Gastrointestinal Assessment Presentation PDF

GASTROINTESTINAL ASSESSMENT ABDOMINAL CONTENTS LIVER Primary Functions  ASSESSMENT Cognition (confusion related to build up of metabolites or Assessments other substances such as ammonia)...

GASTROINTESTINAL ASSESSMENT ABDOMINAL CONTENTS LIVER Primary Functions  ASSESSMENT Cognition (confusion related to build up of metabolites or Assessments other substances such as ammonia) Upper right quadrant pain Skin – Pruritis and rash (build up of bile salts that gather Right shoulder pain (referred pain) under skin); Jaundice from build up of bile Medication toxicities (pay attention to drugs that require hepatic dose changes) Special Tests S/S of Infection – liver produces macrophages, inflammatory mediators Inspections – ascites, spider angioma, contour of abdomen related to ascites Ascites and Third spacing of fluids – liver produces proteins Auscultation – of abdomen in general including albumin Percussion – to find the liver span (ask me Nutritional Status – liver produces enzymes that allow for about the scratch test) the metabolism of foods and nutrients Palpation gentle palpation from umbilicus up Abnormal Bleeding – liver produces complement proteins with flat hand and other clotting factors Ask about the fluid wave test. GALL BLADDER 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 (biliary system rather than gall bladder itself)  ASSESSMENT Common issues Pain and Referred Pain Upper right or mid abdomen Stones (cholelithiasis) Radiation to right shoulder or mid back especially after eating a fatty meal Infections (cholecystitis) Assessment History Questions Inspection Auscultation Nausea/vomiting Percussion Fever/chills Palpation – tenderness to RUQ Jaundice Special tests Signs of peritoneal irritation Changes in colour of stools (usually Guarding to grey – no bile salts to colour them) Rigidity and tenderness.  GASTROINTESTINAL TRACT INCLUDING APPENDIX Primary Functions Oral cavity – mastication and initiation of a bolus, first digestive enzymes introduced Stomach – temporary storage of food, further mechanical breakdown of food (grinding), production of enzymes and specialized cells to break down food Small/large intestine – further/final breakdown, digestion, absorption and elimination of waste  ASSESSMENT History Pain R or L or mid upper quadrants – gastric ulcers Nausea or vomiting Epigastric – epigastric hernia, heartburn, GERD appetite Right Mid abdomen – constipation Umbilical region – early appendicitis, umbilical Pain or heart burn hernia, bowel pain Diarrhea or constipation or any Left mid – diverticulitis, inflammatory bowel syndrome change in bowel function Right lower quadrant – appendicitis, constipation, inguinal hernia Cramping Mid lower – diverticular disease, inflammatory Blood/mucous in stools bowel Right lower - diverticulitis and inguinal hernia  ASSESSMENT CONTINUED Inspection Special tests for Appendicitis Contour, symmetry, discolouration McBurney’s point Auscultation Right abdomen between the umbilicus and the iliac crest – increased pain with Presence of Bowel Sounds in 4 pressure at this point quadrants Rovsing’s sign Percussion Palpation of LLQ causes pain in the RLQ Dullness vs. general tympany Rebound tenderness Palpation Removal of pressure rather than the application of pressure causes Lumps, bumps masses. tenderness  SPLEEN Production of Lymphocytes both 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 History Questions Inspection – can you see a bulge or Left Upper Quadrant abdominal is the abdomen misshapen pain Auscultation – cannot normally Bloating or early satiety hear anything Nausea or Vomiting Percussion – look for abnormal dullness UlQ at costal margin Problems with either diarrhea or constipation Palpation – plapate laterally to identify abnormal bulge – follow 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 History Inspection – pt. may be diaphoretic, Pain – upper left of mid abdominal pain with febrile, tachycardia and tachypneic. radiation to mid back or chest Auscultation – decreased bowel sounds May be reduced by leaning forward Percussion Exacerbated by cough, movement or even deep breathing Palpation Nausea/vomiting Special test Flatulence, diarrhea, steatorrhea Grey Turner Sign – bruising to flanks Abdominal distension Cullen Sign – bruising around umbilicus Undernutrition, weight loss These signs are rare and have a poor Fatigue prognosis KIDNEYS Regulation of electrolyte and fluid balance Regulation of blood pH Production of hormones important for red blood cell production and calcium regulation as well as blood pressure regulation Excretion of waste products from the blood.  ASSESSMENT History Physical Assessment Urinary history – volume, changes in Inspection – flank areas, look for patterns, hematuria, pyuria, colour and swelling, bruising odour, retention or no voiding. Auscultation – listen as CVA for History of illness related to renal/urinary disease – infections (including recent bruits and at upper abdomen for strep infections), cancers, BPH, renal renal arteries calculi Percussion – CVA tenderness Pain assessment – normally flank pain Palpation – Kidneys is deep Edema (usually dependent edema) palpation so you don’t have to do Blood pressure changes this, palpation of the bladder.