referred to as liver flap  HANDS Palmar erythema Dupuytren’s contractures  ARMS  Spider naevi (telangiectatic lesions)- caused by injuries, sun exposure, hormonal changes, or liver disease  Bruising  Wasting  Scratch marks (chronic cholestasis)  FACE, EYES …  Conjuctival pallor (anaemia)  Sclera: jaundice, iritis  Cornea: Kaiser Fleischer’s rings (Wilson’s disease)- are dark rings that appear to encircle the iris of the eye. They are due to copper deposition as a result of particular liver diseases.  Xanthelasma (primary biliary cirrhosis)  Parotid enlargement (alcohol) Parotid enlargement Xanthelasma  NECK AND CHEST  Cervical lymphadenopathy  Left supraclavicular fossa (Virchov’s node)  Gynaecomastia  Loss of hair ABDOMINAL EXAMINATION POSITIONING  Abdomen can be divided in four quadrants  Patient should be lying on supine position  ABDOMINAL EXAMINATION INSPECTION  Shape and movements  Scars  Distension  Localised: mass, organomegaly  Generalized: 5 F’s  Prominent veins (caput medusae)  Striae  Bruises  Pigmentation  Visible peristalsis Tête de Méduse, by Peter Paul Rubens (1618) Campbell de Morgan spots- cherry red papules on the skin containing an abnormal proliferation of blood vessels, harmless, unless they alter in shape or begin to bleed spontaneously Ascitic abdomen  ABDOMINAL EXAMINATION AUSCULTATION  Place the diaphragm of the stethoscope to the right of the umbilicus  Bowel sounds (borborygmi) are caused by peristaltic movements  Occur every 5-10 sec.  Absence of b.s.: paralytic ileus or peritonitis  Bruits over aorta and renal a. could be a sign of an aneurysm and stenosis  ABDOMINAL EXAMINATION PALPATION 1. Ensure that your hands are warm 2. Stand on the patient’s right side 3. Help to position the patient 4. Ask whether the patient feels any pain before you start 5. Begin with superficial examination 6. Move in a systematic manner through the abdominal quadrants 7. Repeat palpation deeply.  ABDOMINAL EXAMINATION PALPATION  Tenderness: discomfort and resistance to palpation  Involuntary guarding: reflex contraction of the abdominal muscles  Rebound tenderness: patient feels pain when the hand is released  Tenderness + rigidity: perforated viscus  Palpable mass (enlarged organ, faeces, tumour)  Aortic pulsation  ABDOMINAL EXAMINATION MURPHY’S SIGN  Pain in RUQ  Inflammation of gallbladder (cholecystitis)  Courvoisier's law  ABDOMINAL EXAMINATION BLUMBERG’S SIGN  a.k.a. rebound tenderness  Pain upon removal of pressure rather than application of pressure to the abdomen  Peritonitis and/ or appendicitis  ABDOMINAL EXAMINATION MCBURNEY’S POINT  tenderness with palpation of McBurney's point, which is located at one-third of the distance from the anterior superior iliac spine to the umbilicus.  Location of AV in retrocecal position  Deep tenderness (= acute appendicitis)  ABDOMINAL EXAMINATION FLUID THRILL  Place the palm of your left hand against the left side of the abdomen  Flick a finger against the right side of the abdomen  Ask the patient to put the edge of a hand on the midline of the abdomen  If a ripple is felt upon flicking we call it a fluid thrill = ascites  ABDOMINAL EXAMINATION PALPATION OF THE LIVER 1. Start palpating in the right iliac fossa 2. Ask the patient to take a deep breath in 3. Move your hand progressively further up the abdomen 4. Try to feel the liver edge  ABDOMINAL EXAMINATION PALPATION OF THE SPLEEN 1. Roll the patient towards you 2. Palpate with your left hand while using your left hand to press forward on the patient’s lower ribs from behind 3. Feel along the costal margin  ABDOMINAL EXAMINATION PERCUSSION  Dull sounds: solid or fluid-filled structures  Resonant sounds: structures containing air or gas ABDOMINAL EXAMINATION THANK YOU FOR YOR ATTENTION.