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gi assessment Flashcards

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1
Q

What organs are found in the Right Upper Quadrant (RUQ)?

A

Liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal gland, part of ascending colon

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2
Q

What organs are found in the Left Upper Quadrant (LUQ)?

A

Stomach, spleen, left lobe of liver, body of pancreas, left kidney and adrenal gland, part of transverse and descending colon

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3
Q

What organs are found in the Right Lower Quadrant (RLQ)?

A

Cecum, appendix, right ovary and fallopian tube, right ureter, right spermatic cord

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4
Q

What organs are found in the Left Lower Quadrant (LLQ)?

A

Part of descending colon, sigmoid colon, left ovary and fallopian tube, left ureter, left spermatic cord

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5
Q

What structures are found in the Midline of the abdomen?

A

Aorta, uterus (if enlarged), bladder (if distended)

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6
Q

What is the correct GI Tract order from start to finish?

A

Mouth, esophagus, stomach, small intestine (duodenum, jejunum, ileum), large intestine (cecum, colon, rectum, anus)

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7
Q

What region of the abdomen is located above the belly button?

A

Epigastric

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8
Q

What region of the abdomen is located around the belly button?

A

Umbilical

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9
Q

What region of the abdomen is located below the belly button?

A

Hypogastric/Suprapubic

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10
Q

What organs are found in the Epigastric region?

A

Stomach, parts of liver and pancreas

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11
Q

What organs are found in the Hypogastric/Suprapubic region?

A

Bladder, reproductive organs

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12
Q

What are the three parts of the small intestine?

A

Duodenum, jejunum, ileum

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13
Q

What organs are found in the Right Lower Quadrant (RLQ) that could cause pain?

A

Appendix (common cause of RLQ pain), cecum, right ovary and tube, right ureter

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14
Q

What organs are found in the Left Lower Quadrant (LLQ) that could cause pain?

A

Sigmoid colon, left ovary and tube, left ureter

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15
Q

What does “viscera” refer to?

A

All internal organs.

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16
Q

What are considered “solid viscera”?

A

Liver, pancreas, spleen, adrenal glands, kidneys, ovaries, and uterus; they maintain a characteristic shape.

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17
Q

What are considered “hollow viscera”?

A

Stomach, gallbladder, small intestine, colon, and bladder; their shape depends on contents.

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18
Q

What is referred pain?

A

Pain that is felt in a location not directly over the involved organ due to the brain’s inability to map internal organs.

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19
Q

Why does referred pain occur?

A

Because pain is referred to a site where the organ was located during fetal development, even though the organs have migrated.

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20
Q

What is an example of referred pain?

A

Radiating pain in the left lower quadrant (LLQ) can indicate appendicitis.

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21
Q

What is an important preparation step for a GI assessment?

A

Ensure the room is well-lit to enhance visibility during the examination.

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22
Q

Why should the patient have an empty bladder before a GI assessment?

A

An empty bladder allows for a clearer examination and may be necessary for obtaining a urine specimen.

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23
Q

What should the temperature of the room be for a GI assessment?

A

The room should be warm to prevent abdominal muscles from tensing up.

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24
Q

How can a patient relax their abdomen during the assessment?

A

Instruct the patient to scrunch their knees up while lying supine with knees flexed to help relax the abdominal muscles.

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25
What should the examiner ensure about their hands and stethoscope?
Both the hands and stethoscope should be warm to promote comfort and cooperation from the patient during the examination.
26
What is the standard order of objective GI assessment?
1. Inspect 2. Auscultate 3. Percuss 4. Palpate
27
What demeanor might you observe during the inspection of a patient’s abdomen?
The patient may appear relaxed or agitated.
28
What are the possible contour shapes of the abdomen during inspection?
Scaphoid (concave/sunken), flat, rounded (slightly rounded), protuberant (bulging/stretched), distended (due to fat, air, gas, ascites, pathology, or stool).
29
What should you assess for symmetry during the abdominal inspection?
Look for normal aortic pulsations (especially in thin individuals), bulges, and visible masses.
30
What is the normal appearance of the umbilicus?
It should be midline, inverted, and without discoloration.
31
What could indicate a problem with the umbilicus during inspection?
Inflammation or hernia may be observed, which is typically harmless.
32
What skin features should you inspect on the abdomen?
Inspect for lesions, rashes, scars, ostomies, tubes, and drains.
33
What should you observe about a stoma during the inspection?
The stoma should be pink/red and moist; it should not appear purple or black.
34
What should you assess in an ostomy bag during inspection?
Assess the color, amount, and consistency of the contents.
35
How does the placement of an ostomy affect its output?
Small intestine ostomies typically produce more liquid output compared to colon ostomies.
36
What technique should you use to auscultate the abdomen?
Press lightly with the diaphragm of the stethoscope.
37
In which quadrant should you begin auscultation of the abdomen?
Begin in the right lower quadrant (RLQ), at the ileocecal valve, and proceed in a clockwise motion (RLQ, RUQ, LUQ, LLQ).
38
What should you listen for when assessing bowel sounds?
Air and fluid moving through the small intestine, which produces high-pitched, irregular, gurgling or cascading sounds (5-30 times/minute).
39
Should you count bowel sounds during auscultation?
No, you do not count bowel sounds; instead, you assess if they are normal (normoactive), absent, hypoactive, or hyperactive.
40
What is borborygmus?
Borborygmus refers to stomach growling sounds.
41
How long should you listen for bowel sounds before determining they are absent?
Listen for 5 minutes in each quadrant before concluding that bowel sounds are absent.
42
What can cause absent or hypoactive bowel sounds?
Causes include peritonitis, infection/inflammation of the peritoneum, surgery/manipulation of the bowel, medications used during surgery, and late bowel obstruction.
43
What can cause hyperactive bowel sounds?
Hyperactive sounds can be caused by diarrhea, laxative use, early bowel obstruction, or gastroenteritis.
44
What should you assess regarding vascular sounds?
Use the bell of the stethoscope to listen for vascular sounds; bruits or abnormal sounds are not normal.
45
What is the predominant sound expected when percussing the abdomen?
Tympany predominates due to air rising to the surface when the patient lies down.
46
What does a dull sound indicate when percussing the abdomen?
A dull sound indicates the presence of a solid organ.
47
What is the method for percussing the abdomen?
Use a smooth, systematic pattern to percuss all four quadrants.
48
How do you assess liver span through percussion?
Percuss down the midclavicular line (MCL) until you hear a change from resonance to dull at the 5th intercostal space (ICS), then percuss up from the abdomen to hear the change from tympany to dull at the costal margin.
49
What is the significance of liver size in percussion?
Taller individuals may have longer livers, affecting where you detect the change in sound.
50
What is the typical palpability of the spleen?
The spleen is typically not palpable and is small unless enlarged due to disease.
51
What does CVAT stand for, and what does it assess?
Costovertebral Angle Tenderness (CVAT) assesses for kidney tenderness, which can indicate infection or other pathology.
52
What special procedure helps differentiate ascites from distention?
The fluid wave test helps differentiate ascites from distention (gas or adipose tissues).
53
How do you perform the fluid wave test?
Stand on the person's right side, place the ulnar edge of another person's hand in the middle of the abdomen, and press on the left flank while waiting to feel a tap on the right flank. If it's gas/adipose tissue, you feel no tap; if it's ascites, you feel a tap on your other hand.
54
What conditions might lead to the presence of ascites?
Conditions like heart failure, certain cancers, and pancreatitis can lead to ascites.
55
What are the key aspects to assess during palpation of the abdomen?
Assess size, location, shape, consistency, surface mobility, pulsatility, and tenderness.
56
What is the technique for palpating the abdomen?
Start from the right lower quadrant (RLQ), use light then deep palpation (1 cm then 5-8 cm), use the first four fingers in a gentle rotary motion, and lift fingers without dragging them as you move clockwise around the abdomen.
57
When should you palpate a known tender area during the assessment?
Palpate the known tender area last to avoid causing discomfort early in the examination.
58
What is the difference between voluntary guarding and involuntary rigidity?
Voluntary guarding is bilateral and occurs when the person is cold, tense, or ticklish; muscles relax slightly during exhalation. Involuntary rigidity is unilateral and indicates a protective response to inflammation of the peritoneum.
59
What is the bimanual technique used for in palpation?
The bimanual technique is used for assessing larger abdomens and retroperitoneal organs; it involves placing one hand on top of the other to palpate deeper structures.
60
What is the hooking method in palpation, and what does it assess?
The hooking method is used to palpate the lower margin of the liver; you hook your fingers over the costal margin from above and ask the patient to take a deep breath to feel the liver's edge.
61
What does a positive Murphy’s sign indicate during gallbladder palpation?
A positive Murphy’s sign indicates cholecystitis; the patient will experience sharp pain and stop inspiration midway when the inflamed gallbladder is pushed onto the examiner’s fingers during deep breath.
62
When is the spleen palpable during palpation?
The spleen is only palpable when it is three times its normal size and can be indicative of conditions like mononucleosis, trauma, leukemia, or lymphomas. If an enlarged spleen is suspected, avoid palpation and refer to a specialist.
63
What technique is used to palpate the kidneys/adrenals?
The bimanual technique (duck bill) is used for palpating the kidneys/adrenals at the right/left flank; you may palpate the right lower pole as a round/smooth sliding mass, which can be a normal finding.
64
What does Blumberg's sign indicate during palpation?
Blumberg's sign indicates rebound tenderness in the RLQ when pressure is applied to the LLQ, which may suggest appendicitis; further imaging may be required.
65
How do you test for the iliopsoas muscle during an appendicitis assessment?
With the patient supine, have them lift their right leg straight up while flexing at the hip, then push down on the lower part of the right thigh. Pain in the RLQ indicates inflammation of the iliopsoas muscle from an inflamed appendix.
66
What does "COCA" stand for in bowel habits assessment?
Color, Odor, Consistency, Amount.
67
What are important factors to assess regarding bowel habits?
Frequency, changes in bowel habits, laxative use, and any signs of bleeding.
68
What does melena indicate in stool assessment?
Melena refers to black or tarry stools, indicating possible bleeding in the upper GI tract.
69
What does red, frank blood in stool indicate?
Red, frank blood indicates lower GI bleeding.
70
What is the order of structures in the GI tract?
1. Mouth → 2. Esophagus → 3. Stomach → 4. Small intestine (Duodenum → Jejunum → Ileum) → 5. Large intestine (Cecum → Colon → Rectum) → 6. Anus
71
What should be assessed during an ostomy evaluation?
1. Stoma color: should be pink/red and moist; NOT purple or black. 2. Ostomy bag contents: assess for color, amount, and consistency. 3. Consideration of placement: Small intestine ostomies typically produce more liquid output than colon ostomies.
72
What is Apple/Android obesity?
Excess fat on the abdomen, common in MEN, and has a significant correlation with metabolic syndrome.
73
What is Pear/Gynoid obesity?
Excess fat on thighs and buttocks, common in WOMEN, and has a non-significant correlation with metabolic syndrome.
74
What are the types of obesity?
1. Apple/Android: Excess fat on abdomen, common in MEN, significant correlation with metabolic syndrome. 2. Pear/Gynoid: Excess fat on thighs and buttocks, common in WOMEN, non-significant correlation with metabolic syndrome.
75
What are the characteristics of a low fat diet?
- Polyunsaturated/monounsaturated fats + - Low/eliminate trans fats - Reduce cholesterol (from animal products)
76
What is the DASH Diet?
- Dietary Approaches to Stop Hypertension - Low sodium - Helps reduce blood pressure
77
What are the characteristics of a renal diet?
- Lower protein - Low in sodium (Na), potassium (K), phosphorus (Phos), and calcium
78
What is the BRAT diet used for?
- For nausea, vomiting, and diarrhea: - Bananas - Rice - Applesauce - Toast
79
What are the characteristics of a low residue diet?
- Low fiber - Avoids seeds, nuts, berries, popcorn, caffeine, and tough meats
80
What should individuals with lactose intolerance avoid?
- No dairy products - Lactaid pills can be helpful
81
What is the purpose of the Carb Control diet?
- American Diabetes Association (ADA) diet - Reduced simple sugars - Reduced carbohydrates for glucose control
82
Who should follow a gluten-free diet?
- Individuals with celiac disease - Avoid wheat, rye, breads, cereals, cookies, and other gluten-containing foods
83
What is marasmus?
- Protein-calories malnutrition - Caused by starvation, cancers, anorexia, and bowel obstruction
84
What does Failure to Thrive (FTT) indicate?
- Lower than expected weight gain and growth in children - Profound weight loss in elderly - Physiologic anorexia
85
What is kwashiorkor?
- Protein malnutrition - High calorie intake but low protein - Abdomen may puff up due to insufficient protein

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