Abdominal Assessment And Bowel Elimination

Question 1

Anatomy of the GI tract

Answer 1

Mouth, esophagus, stomach, small intestine, large intestine, anus

Question 2

Know organs in each quadrant of the abdomen

Answer 2

GO LABEL!!!

Question 3

Subjective bowel assessment

Answer 3

Appetite changes, diet, physical activity, medications, exercise, fluid intake, pattern, characteristics, routines, any pain/discomfort

Question 4

Signs and symptoms of abdominal disorders

Answer 4

Pain, nausea/vomiting, bowel movements, GI bleeding, abdominal dissension

Question 5

DysphaGia

Answer 5

Difficulty swallowing any liquid or solid material

Question 6

Dysphasia

Answer 6

Speech disorders in which there is impairment of the power of expression by speech, writing, or signs of impairment of the power of comprehension of spoken or written language

Question 7

When assessing the abdomen, do what first….

Answer 7

LOOK AND LISTEN
Auscultate before palpate

Question 8

Abdominal skin

Answer 8

Color is normal with smooth texture
Yellow = jaundice
NO lesions
NO rashes
NO scars
NO striae (related to pregnancy, rapid growth, cushings, or obesity) NO spider Angioma (one could be normal, more consider liver damage)

Question 9

Cullens sign

Answer 9

Periumbilical bleeding
NOT NORMAL
Bleeding behind the peritoneum

Question 10

Turners Sign

Answer 10

Flank bleeding
Bleeding behind the lining of the abdominal cavity

Question 11

Abdominal contour

Answer 11

Should be flat or rounded
NOT scaphoid (could be malnourishment) or protuberant

Question 12

Types of localized enlargements

Answer 12

Hernias, tumors, cyst, bowel obstruction

Question 13

Abdominal Aortic Aneurysm

Answer 13

Visible pulsation
Marked pulsation right above the belly button

Question 14

Normal bowel sounds

Answer 14

High pitched, gurgling, cascading sounds

Question 15

Hyperactive sounds

Answer 15

Loud, high pitched, rushing, tinkling sounds (increased motility)
Borborygmus - loud stomach gargling

Question 16

Hypoactive or active sounds

Answer 16

Decreased motility associated with anticholinergic medications, abdominal surgery, ileum, or inflammation of the peritoneum

Listen for five minutes in each quadrant

Question 17

Mixed abdominal sounds

Answer 17

Varied sounds based on quadrant and what is happening

Hyperactive ABOVE a mass/impaction
Hypoactive BELOW the mass/impaction

Question 18

Auscultation of vascular sounds

Answer 18

Use bell to look for bruit
- aorta
- renal artery
- illiac artery
- femoral artery

Question 19

Abdominal palpation

Answer 19

Can identify areas of tenderness
Empty bladder
Lighter —-> deeper palpations (never go to where it hurts)
Do not palpate an abdominal mass

Question 20

Rebound tenderness

Answer 20

Press onto the involved area and let go. Pain upon rebound indicates peritoneal tenderness

Common with appendicitis

Question 21

McBurney’s point

Answer 21

Draw a line from the right anterior superior iliac spine and the umbilicus

This area has discomfort during appendicitis

Question 22

Characteristics of feces

Answer 22

Color, odor, consistency, frequency, shape, constituents

Question 23

Bristol Stool Chart

Answer 23

Type 1 ——> Type 7
Tiny, hard lumps ——> long, liquid diarrhea

Question 24

Common alterations in bowel elimination

Answer 24

Constipation
Diarrhea
Flatulence
Blood in stool
Fecal incontinence
Hemorrhoids

Question 25

Flatulence

Answer 25

Gas in lumen intestines Avg individual produces 1/2 liter of gas/day Needs to be passed or it will cause dissension and pain Good for post-op patience

Question 26

Diarrhea

Answer 26

Caused by infection, food poisoning, meds, food intolerance, diseases, and procedures Dehydration Treatment with avoiding dehydration, probiotic yogurt, and the BRAT diet

Question 27

Constipation

Answer 27

Lack of fiber, fluids, exercise Hard, dry, formed stools with decreased frequency

Question 28

Types of laxatives

Answer 28

Bulk forming Emollient/stool softener Stimulant/irritant Lubricant Saline/osmotic

Question 29

Bulk forming

Answer 29

Increases the fluid, gaseous, or solid bulk in the intestines May take 12hrs to act, sufficient fluid needed, good for long term use

Question 30

Emollient/stool softener

Answer 30

Softens and delays the drying of the feces; permits fat and water to penetrate feces Slow acting, may take several days

Question 31

Stimulant/irritant

Answer 31

Irritates the intestinal mucosa or stimulates nerve endings in the wall of the intestine, causing rapid propulsion of the contents Acts more quickly that bulk forming Fluid is passed with the feces May cause cramps Prolonged use may cause fluid and electrolyte imbalance

Question 32

Lubricant

Answer 32

Lubricates the feces in the colon Prolonged use inhibits the absorption of some fat-soluble vitamins

Question 33

Saline/osmotic

Answer 33

Draws water into the intestine by osmosis, distends bowels, and stimulates peristalsis May be rapid acting Can cause fluid and electrolyte imbalance Not used by older patients Prolonged use inhibits absorption of some fat soluble vitamins

Question 34

Hemorrhoids

Answer 34

Prolapsed, varicose veins of the rectum Inc venous pressure r/t constipation, straining, pregnancy, w weightlifting Bleeding, bright red, pain, itching Treatment: avoid constipation, warm bath, cortisone cream, sclerotherapy, hemorrhoidectomy

Question 35

Guaiac Fecal Occult Blood Test

Answer 35

Detects GI bleeding that isn’t seen most commonly Normal - negative - no blood detected Abnormal- positive -colon or rectal polyps or cancer, hemorrhoids, annal fissures, esophageal or gastric cancer, peptic ulcers, ulcerative colitis, chronic disease, GERD, esophageal varies False-positive: - recent dental procedure, bleeding gums, eating red meat, fish, turnips, horseradish, high doses of Vitamin C, NSAID

Question 36

Valsalva Maneuver

Answer 36

Patient inspires deeply and holds breath while contracting ab muscles and bearing down - Inc intra abdominal and intra thoracic pressure. - Dec venous return to heart - bradycardia, Dec BP, Dec CO

Question 37

Stoma

Answer 37

Whole opening into a hallow organ Tracheostomy - a stoma in the trachea

Question 38

Appendicitis referred pain

Answer 38

Umbilical pain Rebound tenderness McBurneys Point ( right)

Question 39

Cholecystitis referred pain

Answer 39

RUQ pain with radiation to shoulder/back 5 Fs: fat, fair, forty, flatulence, female

Question 40

Constipation referred pain

Answer 40

Sharp pain mimicking appendicitis Diffuse tenderness with palpation

Question 41

Diverticulitis

Answer 41

LLQ Pain worse after eating

Question 42

Pancreatitis referred pain

Answer 42

RUQ and epigastric pain

Question 43

Peptic Ulcer referred pain

Answer 43

Epigastric pain 1-2 hours after meals Sudden and severe Right shoulder radiation

Question 44

Peritonitis referred pain

Answer 44

Abdominal pain Inc with movement Rebound tenderness

Question 45

Abdominal Aortic Aneurism (AAA)

Answer 45

Often asymptomatic Back/abdominal pain Pulsatile mass may be palpable