To take in, break down and absorb nutrients to be used by all cells of the body

Surface mucosal cells mucus Mucous neck cells mucus Parietal cells HCl acid & intrinsic factor Endocrine cells gastrin Chief cells - pepsinogen

3 Phases: 1. Cephalic Phase

Anticipatory & prepares

the stomach to receive food

2. Gastric Phase
period of greatest gastric

secretion Activated by the presence of food in the stomach

3. Intestinal Phase

3 Phases: 1. Cephalic Phase 2. Gastric Phase 3. Intestinal Phase

Primarily inhibits

gastric secretion Presence of acidic chyme into the duodenum

Digestion Excretion Nutrient Storage Nutrient conversion Detoxification of harmful chemicals Synthesis of new molecules

Produce bicarbonate ions which neutralizes acidic chyme Release of pancreatic enzymes for the digestion of all major classes of food.

Absorbing water Secreting mucus Eliminating wastes (defecation)

Developmental Psychosocial Cultural & Environmental

Present Illness COLDSPA > Character > Onset > Location > Duration > Severity > Pattern > Associated Factors

PQRSTU
Provocative/Palliative Quality/Quantity Region/Radiation Severity Scale Timing Understanding Patients

Perception

Bowel elimination > Have you experienced a change in bowel elimination? > Do you have any accompanying symptom? Have you experienced any yellowing of your skin or whites of your eye? Itchy skin? Dark urine? Clay-colored stool?

Past Health History Have you ever had any of the following? > Ulcers > liver disease > appendicitis > gallbladder disease Have you ever had hepatitis? Have you ever had abdominal surgery or trauma to the abdomen?

Family History Is there a history of any of the following diseases or disorders in your family? > colon > stomach > liver > kidney > bladder cancer > gallbladder dse

Lifestyle & Health Practices Do you drink alcohol? How much? How often? Do you smoke? How many packs/day? What type of foods & how much of food do you typically consume each day? What kind of stress do you have in your life? How does it affect your elimination? If you have a GI disorder, how does it affect your lifestyle?

Good light Relaxed patient

The patient should not have a full bladder Make the patient comfortable in a supine

position, with a pillow for the head & perhaps another under the knees. Patients arms should be at the side or folded across the chest Before palpation, ask the patient to point any areas of pain, & examine tender areas last

 Monitor your examination by watching the patients

face for signs of discomfort Have warm hands, warm stethoscope and short fingernails Approach slowly & avoid quick, unexpected movements Distract the patient with conversation or questions If the patient is very frightened or very ticklish, begin palpation with his or her own hand beneath yours. In a few moments you can slip your hand underneath to palpate directly.

Full exposure of the abdomen ( above the xiphoid process to the symphysis pubis)

Skin
Color Striae Scars Dilated veins Rashes & lesions

The umbilicus

CULLENS SIGN

Peritoneal Bleeding Gray blue area at abdomen & periumbilical area

Ex: ruptured ectopic pregnancy

TURNERS SIGN

Peritoneal Bleeding Gray blue at flank area

Contour of abdomen
Flat, rounded, scaphoid or protruberant Do the flanks bulge or are there any local bulges? Symmetry Visible organs or masses

* When looking at the contour of the abdomen, it is helpful to sit or bend down so that you can view the abdomen tangentially.

Measuring abdominal girth: (1) Measure abdominal girth at the same time of the day (2) Ideal position standing; otherwise supine position (3) Use a tape measure (4) Place the tape measure behind the client & measure at the umbilicus. (5) Record the distance (6) Take all future measurements at the same location

Peristalsis Pulsations

Listening to:
bowel sounds vascular sounds friction rubs

* Auscultate before percussing & palpating, because the later techniques could alter peristaltic action

Bowel sounds series of intermittent, soft clicks & gurgles heard at a rate of 5 to 30/min.
Hypoactive slow & sluggish Hyperactive loud, high-pitched & rushing Absent paralytic ileus

* Borborygmi normal hyperactive sounds described as loud, prolonged gurgles characteristic of stomach growling

Approach:
Use the diaphragm of the stethoscope Apply light pressure or simply rest the

stethoscope on tender areas Begin in the RLQ & proceed clockwise

Approach:
Use the bell of the stethoscope Begin at the midline below xiphoid process then

proceed from side to side over renal, iliac & femoral arteries

* Bruit low-pitched, murmur like sounds - note for timing

Approach:
Use the diaphragm of the stethoscope Listen over the R & L lower rib cage Listen for a high-pitched, coarse, grating sound =

Friction Rub

SOUND

LOCATION Any quadrant

CAUSATIVE FACTOR Gastroenteritis, diarrhea

Bowel Sounds Hyperactive sounds

Hyperactive sounds ffd by absence of sound High-pitched sound w/ cramping Vascular Sounds Systolic Bruit (blowing)

Any quadrant
Any quadrant Midline below xiphoid L & R lower costal borders @ clavicular line L & R abdomen @ clavicular line bet. Umbilicus & ant. Iliac spine Epigastrium & around umbilicus L & R upper quadrants over liver & spleen

Paralytic ileus
Intestinal obstruction Aortic arterial obstruction Stenosis of renal arteries Stenosis of iliac arteries Portal Hypertension Tumor or inflammation of organ

Venous Hum (continuous tone) Rubbing Friction Rub ( harsh,

Assess amount & distribution of gases Identify possible masses Estimate size of liver & spleen

PERCUSSION Percuss for tone

Approach:
> lightly & systematically percuss all quadrants beginning in the RLQ. > Percuss tender areas last

tympany over the abdomen normal dullness liver & spleen, nonevacuated

descending colon hyperresonance gaseous distended abdomen enlarged area of dullness enlarged liver or spleen abnormal dullness distended bladder, large masses or ascites

To determine the upper & lower borders of the liver at the AAL, MCL & MSL. (1) Begin at the level below the umbilicus extended MCL RLQ and percuss upward tympanic to dull = lower border (costal margin) (2) Percuss downward from 4th ICS right MCL resonant to dull = upper border (6th ICS) * Liver span 5 -10cm (2-4in) (3) Percuss along the MSL 4 9 cm (1.5 3in)

To determine the descent of the liver

ask pt. to deep breath & repeat procedure

* dullness may descend from 1 -4cm below the costal margin

Enlarged spleen percuss lowest interspace in left anterior axillary line Ask patient to take a deep breath & repeat A change from tympany to dullness suggests splenic enlargement.

To determine:
organ size & placement muscle tightness masses tenderness presence of fluid

Correct method of palpation. hand is held flat & relaxed & 'molded' to abdominal wall

Incorrect Method of Palpation. hand is held rigid & mostly not in contact with abdominal wall.

Light palpation on 4 quadrants then Deep palpation on 4 quadrants Obese: use bimanual palpation

Palpate the aorta Palpate for rebound tenderness > Blumbergs sign > Rovsings sign Percuss the abdomen for ascites Test for psoas sign Test for Murphys sign Test for cutaneous hyperesthesia

Blumbergs sign (peritonitis)

pain on abrupt

release of steady pressure over site of suspected abd lesion Emergency case

Appendicitis

(+) = right hypogastric pain Irritation of the obturator muscle by an inflamed appendix

Patient supine Examiners hand above patients right knee Client to raise leg to meet the hand abd pain (abnormal) Appendicitis/ peritoneal irritation

Pick up a fold of skin Maneuver is painless Localized pain = appendicitis

Liver palpation, patient takes deep breath Painless liver palpation (normal) Sharp abd pain (abnormal)

Cholecystitis

(gallbladder)

DISORDER Appendicitis

PAIN CHARACTERISTICS Epigastric & periumbilical Localizes to RLQ Sudden onset RUQ, radiates to right scapula Sudden onset Cramping LLQ Radiates to the back Aching, gnawing, epigastric Fullness in the rectal area Abdominal cramping, unilateral pain Epigastric pain Heartburn, chest pain

Cholecystitis Diverticulitis Duodenal Ulcer Ectopic Pregnancy Gastritis GERD

OBESITY

GASEOUS DISTENTION

TUMOR

ASCITES

Fluid wave test

SHIFTING DULLNESS

UMBILICAL HERNIA

VENTRAL HERNIA

HIATAL HERNIA

MALNUTRITION

OBESITY

ANOREXIA NERVOSA

BULIMIA

ESOPHAGEAL CANCER

GASTRIC CANCER

COLON CANCER

SUBJECTIVE DATA

OBJECTIVE DATA

States appetite is good, no dysphagia, no food intolerance, no abdominal pain. Has 1 2 formed bowel movement/day.

Abdomen flat, symetric, no visible mass or bulging. Umbilicus midline & inverted. Bowel sounds present in all quadrants, no bruit. Tympany predominates in all 4 quadrants, liver span is 6cm in right MCL. Abdomen soft, no masses, no tenderness

SUBJECTIVE DATA

OBJECTIVE DATA

General abdominal pain at 8/10 accompanied by nausea & vomiting . non projectile.

Absence of bowel sounds. Tympanic & tenderness felt over RLQ on palpation. Abdominal guarding observed , rebound tenderness present in RLQ. Positive iliopsoas muscle & obturator test. BP 110/70. Temp. 38.3C, PR 107/min, RR 18/min.