Elimination: Gastrointestinal

Question 1

Esophagus

Answer 1

• Peristalsis

* Mediastinal location

Question 2

Stomach

Answer 2

• Upper left quadrant
• Stores food
• Digestive enzymes
• Pyloric sphincter connects small intestine

Question 3

Small Intestine

Answer 3

• Largest segment of GI tract
• Secrets/absorbs nutrients
• Duodenum (proximal), Jejunum (middle), Ileum (distal)
• Ileocecal valve/sphincter control flow of food to large intestine/prevent back flow of bacteria
• Common tile duct empties into duodenum

Question 4

Large Intestine

Answer 4

• Ascending (right), Transverse (right to left), Descending (left)
• Terminal portion= sigmoid colon, rectum, anus

Question 5

Primary Functions of GI Tract

Answer 5

• Breakdown
• Absorption
• Elimination

Question 6

Chewing/Swallowing Function

Answer 6

• Breaks down food (mastication [mechanical])
• Digestive enzymes
• Epiglottis covers trachea to prevent aspiration

Question 7

Gastic Function

Answer 7

• Digestive enzymes breakdown food and destroy ingested bacteria
• Chyme= partially digested food mixed with secretions

Question 8

Small Intestine Function

Answer 8

• Starting at jejunum, absorption is main function

* Digestive enzymes (amylase, lipase, bile)

Question 9

Large Intestine

Answer 9

• Bacteria helps breakdown food

* Slow peristalsis allows for REABSORPTION of WATER and ELECTROLYTES as main function

Question 10

Waste Removal

Answer 10

• Feces= food, bacteria, water, inorganic substances

* Elimination begins with distention of rectum, contractions of rectum, relaxation of internal anal sphincter

Question 11

Factors Affecting Defecation: Diet↑↓

Answer 11

• Constipation from refined foods (no bulk/fiber)
• Lack of bulk= less pressure= ↓ peristalsis
*Longer food sits in colon–> harder/drier stool
• Irregular eating patterns

Question 12

Factors Affecting Defecation: Fluid

Answer 12

• 1500-2000 ml/day for normal bowel movements

* ↓ fluid intake= harder/drier stool

Question 13

Factors Affecting Defecation: Exercise

Answer 13

• Promotes peristalsis

Question 14

Factors Affecting Defecation: Stress

Answer 14

• Diarrhea

Question 15

Factors Affecting Defecation: Lifestyle

Answer 15

• Postponing, embarrassed, change in environment

Question 16

Factors Affecting Defecation: Medications

Answer 16

• Diarrhea (antibiotics), constipation (opioids)

Question 17

Abdominal Assessment

Answer 17

1. Inspection
2. Auscultation
3. Percussion
4. Palpation

Question 18

Contraindications for Physical Exam (percussion/palpation specifically)

Answer 18

• Appendicitis
• Abdominal Aortic Aneurysm
• Tumors

Question 19

Physical Assessment of Oral Cavity: Contour

Answer 19

• Uvula= smooth

* Hard palate= dome-shaped, firm

Question 20

Physical Assessment of Oral Cavity: Color

Answer 20

• Red/smooth/beefy= Vitamin B12 deficiency (pernicious anemia)
• Hard palate: white
• Soft palate: pink

Question 21

Physical Assessment of Oral Cavity: Texture

Answer 21

• Oral Mucosa: smooth, shiny, no cracks

* Tongue: rough from papillae

Question 22

Physical Assessment of Oral Cavity: Growths

Answer 22

• Note any white, ulcerations, masses, nodes

Question 23

Physical Assessment of Oral Cavity: Teeth

Answer 23

• Dentures, partial, own teeth
• Location, size, how many missing
• Gums: color, retraction, bleeding, swelling

Question 24

Physical Assessment of Oral Cavity: Gag Reflex

Answer 24

• Stimulate gently

* Tests cranial nerves IX and X (glossopharyngeal and vagus)

Question 25

Abdominal Assessment: Inspection

Answer 25

• Empty bladder, supine position, arms at side, knees slightly flexed, drape, curtains

Question 26

Abdominal Assessment: Inspection: Shape

Answer 26

* Flat: WD/WN; young, athletes, thin adults * Slighting Rounded: slightly convexity; young children * Protuberance: increased convexity from fat, less muscle tone, pregnancy; more than young child * Scaphoid: lean people * Distended: Fat, Flatus, Feces, Fatal growth, Fluid, Fetus

Question 27

Abdominal Assessment: Inspection: Other Characteristics

Answer 27

* Symmetry: asymmetry could mean obstruction, hernia, tumor, spinal curvature * Visible Peristalsis: strong contractions= obstruction * Scars * Masses: hernia, tumor, cyst, severe constipation

Question 28

Abdominal Assessment: Auscultation

Answer 28

* Location, character, frequency of bowel sounds * Vascular sounds (bruits) * Listen to all 4 quadrants, diaphragm of stethoscope pressed lightly

Question 29

Abdominal Assessment: Auscultation: Frequency

Answer 29

* Normal: 4-12/minute * Hyperactive: >5-10 in 30 seconds or less * Hypoactive: 1-2 in 2 minutes * Must listen for FIVE minutes before documenting absent bowel sounds

Question 30

Abdominal Assessment: Auscultation: Characteristics↑↓

Answer 30

• Normal: bubbling, soft • Hyperactive: loud, gurgling • Obstruction: "rushing," tinkering, high-pitched • Borborygmi: ↑ frequency/intensity • Absent/Hypoactive: post surgery *can take up to 72 hours for sounds to return *BEST assessment is to ask about passed gas • Bell of stethoscope for bruits (aortic, femoral, iliac, renal arteries)

Question 31

Abdominal Assessment: Percussion

Answer 31

* Size/density * Tympanic: hollow, drum like; gaseous distention * Tympani is NORMAL (air in stomach/SI) * Dullness: solid

Question 32

Abdominal Assessment: Palpation

Answer 32

* Pain | * Rebound Tenderness: press at 90 degree angle away from tender area; tenderness felt on release

Question 33

Assessment of Feces: Pattern

Answer 33

• Frequency • Time *Baseline

Question 34

Assessment of Feces: Color

Answer 34

* Brown= normal * Green/Orange= infection, malabsorption * Red= tarry/blood * Clay= barium, bile * Foods

Question 35

Assessment of Feces: Consistency and Shape

Answer 35

* Normal= soft and formed | * Abnormal= ribbon-like (obstruction, mass); pellets (constipation)

Question 36

Assessment of Feces: Odor

Answer 36

* Foods | * Blood

Question 37

Assessment of Feces: Abnormal Constituents

Answer 37

• Blood, pus, excess mucus/fat, parasites

Question 38

Diagnostic Tests for GI System

Answer 38

* Abdominal Xray | * Stool: occult blood (OB; Guaiac test), parasites, cultures