Week 11 - GI, GU Flashcards
RUQ
liver, gallbladder, duodenum, head of pancreas, right kidney, hepatic flexure of colon, parts of ascending and transverse colon
LUQ
stomach, spleen, left lobe of liver, body of pancreas, left kidney, splenic flexure of colon, parts of transverse and descending colon
RLQ
cecum, appendix, right ovary and fallopian tube, right ureter, right spermatic cord
LLQ
part of descending colon, sigmoid colon, left ovary and fallopian tube, left ureter, left spermatic cord
referred pain
Liver – may produce dull pain in RUQ or epigastrium.
Esophagus – i.e. Gastroesophageal reflex disease (GERD) burning pain in midepigastrium or behind sternum that radiates upward (“heartburn”).
Gallbladder – cholecystitis is sudden pain in RUQ that may radiate to the right or left scapula.
Stomach – gastric ulcer pain is dull, aching, or burning in epigastric region, often radiates to the back.
Appendix – starts as dull, diffuse pain in periumbilical region that later shifts to be localized in the RLQ.
Kidney – kidney stones produce a sudden onset of severe flank or lower abdominal pain.
subjective data - GI
Appetite:
Appetite change/loss? Weight gain/loss? Time period? Due to diet?
Dysphagia:
Any difficulty swallowing? When did you first notice this?
Food intolerance:
Foods that you cannot eat? Result? Use/frequency of antacids?
Abdominal pain:
Any abdominal pain? Please point to it.
Nausea/vomiting:
Any nausea or vomiting? How often? How much comes up? Colour/odour?
Bowel habits:
How often do you have a bowel movement?
Abdominal history:
Any history of gastrointestinal problems: ulcer, gallbladder disease, hepatitis/jaundice, appendicitis, colitis, hernia?
Medications:
Currently taking? OTC? Herbal/natural supplements?
Alcohol and tobacco:
How much/often do you drink? How much/often do you smoke?
Nutritional assessment:
Please tell me all the food you ate yesterday, starting with breakfast. Following Canada’s Food Guide?
developmental considerations - older adults
Suprapubic fat accumulation in women, abdominal accumulation in men
Decreased salivation, gastric acid secretion, delayed esophageal emptying (risk of aspiration)
More susceptible to dehydration
Decreased liver size and increased gallstones
Decreased renal function (adverse or toxic drug effects)
Constipation
objective data - GI
Contour – changes with bloating, pregnancy, ascites – terms: flat, rounded, distended, protuberant, scaphoid/cachectic. Most common finding is abdominal distension.
Symmetry – think about the organs, which organs could cause asymmetrical abdominal assessment? Note any bulges or masses.
Umbilicus – umbilical hernia? Inverted, everted
Skin – striae (stretch marks), rashes and sores?
Pulsation or movement – normal to see pulsations from the aorta in the epigastric area (easier to see in thin patients). Waves of peristalsis may be visible normally, if with distension may be abnormal.
Demeanor – pain in the abdominal region will often results in a tense or ridged abdomen, guarding.
bowel sounds
hyperactive
hypoactive
absent
normal
vascular sounds - (bruits) abnormal
assess abdomen order
inspection, auscultation, percussion, palpation
light palpation
assessing texture, temp, moisture, swelling, rigidity, pulsation, and presence of tenderness/pain
diagnostic tests
Rebound Tenderness/Blumberg’s sign
– pain on release of pressure. Means peritoneal inflammation. And often appendicitis.
Inspiratory Arrest/Murphy’s sign
– liver or gallbladder pain. Hold fingers under the liver border and have patient take a deep breath. If pain at liver margins, then positive for liver or gallbladder inflammation
Iliopsoas muscle test
– done when acute abdominal pain is suspect for appendicitis. With patient supine, lift the right leg straight up, flexing at the hip, and push down over the lower part of the right thigh as the patient tries to hold the leg up. With appendicitis
– there is RLQ pain with this maneuver. If no pain, it is negative.
Ascites is the accumulation of protein
-containing (ascitic) fluid within the abdomen. Many disorders can cause ascites, but the most common is high blood pressure in the veins that bring blood to the liver (portal hypertension), which is usually due to cirrhosis.
subjective data - GI bowel
Usual bowel routine:
- Bowels move regularly? How often? Usual colour? Hard or soft? Pain while passing a bowel movement?
Change in bowel habits:
- Any change in usual bowel habits? Loose stools or diarrhea? When did this start? Is the diarrhea associated with nausea and vomiting, abdominal pain, something you ate recently?
Rectal bleeding, blood in the stool:
- Ever had black or bloody stools? When did you first notice blood in the stools? What is the colour, bright red or dark red-black?
How much blood:
- spotting on the toilet paper or outright passing of blood with the stool? Do the bloody stools have a particular smell?
Medications:
- What medications do you take—prescription and over-the-counter? Laxatives or stool softeners? Which ones? How often? Iron pills? Do you ever use enemas to move your bowels? How often?
Rectal conditions:
- Any problems in rectal area: itching, pain or burning, hemorrhoids? How do you treat these? Any hemorrhoid preparations? Ever had a fissure, or fistula? How was this treated?
Family history:
- Any family history of polyps or cancer in colon or rectum, inflammatory bowel disease, prostate cancer?
Self-care behaviors:
- What is the usual amount of high-fiber foods in your daily diet: cereals, apples or other fruits, vegetables, whole-grain breads? How many glasses of water do you drink each day?
structure - male GU
penis
- corpora cavermosa
- corpora spongiosum
- glans
- corona
- urethra
- foreskin
scrotum
- rugae
- cremaster/ dartos muscles
- testis
- epididymis
- vas deferens
- spermatic cord
- ejaculatory duct
inguinal area
- inguinal ligament
- inguinal canal
- femoral canal
male subjective data -GU
Frequency, urgency,
- normal 5-6x/day
nocturia
dysuria (pain or burning sensation)
- common with cystitis, prostatitis, and urethritis
Hesitancy and straining
Urine colour
- Is the usual urine clear or discoloured, cloudy, foul-smelling, bloody
Past genitourinary history
Pain, lesion, discharge
Scrotum: self-care behaviours
Sexual activity and contraceptive use
Sexually transmitted infection contact
- Any sexual contact with a partner who has an STI, such as gonorrhea, herpes, HIV, Chlamydia infection, genital warts, syphilis?
