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.
• Medications? What and how often? Taking
as prescribed?
• Do you drink alcohol? How much? How
often? When was last drink?
• Smoke? How much and how long?
Considered stopping or cutting down?
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 Health History:
Present Health Status
• How often do you have a bowel
movement? When was the last one? What
are color and consistency of stool?
• Do you leak urine when cough, laugh, or
exercise? Ever use pads, tissue, cloth in
underwear to catch urine?

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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? Able to
cope with ostomy?

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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: Family History
• Family history of diseases of GI system—
gastroesophageal reflux disease (GERD)?
Peptic ulcer disease? Stomach/colon
cancer?
• Family history of diseases of urinary tract
such as kidney stones? Kidney/bladder
cancer?

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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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 Abdominal Pain
• Pain associated with other symptoms—
stress, fatigue, nausea and vomiting, gas,
eating certain foods, fever, chills,
constipation, diarrhea, rectal bleeding,
frequent urination, or vaginal/penile
discharge?
• Females: Associated with menstrual period?
Last menstrual period? Pregnant?

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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?

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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?
• 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

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 Procedures and Techniques
with Normal Findings
• Surface characteristics: smooth, centrally located
umbilicus
– Striae, scars, faint vascular network
• Contour—sunken, slight protrusion if overweight/
obese
– Adjust light—create shadows; highlight changes
– View at eye level/behind clients head—symmetry
– When lying—cough, inspect for sudden bulge
• If distended, measure abdominal girth
(circumference at superior iliac crests)

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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
• 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

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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
– Flow of gastric secretions up into esophagus
– Weakened lower esophageal pressure or
increased intraabdominal pressure
– Complaints of heartburn, regurgitation, and
dysphagia (difficulty swallowing) that are
aggravated by lying down or relieved by sitting
up, taking antacids, or eating

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 Common Problems
Alimentary Tract
• Hiatal hernia
– Protrusion of stomach through esophageal hiatus
of diaphragm into mediastinal cavity
– Muscle weakness is a primary factor
• Pregnancy, obesity, and ascites
• More common in women and older adults
– Clinical manifestations same as GERD:
heartburn, regurgitation, and dysphagia

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 Common Problems
Alimentary Tract
• Peptic ulcer disease
– Lower end of esophagus, stomach, or
duodenum
• Duodenal ulcer most common; break in mucosa
that forms scar
– Gastric/duodenal ulcers—H. pylori infection
– Gastric ulcers also caused by stress,
medications (corticosteroids, aspirin, NSAIDs)

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 Common Problems
Alimentary Tract
• Diverticulitis
– Inflammation of diverticula, herniations
through muscular wall in colon
– Fecal material through thin-walled diverticula
causes inflammation and abscesses
– Low-fiber diet—risk factor for diverticulitis
– Clinical findings
• Cramping pain in LLQ, nausea, vomiting, and
altered bowel habits, usually constipation
• Abdomen distended and tympanic; decreased
bowel sounds and localized tenderness
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 Common Problems
Hepatobiliary System
• Viral hepatitis: inflammation of liver
• Clinical findings
– Common symptoms: anorexia, vague
abdominal pain, nausea, vomiting, malaise,
and fever
– Enlarged liver and spleen are classic findings
– Liver inflammation may alter bilirubin
conjugation—jaundice (sclera and skin), clay
colored stool, and dark amber urine
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 Common Problems
Hepatobiliary System
• Cirrhosis
– Chronic degenerative liver disease; diffuse destruction/
regeneration of hepatic parenchymal cells
– Lobes of liver become fibrotic/infiltrated with fat
– Causes: viral hepatitis, biliary obstruction, alcohol abuse
– Clinical findings
• Liver becomes palpable and hard
• Associated signs: ascites, jaundice, cutaneous spider
angiomas, dark urine, clay-colored stools, and spleen
enlargement
• End-stage cirrhosis is hepatic encephalopathy and
coma
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 Common Problems
Hepatobiliary System
• Cholecystitis with cholelithiasis
– Inflammation of gallbladder (cholecystitis);
with gallstones (cholelithiasis)
– Bile duct obstructed—edema (inflammation)
or gallstone
– Clinical findings
• Primary symptom is RUQ colicky pain that may
radiate to mid-torso or right scapula
– Indigestion and mild transient jaundice
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 Common Problems
Pancreas
• Pancreatitis
– Acute or chronic inflammation from
autodigestion
– Flow of pancreatic digestive enzymes into
duodenum is obstructed; digestive enzymes act
on the pancreas itself
– Caused by alcoholism or by obstruction of
sphincter of Oddi by gallstones

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 Common Problems
Urinary System
• Urinary tract infections
– Urinary bladder (cystitis), urethra (urethritis), or renal
pelvis (pyelonephritis)
– Gram-negative organisms such as E. coli, Klebsiella
proteus, or pseudomonas
• Originate/ascend from intestine through urethra to
bladder
– More common in women (short urethra); rectal
bacteria colonize perineum and vaginal vestibule
– Sexual intercourse major precipitating factor

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 Common Problems
Urinary System
• Urinary tract infections
– Clinical findings
• Symptoms of urethritis: frequency, urgency, and
dysuria
• Symptoms of cystitis: same plus signs of
bacteriuria/fever
• Clients with pyelonephritis—flank pain, dysuria,
nocturia, and frequency

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 Common Problems
Urinary System
• Glomerulonephritis
– Inflammation of renal glomeruli caused by
autoimmune process
– Clinical findings
• Fever, chills, nausea, malaise, and arthralgia
• Costovertebral angle tenderness is present

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 Common Problems
Urinary System
• Chronic renal failure
– Slow, insidious, irreversible impairment of renal
function
– Uremia develops gradually
– Major causes: diabetic nephropathy,
glomerulonephritis, polycystic kidney disease
– Clinical findings
• Oliguria/anuria; signs of fluid volume overload
(dependent edema, weight gain, and pulmonary
edema)
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