HA: GI and GU Systems

What do you do first in the assessment of the abdomen?
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Terms in this set (57)
What organs are in the RLQ?Appendix Ascending colon Bladder Cecum Ovary, uterus, and fallopen tubes (female) Prostate and spermatic cord (male) Small intestine Ureter (right)What organs are in the RUQ?Ascending colon Duodenum Gallbladder Right kidney Liver Pancreas (head) Transverse colon Ureter (right)What organs are in the LUQ?Descending colon Left kidney Pancreas (body and tail) Spleen Stomach Transverse colon Ureter (left)What organs are in the LLQ?Bladder Descending colon Ovary, uterus, fallopian tube (female) Prostate and spermatic cord (male) Small intestine Sigmoid colon Ureter (left)What does the mesentery do?Keeps vessels together and helps with blood supplyWhat is the costovertebral angle?Angle of lower rib to the vertebra -where you percuss for tenderness to see if kidneys are inflamedWhat are abdominal considerations in children?-Less muscle= easier palpation of organs -Protuberant abdomen until about 7What are abdominal considerations in aging adults?-Smaller liver and decreased function (leads to toxicity from drugs) -Decreased gastric secretions and salivation* -Delayed stomach emptying -Perceived constipation (laxative dependency= gut stops from doing it itself) -Increased incidence (colon cancer) -Increased risk of gallstonesWhat are abdominal considerations in pregnant women?-Abdominal muscles relax -Internal organs displaced -N/V in 50-75% -Pylorsis: heart burn -Diastatsis rectiWhat is general and current problems of the GI system?-Abdominal pain acute or chronic -Indigestion, nausea, vomiting -Appetite, early satiety, changes in weight -Hematemesis (vomiting blood)(upper GI= bright; lower GI= dark) -Dyphagia, odynophagia (painful swallowing) -Food intolerance -Bowel habits (changes), melon (blog in stool from upper GI= dark stool), hematochezia (blood in stool from lower GI= bright red) -Diarrhea, constipation -Past abdominal history and surgeries -Medications, immunizations, past IV drug use, alcohol -Nutritional assessmentWhat is visceral abdominal pain?-Internal organ -Difficult to localize, varies in quality -Subjective: gnawing, burning, cramping, aching -Objective: diaphoresis, pallor, nausea, vomiting, restlessWhat is parietal abdominal pain?-Inflamed peritoneum -Usually more severe, localized over involved area -"steady aching pain, sharp" -Aggravated with movementWhat is referred abdominal pain?-Another site on body perhaps innervated at same spinal level as involved structureWhat are patient factors of preparation for abdominal exam?-Empty bladder -Relaxed, well draped -Comfortable supine position with pillow for head, knees bent (may need pillow for support), arms at side -Exposed abdomen from xiphoid process to symphysis pubis -Groin visible, genitals drappedWhat are examiner factors of preparation for abdominal exam?-Wash hands -Good lighting -Privacy, draping -Warm room, stethoscope, and hands -Short fingernails -Soothing voice -Inspect, auscultate, percuss, palpate (lightly 1st) -Examine painful areas last -Watch patients face for signs of discomfortWhat is the order of examination of the abdomen?Inspect Auscultate Percuss Palpate (palpating first would disrupt bowel sounds or cause them)What quadrant to you start in?RLQ and go clockwiseWhat should you think about while palpating?The underlying organsWhat do you check for in inspection?Contour/symmetry Skin Umbilicus Pulsations/PeristalsisWhat are normal profiles of the abdomen?Flat Rounded Scaphoid (concave) Protuberant (pregnant or obese)What leads to portal htn caput medusa?Cirrhosis of the liverWhat is ascites and what leads to it?It is a protuberant abdomen filled with fluid and cirrhosis of the liver leads to itWhat do you auscultate for?-Bowel sounds (when, where (quadrant), how long, borborygmus (hyperactive bowel sounds) -Vascular sounds (bruits)How do you document bowel sounds?-Normal: 5-35/min -Hypoactive <5/min (listen for a min. and if you hear more than 5 move on) (post surgical temporary paralysis of bowel) (no food until sounds return=at risk for aspiration) -Hyperactive >30/min -Absent (must listen 5 min before claiming bowel sounds absent)Where do you listen to bruits?Aorta, left renal artery, iliac artery, femoral arteryWhat do you percuss for?Tympany: gas/air in stomach, small intestine, and large intestine Dullness: solid masses, distended bladder, liver, spleen, and kidneysHow do you palpate the costovertebral angle?Place one hand over the 12th rib Thump with the ulnar area of the fist Normally no pain (if pain sign of kidney infection or disease)How do you do light palpations?-4 fingers close together pressed 1-2 cm deep using a circular/rotary motion -Assess for voluntary guarding -Palpate for skin temp, texture, lessons, tenderness and muscles underneathHw do you do deep palpations?-Depress 2-3 in (5-8 cm) -Use 2 hands -Palpate for masses, organs, thrill over arteries, fluid wave -Match palpation findings with percussion findings -Assess for masses: location, size, shape, mobility, smooth, nodular, pulsating, guardingWhat do you assess for with peritoneal inflammation?-Localize pain and where -Ask patient to cough (causes vibrations and pain) -Rebound tenderness* (push down on inflamed area and when you let go it will hurt-done at end of exam) -Referred pain?How do you palpate the liver?-Left hand parallel o the 11th and 12th rib on posterior of client -Right hand with fingers parallel to MCL -Push deeply under right costal marginHow do you palpate the spleen?-Normally not palpable -Place left hand behind the 11th and 12th rib -Right hand point toward the axilla, use below the rib marginWhat are some additional techniques for palpating the abdomen?Fluid wave (palpated on opposite side of abdomen) Blumburg sign-rebound tendernessWhat leads to abdominal distention?Ascites Obesity Tumor Large ovarian cyst Gas FecesHow do you assess that the bladder?-Normally cannot be palpated unless distended above symphysis pubis -Check for tenderness of area -Percuss for dullnessWhat are bowel sounds like with a fecal impaction?No bowel sounds in the descending colon (where impaction is) because it is stretched and there are bowel sounds in the ascending colon because its trying to push the impaction out -can see the left side distendedWhat should be the first thing you think about when the patient says they have blood in there stool?Do they have hemorrhoidsWhat is subjective data you should gather for the anus/rectum?-Family history -Usual bowel routine -Change in bowel habits -Rectal bleeding and blood in stool (melena or bright red, amount, when occurs?) -Medication use (laxatives, stool softeners, iron (can cause dark stool) -Rectal conditions (pruritus, hemorrhoids, tissue, fistula) -Self care behaviors (diet with high fiber, most recent examination)What should you do in the physical exam of the anus/rectum?-Inspect skin of perianal and sacrococygeal areas for intactness -Check for inflammation, rashes, swelling, discharge, bleeding, lesions, fissure, fistula, external hemorrhoids, excoriations, and pilonidal abscess (ingrown hair about anus)What findings should you document about the abdomen?Contour Tenderness Palpation, percussion, bowel sounds Abnormal structures Abdominal artery bruitsWhat subjective data should you gather about the renal and urinary system?-Suprapubic pain (bladder or ovary) -Pain with urination (dysuria) -Urgency, frequency (how often) -Hesitancy, decreased stream in males (BPH) -Urinating large amounts and often (polyuria= diabetes) -Urinating at night (nocturia) -Leaking urine (urinary incontinence) -Blood in urine (gross) (hematuria-seeing blood in urine) -Kidney or flank pain (costovertabral angle) (dull, aching steady, radiated anteriorly toward umbilicus, may have fever, chills in acute pyelonephritis) -Ureteral colic (intermittent pain/passing stone) (severe, colicky, originates in costovertebral angle, radiates around trunk into lower quadrant of abdomen, thigh, testicle or labium, sudden obstruction of ureter from stones/blood clots)What should you do in the physical assessment of renal and urinary?Inspection -suprapubic bulge of distended bladder or pregnant uterus Percussion -large area of dullness might indicate a preset uterus Palpation -idenity physiologic mass of pregnant uterus -bladder not usually palpable -distended-obstructive mass or ureteral stricture, BPH, neurological cause due to strike, MS -kidneys-not usually palpable (causes=hydroenphrosis, cysts, tumors; bilateral= polycystic dz) -pain on kidney palpation= pyelonephritisWhat is subjective info you should gather for the male reproductive system?(1/10 patients may have same-sex, bisexual, transgender partner preferences-important to both male and female patients) -Sexual funciton -Priapism (erection longer than 4 hr) -Penile discharge/lesions-hx, amount, color, sores, pay. associated fever, chills -History of STDs -Scrotal pain, swelling -Inguinal pain, swelling (hernia) -Problems with urination (prostate enlargement=BPH)How do you do a physical exam of the male reproductive system?Inspection -Penis: skin, forsaken (prepuce), glans -phimosis is tight prepuce that cannot be retracted one glans -replace foreskin after exam of glans -Location of urethral meatus -hypospadias* is congenital, ventral displacement of meatus (4/1000) newborns -Discharge -Scrotum: skin scrotal contours (note swelling, masses, veins) -Hernias-inguinal and femoral areas; bulging and asymmetry -patient should bear down to accentuate bulgeWhat happens to the male reproductive system as they age?-Decreased penis size -Testicles hang lower in scrotum -Prostate gland enlargement (BPH by age 60, 70% males affected)What subjective info should you gather about the female reproductive system?-Menarche, menstruation, menopause -Amenorrea (stop), dismenorrea (pain), premenstrual syndrome (PMS), abnormal uterine bleeding -Pregnancy -Contraception -STD hx/HPV vaccine (85% sexually active persons exposed to HPV; >100 types) (type 16 and 18 associated with 70% of cervical cancer) (type 6 and 11 assoc. with 90% of cervical warts) -Vulvovaginal symptoms (dischare, itching, lesions)How do you do the physical exam on the female reproductive system?External exam if needed-requires good lighting and patient comfortable position -inspect external genitalia -note inflammation, ulceration, dischare, swelling, lacerations, brush, nodules -note any changes in normal anatomical findings Older adults: atrophy and hair loss of vulva