GIT - Assessment & Diagnostic Tests

Question 1

Assessment

Answer 1

• health history - previous problems
• chief complaint - if pain - onset, duration, characteristics, location, severity
• physical assessment
  
  • inspection
  • auscultation
  • percussion
  • palpation

Question 2

Assessment - Abdomen Divisions

Answer 2

• 4 quadrants +
  
  • right upper quadrant
  • left upper quadrant
  • right lower quadrant
  • left lower quadrant
• 9 regions #
  
  • right hypochondriac region (below the ribs)
  • epigastric region
  • left hypochondriac region
  • right lumbar region
  • umbilical region
  • left lumbar region
  • right iliac region
  • hypogastric region (below the stomach)
  • left iliac region

Question 3

General Assessment

Answer 3

• pain history - PQRST
• indigestion
• intestinal gas
• nausea & vomiting
• change of bowel habits - constipation / diarrhoea
• nutritional patterns - food habits
• weight gain / loss
• medications - prescribed and OTC
• vital signs

Question 4

Physical Assessment - Inspection

Answer 4

• observe position patient assumes - flexing knees, guarding
• start at mouth - status of tongue, wastage, damage, swelling, colour, pallor, teeth
• abdomen - should be flat, if full / distended - gas, fluid, obstruction, constipation, if concave - malnutrition
• 5 F’s - flatus, faeces, fat, feotus, fibroids
• measure girth of abdomen at level umbilicus

Question 5

Physical Assessment - Inspection - Output

Answer 5

• vomiting
  
  • type (projectile)
  • colour (coffee grounds, bright blood)
  • smell (faecal smelling)
  • frequency
  • amount
• faeces
• urine
• NG asperate if inserted for decompression

Question 6

Physical Assessment - Auscultation

Answer 6

• listen for 1-2 minutes
• only after listening for 5 minutes can it be determined that there are NO bowel sounds
• bowel sounds - usually gurgling / clicking

Question 7

Physical Assessment - Percussion / Palpation

Answer 7

• looking for excessive gas, fluid, solid or masses
• 2 middle fingers, striking happens from wrist
• on gas - timpanic or resonate, on fluid - dull, on solid - feel the lump
• palpation - for lumps, pain, guarding, distention

Question 8

Assessment Abnormalities

Answer 8

• mouth
  
  • ulcer, leukoplakia (white or grey patches inside the mouth), herpes simplex, monilia (yeast infection), glossitis (swelling in the tongue), gingivitis (gum disease)
• abdomen
  
  • distention, ascites (buildup of fluid due to liver being unable to filter / get rid of excess), bruit (sound of turbulent blood flow), hyperresonance (exaggeration of resonance), hepatomegaly (enlarged liver), splenomegaly (enlarged spleen)
• oesphagus / stomach
  
  • dysphagia (difficulty swallowing), haematemesis (vomiting blood)
• rectum
  
  • fissue, tenesmus (involuntary frequent spasms of the rectum), steatorrhoea (presence of fat in feces), melaena stool

Question 9

Diagnostic Studies

Answer 9

• most will require empty stomach and / or bowel
• bowel preperations - gylcoprep, low residue diets, laxatives
• common tests:
  
  • barium swallow / enema
  • ultrasound
  • cholangiogram - biliary tract, liver, gallblader, pancreas
  • gastric analysis - gasteroenteritis, bowel obstruction
  • breath tests - intolerances, peptic ulcer diease (urea breath tests)
  • stools tested for fat, blood, pus, paracites
  • endoscopy
  • colonoscopy
  • plain abdo x-ray, CT, MRI
  • FBE