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Abdomen and Gastrointestinal

System
Chapter 20

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Health History:
Present Health Status
• Any chronic diseases that affect your GI or urinary systems? Describe.
• Do you drink alcohol? How much? How often? When was last drink?
• Smoke? How much and how long? Considered stopping or cutting down?
• How often do you have a bowel movement? When was the last one? What
are color and consistency of stool?

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Health History:
Past Medical History
• Have had problems with abdomen or
digestive system? Esophagus? Stomach?
Intestines? Liver? Gallbladder? Pancreas?
Spleen? Describe
• Surgery of abdomen or urinary tract?
Describe. Change in routines, changes in
food/bowel or urinary elimination?

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Health History:
Past Medical History
• Had problems with urinary tract? Describe.
• Injury to or surgery on your
digestive/urinary tract? Describe.

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Health History:
Problem-Based History
• Abdominal pain
– How long have you had ? Where? When did you first feel
pain? What activity were you doing?
– Describe pain. Constant/intermittent? Had episodes
before? Did pain start suddenly?
– Has pain changed location since started? Felt elsewhere?
– Worse when stomach empty? Affected by eating? Worse
at night/day?
– What relieves the pain? Particular position?

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Nausea and Vomiting
• Nausea or vomiting for how long? Frequency?
• How much do you vomit? What does it look like? Contain blood? Have an odor?
• Females: Could you be pregnant?
• Nausea without vomiting?
• Foods eaten in last 24 hours? Where? How long after eating did you vomit?
Anyone else had these symptoms over same time period?
• Other symptoms: Pain? Constipation? Diarrhea? Change in stool/urine color?
Fever or chills?

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Indigestion
• Indigestion/heartburn for how long? Where?
Stomach? Chest? How often?
• What makes it worse? Change of position?
• What relieves the pain? Antacids or acid
blockers?
• Other symptoms: Radiating pain? Sweating?
Lightheadedness?

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Abdominal Distention

• How long? Come and go? Related to


eating? What relieves it?
• Other symptoms: Vomiting? Loss of
appetite? Weight loss? Change in bowel
habits? Shortness of breath? Pain?
– Abdominal girth-- mark

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Change in Bowel Habits
• Describe change: Frequency; consistency of feces?
First notice change? How long? Changed diet?
Changed activity level? What does stool look like—
bloody, mucoid, fatty, watery?
• Other symptoms: Increased gas, pain, fever, nausea,
vomiting, abdominal cramping, diarrhea? Time of day
when occurs—after eating or at night?

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Yellow Discoloration of Eyes or
Skin (Jaundice)
• First noticed? More noticeable? (May be a
normal finding in dark-skinned individuals)
• Associated with abdominal pain, loss of
appetite, nausea, vomiting, fever?
• Blood transfusion/tattoos in past year? Using
IV drugs? Eat raw shellfish, e.g., oysters?
Traveled abroad in last year? Where? Drink
unclean water?
• Has color of your urine or stools changed?

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Problems with Urination
• Describe. Usual pattern of urination? Pain
or burning? Frequency/urgency? When did
it begin?
• Associated symptoms: Fever, chills, back
pain?
• Describe color. Blood in urine?
• Unexpected weight gain? Swelling in
ankles at end of day or shortness of
breath? Urinating less?
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Procedures and Techniques
with Normal Findings
• General appearance
– Observe client’s general behavior and
position
• Abdomen
– Inspect abdomen for skin color, surface
characteristics, contour, and surface
movements
– Pediatric pot-belly normal

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Procedures and Techniques
with Normal Findings
• Inspect surface for movements
– Peristalsis not visible—midline pulsation if thin
– Client raises head—rectus abdominus muscle
prominent with midline bulge
• If ostomy—remove bag; inspect stoma
– Red/moist, area were bag is attached to skin;
well healed, without lesions

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Procedures and Techniques
with Normal Findings
• Auscultate for bowel sounds
– Auscultate before palpating/percussing
– Quiet environment
– Use diaphragm and press lightly in all 4 quadrants
• Diaphragm of stethoscope—systematically
– Sounds every 5-15 seconds, last 1 to several seconds
– High pitched gurgles/clicks

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Procedures and Techniques
with Normal Findings
• Palpate abdomen (light) for tenderness, muscle
tone, and surface characteristics
– All quadrants—pads of fingers; 1-2 cm
– No tenderness, muscles should be relaxed (anxious
clients may have muscle resistance on palpation)
– If abdominal pain, palpate area of pain last

– Follow with percussion in some situations

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Age-Related Variations:
Older Adults
• Health history
– Had abdominal pains not felt before recently?
– Constipation? How defined? Liquids
drunk/day? Bulk or fiber eaten? Taking
laxatives? How often?
– Do you unintentionally leak urine? When?
What do you do to stay dry?

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Age-Related Variations:
Older Adults
• Examination: procedures and techniques
same as those for younger adult
• Normal and abnormal findings
– Increased fat deposits over abdomen/less
subcutaneous fat over extremities
– Abdomen soft (loss of abdominal muscle
tone)—organ palpation easier
– Note distention/concavity associated with
general wasting signs or anteroposterior rib
expansion

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Common Problems
Alimentary Tract
• Gastroesophageal reflux disease GERD
– Flow of gastric secretions up into esophagus
– Weakened lower esophageal pressure or
increased intraabdominal pressure
– Complaints of gnawing epigastric pain with
some reference, regurgitation, and dysphagia
(difficulty swallowing) that are aggravated by
lying down or relieved by sitting up, taking
antacids, or eating
– IBS– increase after eating due to perstalsis
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Common Problems
Hepatobiliary System

• Viral hepatitis A–– feces


• Hepatitis B, C– blood borne

• Immunization for Hepatitis B and


recommended at birth.

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Common Problems
Hepatobiliary System
• Cirrhosis – chronic degenerative disease of the
liver– jaundice maybe, liver enzyme changes
• Cholecystitis- inflammation of the gallbladder,
RUQ pain, light colored stools
• Pancreatitis– acute or chronic inflammation of
the pancreas, pain dull or sharp and steady,
fatty stools.

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Common Problems
Urinary System
• Urinary tract infections-pain on voiding,
pain (dysuria) can progress to
pyelonephritis (flank pain, fever)
• Nephrolithiasis– kidney stones– fever,
hematuria– severe pain
• Acute renal failure– sudden increase in
BUN, Creatinine, decreased u/o
• Chronic renal failure- slow onset of
symptoms above usually caused from
another chronic condition-- edema
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