Gatrointestinal assessment

THIS IS ABOUT GASTROINTESTINAL ASSESSMENT

1. WEL COME PRESENTED BY Mr. CHETAN R SANGATI First YEAR MSc NURSING Dept OF MEDICAL SURGICAL SURSING

2. GASTROINTESTINAL ASSESSMENT

3. INTRODUCTION The functions of the gastrointestinal (GI) tract and its accessory organs are essential for life. The process of digestion supplies nutrients to each and every cell in our body. If there is a disruption in any of these mechanisms, the whole body suffers.

4. Once the person get disturbance they will show symptoms related to GI then the doctor will go for the physical examination by fallowing techniques. Physical exam techniques such as inspection, palpation, percussion, and auscultation will be highlighted.

5. Glossary Ascites - An abnormal accumulation of serous fluid in the abdominal cavity containing large amounts of protein and electrolytes. Bulge - A protruding part; an outward curve or swelling. Cirrhosis - Cirrhosis of the liver is a chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue and the loss of functional liver cells.

6. Digestion - The process by which food is converted into substances that can be absorbed and assimilated by the body . Dysphagia - Difficulty in swallowing. Esophageal varices - Abnormally dilated or swollen vessels in the esophagus, which can lead to bleeding. Food allergy - An abnormally high sensitivity to certain foods.

7. Food intolerance - Inability to completely digest a type of food, usually due to an enzyme deficiency. Hernia - The protrusion of an organ or other bodily structure through the wall that normally contains it; a rupture. Mass - An aggregate of cells clumped together, such as a tumor.

8. Referred pain - Pain sensation experienced in one part of the body that is different to the actual area of pathology. Spider nevi (or angioma ) - A dilation of superficial capillaries with a central red dot from which blood vessels radiate. Visceral pain - Pain related to the internal organs.

9. FOCUSSED GASTROINTESTINAL ASSESSMENT While conducting the physical examination on a patient we should collect the subjective and objective data of the patient. Components may include : Chief complaint Present health status Past health history Current lifestyle

10. Psychosocial status Family history Physical assessment

11. Communication during the history and physical must be respectful and performed in a culturally-sensitive manner. Privacy is vital, and the healthcare professional needs to be aware of posture, body language, and tone of voice while interviewing the patient . Take into consideration that a patient’s ethnicity and culture may affect the history that the patient provides.

12. Gastrointestinal history tacking Gastrointestinal disease usually manifests as the presence of one or more of the following: •Change in appetite •Weight gain or loss • Dysphagia •Intolerance to certain foods •Nausea and vomiting Changing in bowel movement Abdominal pain

13. APPETITE Ask your patients if they have had any changes in appetite or food intake. If they have, ask for more information about the change. Appetite and eating can be influenced by many factors that may indicate gastrointestinal disease or that can be attributed to socioeconomic considerations such as food availability, family norms, peers, and cultural practices. A loss of taste sensation can contribute to loss of appetite and potentially result in poor nutrition, especially in older individuals

14. Weight Loss or Gain Weight loss may be associated with illness and weight gain may associated with fluid retention.

15. Dysphagia Ask your patient if they have any difficulty swallowing and when the difficulty first occurred. More than 50 pairs of muscles and many nerves work to move food from the mouth to the stomach. It is important to note what the patient has difficulty swallowing (e.g. solids versus liquids), and the area that the patient feels is where food gets “stuck

16. People with nervous system problems and head injuries ,cerebral palsy , Parkinson's disease will leads to dyspegia.

17. Intolerance to food Food intolerance may be related to disorders such as celiac disease, insulin-dependent diabetes, and inflammatory bowel disease. Symptoms of intolerance to a particular food might include stomach discomfort, gas, bloating, flatulence, pain, and diarrhea.

18. NAUSEA AND VOMITING Nausea and vomiting can be side effects of medications, a manifestation of many diseases, and can occur frequently in early pregnancy. Ask your patients about the frequency of these symptoms. Nausea and vomiting may also indicate food poisoning. Questions about types of food eaten in the past 24 hours should be asked to rule out potential poisoning.

19. If vomiting is present, you will want to ask about the amount, frequency, color, and odor of the vomitus . Ask if there is any blood in the vomit or if the vomit appears to be like coffee grounds. Hematemesis , or blood in the vomitus , is a common symptom of gastric or duodenal ulcers and may also indicate esophageal varices .

20. PAST GI DISEASE Ask about any past history of gastrointestinal disorders such as ulcers, gall bladder disease, hepatitis, appendicitis, hernias. Ask the patient if they received treatment and if the treatment was successful. History should also include past abdominal surgeries, any abdominal problems after the surgery, and abdominal x-rays or tests (including colonoscopy) and their results .

21. Medication history Many medications can produce gastrointestinal symptoms. Almost every class of drugs has the potential for gastrointestinal side effects. Most of the side effects include nausea, vomiting, diarrhea, and/or constipation. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) may cause abdominal pain and may increase the likelihood of gastrointestinal bleeding.

22. SOCIAL HISTORY AND LIFE RISK FACTORS In taking a complete history, it is important to address lifestyle risk factors and social behaviors that may contribute to unhealthy lifestyles and increase the risk of gastrointestinal disorders. Ask your patients about the frequency and duration of alcohol consumption, caffeine intake, and cigarette smoking at this time.

23. Nutritional assessment Nutritional assessment should be done for the patient Recent unintentional weight loss • Chemotherapy or radiation • Recent weight gain • Food allergies or intolerance • Decreased appetite • Multiple medications • Alterations in sense of taste

24. Physical examination Inspection is first, as it is non-invasive. Auscultation is performed following inspection; the abdomen should be auscultated before percussion or palpation to prevent production of false bowel sounds. For accurate assessment of the abdomen, patient relaxation is essential. The patient should be comfortable with knees supported and arms at the sides, and should have an empty bladder.

25. The environment should include a comfortable temperature, with good light. INSPECTION: Visualization of the entire of the abdomen. The abdomen divided in to four or nine quadrants.

26. Inspect for the abdomen for Bulges • Masses • Hernias • Ascites • Spider nevi • Enlarged veins • Pulsations or movements • Inability to lie flat

27. Normally, blood vessels are not evident on the abdomen. However they may be present in the elderly or pregnant client due to the loss of subcutaneous fat. During inspection ask your patient to lift their head slightly. If you notice a protrusion around the umbilicus or any incisions, a hernia may be present

28. Auscultation You should always auscultate the abdomen after inspection and before percussion or palpation so you do not produce false bowel sounds by percussion or palpation.

29. Physical examination percussion Percussion is used to elicit tenderness or sounds that give clues to underlying problems. When percussion directly over suspected areas of tenderness, monitor the patient for signs of discomfort.

30. “Press the distal part of the middle finger of your non-dominant hand firmly on the body part. Keep the rest of your hand off the body surface. Flex the wrist, but not the forearm, of your dominant hand. Using the middle finger of your dominant hand, tap quickly and directly over the point where your other middle finger contacts the patient’s skin, keeping the fingers perpendicular. Listen to the sounds produced.”

31. Percussion of the abdomen When examining the abdomen, percuss for general tympany , liver span, and splenic dullness. Tympany should be the predominant sound when percussing the abdomen. Air “floats” to the top of the abdomen in the supine position and tympany reflects a drum-like sound Dullness is usually heard over solid organs or masses such as the liver, spleen, or a full bladder

32. Percussion of kidney Percussing over the kidneys does not usually produce pain or discomfort. If tenderness is present, a urinary tract infection or kidney inflammation may be present. Costovertebral angle tenderness may be elicited when the patient is in a standing or upright position. Place the palm of your non-dominant hand near the posterior costovertebral margin over the kidney.

33. Physical examination palpation Palpation is another commonly used physical exam technique that requires you to touch your patient with different parts of your hand using different strength pressures. During light palpation, you press the skin about ½ inch to ¾ inch with the pads of your fingers.

34. Palpation allows you to assess for tenderness, temperature, moisture, pulsations, masses, and internal organs.

35. Abdominal Pain Introduction If your patient is experiencing abdominal pain, have them point to the exact location of the pain. Abdominal pain can be classified as: • Visceral • Parietal • Referred

36. Visceral Pain Visceral pain is usually described as dull, crampy , squeezing, or aching. It can be constant or intermittent. Parietal Pain Parietal pain is usually from inflammation over the peritoneum. Peritoneal inflammation usually indicates an underlying emergency and should be assessed quickly. Parietal pain is usually intense, constant, and on one side.

37. Mnemonic for pain assessment ( pqrst ) P- Provocative or Palliative: What makes the pain or symptom(s) better or worse? Q- Quality: Describe the pain or symptom(s) (burning, dull, sharp) R- Region or Radiation: Where in the body does the pain or symptom(s) occur? Is there radiation or extension or the pain or symptom(s) to another area of the abdomen?

38. S-Severity: On a scale of 1-10, (10 being the worst) how bad is the pain or symptom(s)? Another visual pain scale may be appropriate for patients that are unable to identify with this scale. T- Timing: Does it occur in association with something else? (e.g. eating, exertion, movement)

39. Assessing Abdominal Pain: Muscle Tests The patient history is extremely important in assessing abdominal pain. Pain may be chronic or acute and related to inflammation, infection, allergy, or food intolerance.

40. Iliopsoas Muscle Test The iliopsoas muscle test is used most often when acute abdominal pain is present and appendicitis is suspected. When your patient is lying in the supine position ask him or her to lift their right leg straight up, flexing only at the hip. Push down on the lower part of the thigh when your patient is trying to hold their leg up. If the patient feels pain in the iliopsoas muscle (the right lower quadrant of the abdomen) the test is positive and may indicate a perforated or inflamed appendix .

41. The Obturator Test The obturator muscle test is also performed when acute abdominal pain is present and appendicitis is suspected. When your patient is lying in the supine position ask him or her to lift their right leg straight up, flexing at the hip, and 90 degrees at the knee. Hold the ankle and rotate the leg internally and externally. If the patient feels pain in the area of the internal obturator muscle (the right lower quadrant of the abdomen and pelvis) the test is positive and may also indicate a perforated or inflamed appendix

42. COMMON LABRORATRY VALVUES

43. Conclusion Digestion, transport, and absorption are the processes by which the digestive system supplies nutrients to each and every cell of our body. If there is a disruption to this process, the whole body suffers. By asking specific questions about a patient’s gastrointestinal history and performing focused abdominal exam techniques for your adult patient, you will be able to assess for the slightest changes in gastrointestinal function.

44. Alterations in your gastrointestinal assessment findings could indicate potential problems. Being knowledgeable about the focused, gastrointestinal assessment will allow you to intervene quickly and appropriately for gastrointestinal disorders.

45. REFERENCES Caple , C. (2011). Physical assessment: Performing- cultural considerations. Glendale, CA: Cinahl Information Systems. Jarvis, C. (2011). Physical examination and health assessment, (6th ed.). St. Louis: W.B. Saunders. Merck Manual Online (2013). Retrieved August 2013 from www.merck.com. National Institute of Health [NIH] (2011). Dysphagia . Retrieved August, 2014 from: http://www.nidcd.nih.gov/health/voice/pages/dysph.aspx.

46. Mosby Company. (2012). Mosby’s medical dictionary (9th ed.). New York: Elsevier. Shaw, M. (2012). Assessment made incredibly easy (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Venes , D. (ed.) (2013). Tabers ® cyclopedic medical dictionary (22nd ed.). Philadelphia: F.A. Davis Co. At the time this course was constructed all URL's in the reference list were current and accessible. RN.com is committed to providing healthcare professionals with the most up-to-date information available.

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