GIT Assessment PDF

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Summary

Gastrointestinal assessment ...

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GIT AS ASSESSMENT SESSMENT > GASTROINTESTINAL AS ASSES SES SESSMENT SMENT

Objectives    

Review organs and structures of the GIT system Obtain the health history of a patient presenting with abdominal problems. Describe how to perform a physical assessment of the GIT system Describe assessment techniques of a patient with suspected appendicitis and ascites

Anatomy and Physiology of Abdominal Cavity

Anatomic Mapping

Nine Abdominal Regions

Four Quadrants & Underlying Organs

Background of GIT System -

A hollow tube that begins at the mouth and ends at the anus

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The GIT consists of smooth muscle alternating with blood vessels and nerve tissue

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Specialised circular and longitudinal fibers contract, causing peristalsis, which aid food through the GIT

Digestion Starts in the mouth -

Chewing, salivating & swallowing Tongue provides sense of taste Saliva produced by 3 glands – parotid, submandibular & sublingual

Proceeds to the pharynx (throat) -

Allows passage of food from mouth to oesophagus Assists in swallowing & secretes mucus Epiglottis sits behind root of tongue closes over larynx when food is swallowed

Down to the oesophagus -

Upper oesophageal sphincter relaxes and food moves into oesophagus Peristalsis propels food down the oesophagus to the stomach Oesophageal sphincter opens to allow food into the stomach

The stomach 

Cardiac sphincter prevents acid contents of the stomach from moving back into the oesophagus

3 main functions of the stomach: -

Stores food Mixes food with gastric juices Passes chyme (watery mixture of partly digested food & digestive juices) into small intestine

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Rugae, accordion like folds in stomach lining allow the stomach to expand when there are large amounts of food & fluid Average meal remains in stomach 3-4 hours Pyloric sphincter acts as a valve to control the flow of food from the stomach to the small intestine

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Small Intestine About 6 meters long & divided into 3 sections -

Duodenum Jejunum Ileum

• Nutrients are absorbed through thin mucous membrane lining of the small intestine into blood stream • CHO, fats, proteins are broken down • Peristalsis moves food through to large intestine Digestion

Large intestine (colon) 1.5 meters long Parts Includes -

Cecum (appendix is attached here) Ascending, transverse, descending & sigmoid colon Rectum Anus

Absorbing excess water & electrolytes Storing food residue Eliminating waste products in form of faeces

Accessory Organs The Gallbladder -

Small pear shaped organ which lies under the liver Stores and concentrate bile from the liver Bile contributes to fat digestion and absorption

The Pancreas -

Lies horizontally in the abdomen, behind the stomach Consists of head, body & tail Releases hormones insulin & glycogen into bloodstream (endocrine) Produces pancreatic enzymes which aid in digestion (exocrine)

The Liver -

Found in the right upper quadrant, under the diaphragm

Functions include -

Metabolizing CHO Detoxifying food Converting ammonia to urea for excretion Synthesizing plasma proteins, nonessential amino acids, Vit A & essential nutrients such as iron & Vit D, K & B12

The Vascular Structures -

The abdominal aorta supplies blood to the GIT Enters the abdomen & separates into common iliac arteries, then branches into many arteries extending the length of the GIT Gastric & splenic veins drain absorbed nutrients into portal vein of liver Exits the liver through the hepatic vein emptying into inferior vena cava

Common Chief Complaints

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Nausea Vomiting Diarrhoea Constipation Abdominal distension Abdominal pain Belching Flatulence

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Dysuria Nocturia Urinary Incontinence Anorexia Dysphagia Wight gain Weight loss

Assessing Abdominal/Epigastric Pain -

Any associated symptoms –? Nausea or vomiting For females date of last menstrual period

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For males testicular pain or swelling

PQRST Method

COLDSPA Method:

P= Provocation/ Palliation

C= Character

Q= Quality

O= Onset

R= Radiation

L= Location

S= Severity Scale

D= Duration

T= Timing

S= Severity P= Pattern A= Associated Factors/symptoms

GIT Assessment Continues:

Weight Loss or Gain -

Is it substantial Over what time frame – gradual or sudden

Dysphagia Solids or liquids -

Site where food gets stuck Is food regurgitated Any associated pain

Change in Appetite -

Any loss of appetite

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Changes in food intake In infants Breast feeding or formula Any changes in feeding pattern Food intolerances

Altered Bowel Habits -

Frequency, colour, consistency Any blood or Melena Pain before, during or after defecation

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Sense of incomplete emptying

Altered Bowel Habits -

Use of laxatives Haemorrhoids

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Belching or bloating flatulence Change in bowel habits

Equipment -

Blanket / Gowns & Pillow to be placed under the knees Tape Measure , Weighing scale, Height tape measure,

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Lighting, stethoscope, pen, assessment charts

Physical Assessment Nutritional assessment: to be done first -

Height Weight BMI Waist & Hip Measurements

Physical Assessment: Inspection General Appearance • Body position • Movement • Level of distress • Colour – jaundice, pale, red & flushed • Match between appearance & stated Age

Inspect the Mouth • Symmetry & swelling • Lips, gums, teeth – caries • missing teeth, dentures • red or receding gums • Tongue – dryness, lesions, coating • Any breath odours

Order for abdominal assessment: Inspection            

Contour Symmetry Abdominal Muscles Pigmentation Scars Striae Respiratory movement Masses Pulsations Hernias Visible peristalsis Ascites

Auscultation      

Auscultate before palpation so as not to alter bowel sounds Divide abdomen into 4 quadrants Lightly place stethoscope in the RLQ Auscultate clockwise in each of the 4 quadrants Note character and frequency of bowel sounds Normal bowel sounds consist of gurgles & click sounds 5-30 per minute

Percussion

Detect size & location of abdominal organ Detect air or fluid

AssessTo

Using the finger of your dominant hand and strike a finger resting on the patients abdome Beginning in RLQ

Percuss

Do not percuss if the patient has: Abdominal aortic aneurysm Renal or abdominal organ transplant

STOP Percussion - Two Sounds: • Tympany (drum like sound) -

Heard over hollow organs such as an empty stomach or bowel Air floats to the top

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Heard over solid organs such as liver, or intestines filled with faeces

• Dullness

Palpation 1. Patient should be lying supine with hands on sides 2. Expose Patient abdomen and examine ALL four Quadrants 3. Put fingers of one hand close together, depress skin about 1.3 cm with your fingertips 4. Determine size, shape, position & tenderness of major abdominal organs, detect any masses or fluid accumulation 5. Make gentle , rotating movements ; Normal abdomen should be soft, nontender STOP OP Do not palpate if abdomen is rigid 6. ST

Diagnostic Tests • Stool for occult blood (FOB) • Stool for Microbiology & Culture • Pregnancy test • Urinalysis...