GI&GU

• Surface landmarks


  • Borders of abdominal cavity
  • Abdominal muscles
  • Linea alba
  • Rectus abdominis
  • Internal anatomy (viscera)
  • Solid viscera
  • Liver
  • Pancreas
  • Spleen
  • Adrenal glands
  • Kidneys
  • Ovaries
  • Uterus
• Hollow viscera


  • Stomach
  • Gallbladder
  • Small intestine
  • Colon
  • Bladder
• Abdominal wall divided into four quadrants

  • Right upper quadrant (RUQ)
  • Left upper quadrant (LUQ)
  • Right lower quadrant (RLQ)
  • Left lower quadrant (LLQ)
• Cultural and Social Considerations

  • Prevalence of lactose intolerance
  • Rates of celiac disease
  • Gastroesophageal reflux disease (GERD) and modifiable risk factors
  • Peptic ulcer disease (Canada has the highest incidence in the world)
  • Inflammatory bowel disease (Canada has one of the highest rates)
  • Relationship of hepatitis A and GI illnesses to socioeconomic factors
• Subjective Data: Health History

  • Appetite
  • Dysphagia
  • Food intolerance
  • Abdominal pain
  • Nausea/vomiting
  • Bowel habits
  • Past abdominal history
  • Medications
  • Alcohol and tobacco
  • Nutritional assessment
• Promoting Health: Hepatitis Risk


  1. Practice safe sex

  2. Do not share items that may have bodily fluids on them

  3. Be aware of environment

  4. Watch diet and weight

  5. Travel wisely

  6. Use medications wisely

  7. Do not mix medications without consulting a health care provider

  8. Drink alcohol in moderation
• Objective Data: Physical Exam

  • Inspect
  • Auscultate
  • Abdomen—Percuss
• Objective Data: Physical Exam – Abdomen

  • Contour
  • Symmetry
  • Umbilicus
  • Skin
  • Pulsation or movement
  • Hair distribution
  • Demeanor
  • Bowel sounds
  • Vascular sounds (bruits)
  • General tympany
• Objective Data: Physical Exam – Palpation


  • Surface and deep areas—Palpate
  • Measures to enhance muscle relaxation
  • Light palpation
  • Voluntary guarding
  • Deep palpation
  • Bimanual palpation
  • Location, size, and shape
  • Consistency and surface
  • Mobility
  • Pulsatility
  • Tenderness
  • Liver
  • Usual technique
  • Hooking technique
  • Spleen
  • Kidneys
  • Aortic pulse
• Normal Range of Findings

  • Rebound tenderness (Blumberg's sign)
  • Inspiratory arrest (Murphy's sign)
  • Iliopsoas muscle test
  • Obturator test
  • Ascites
  • Fluid wave
  • Shifting dullness
• Abnormal Findings


  • Abdominal distension
  • Obesity
  • Air or gas
  • Ascites
  • Ovarian cyst
  • Pregnancy
  • Feces
  • Tumour
  • Liver: RUQ or epigastrium
  • Esophagus: midepigastrium or lower sternum
  • Gallbladder: right or left scapula
  • Pancreas: midepigastric, radiating to back
  • Duodenum: does not radiate
  • Stomach: epigastric, radiates to back or substernal
  • Appendix: periumbilical, shifts to RUQ
  • Kidney: flank or lower abdominal
  • Small intestine: diffuse abdominal
  • Colon: lower abdomen
  • Umbilical hernia
  • Epigastric hernia
  • Incisional hernia
  • Bowel sounds
  • Succussion splash(sloshing sound)
  • Hypoactive bowel sounds
  • Hyperactive bowel sounds
  • Vascular sounds
  • Arterial
  • Venous hum
  • Enlarged liver
  • Enlarged nodular liver
  • Enlarged gallbladder
  • Enlarged spleen
  • Enlarged kidney
  • Aortic aneurysm
• Structure and Function: Anus & Rectum

  • Anal canal
  • Rectum
• Subjective Data: Health History

  • Usual bowel routine
  • Change in bowel habits
  • Rectal bleeding or blood in the stool
  • Medications (laxatives, stool softeners, iron)
  • Rectal conditions (pruritis, hemorrhoids, fissure, fistula)
  • Family history (cancer)
  • Self-care behaviours (diet high in fiber, most recent exams)
• Objective Data: Inspection


  • Positioning
  • Perianal area
• Health Promotion: Colorectal Cancer Screening

  1. Recommendations for screening

  2. Risk factors
• Structure and Function (1 of 3)

  • Penis
  • Corpora cavernosa
  • Corpora spongiosum
  • Glans
  • Corona
  • Urethra
  • Foreskin
• Structure and Function (2 of 3)

  • Scrotum
  • Rugae
  • Cremaster/dartos muscles
  • Testis
  • Epididymis
  • Vas deferens
  • Spermatic cord
  • Ejaculatory duct
• Structure and Function (3 of 3)

  • Inguinal area
  • Inguinal ligament
  • Inguinal canal
  • Internal ring
  • External ring
  • Femoral canal
• Subjective Data: Health History

  • Frequency, urgency, and nocturia
  • Dysuria
  • Hesitancy and straining
  • Urine colour
  • Past genitourinary history
  • Penis: pain, lesion, discharge
  • Scrotum: self-care behaviours, masses
  • Sexual activity and contraceptive use
  • STI contact
• Subjective Data: Additional Questions

  • Infants and children
  • Preadolescents/Adolescents
  • Older adults
• Interviewing Adolescent Male Patients

  1. Ask questions appropriate for a boy's age, but be aware that norms vary widely

  2. Ask direct, matter-of-fact questions; avoid sounding judgemental

  3. Start with a permission statement

  4. Try the ubiquity approach

  5. Open the door to later conversation

  6. Preadolescents and Adolescents
• Objective Data: Physical Exam & Preparation

  • Preparation
• Subjective Data: Additional Questions

  • Infants and children: Urination, Toilet training, Abnormalities, Molestation
  • Preadolescents/Adolescents: Puberty, Nocturnal emission, Erotic feelings, Sexual activity, Self-examination, Molestation
  • Older adults: Prostate enlargement, Incontinence, Nocturia, Sexual function
• Interviewing Adolescent Male Patients

  1. Ask questions appropriate for a boy's age, but be aware that norms vary widely

  2. Ask direct, matter-of-fact questions; avoid sounding judgemental

  3. Start with a permission statement ("Often boys your age experience…")

  4. Try the ubiquity approach ("When did you…" rather than "Do you…")

  5. Open the door to later conversation
• Preadolescents and Adolescents

  • "Around age 12 to 13 years, …"
  • "Who can you talk to …?"
  • "Boys around age 12 to 13 years have a normal experience …"
  • "Has a nurse or doctor ever taught you …?"
  • "Has anyone ever touched your genitals …?"
• Objective Data: Physical Exam & Preparation

  • Preparation: Position, Apprehension regarding exam
  • Equipment needed: Gloves, Occasionally need: glass slide for urethral specimen, Materials for cytology, Flashlight
• Objective Data: Inspect & Palpate

  • Penis: Skin, Glans, Urethral meatus, Pubic hair, Urethral discharge, shaft
  • Scrotum: Skin, Testis, Epididymis, Spermatic cord, Masses: note characteristics; transillumination
• Objective Data: Hernia & Lymph Nodes

  1. Check for hernia: Patient standing and straining down, Palpation technique

  2. Check inguinal lymph nodes: Horizontal chain along groin and vertical chain along upper inner thigh
• Urine Output


  Normally 1500 mL/day, Moderate distension and urge to urinate with 200 – 250 mL
• Objective Data: Urine Output

  • Assessment with indwelling catheter: Monitor for signs and symptoms of catheter-acquired urinary tract infection (CAUTI), Discuss signs and symptoms of UTI, Risk factors: prolonged catheterization, female gender, diabetes, malnutrition, old age, and impaired immunity, Proper anchorage
• Developmental Considerations (1 of 2)

  • Infants: Descent of testes
  • Adolescents: Signs of puberty, Tanner's sexual maturity rating
  • Adults and older adults: Sperm production begins to decrease at 40 years, Testosterone declines gradually after age 55 years, Slower and less intense sexual response, Sexual expression in later life, Physical changes do not interfere with libido
• Developmental Considerations (2 of 2)


  • Infants and children: Observe first voiding, if possible, If uncircumcised, foreskin tight in first 3 months, Strong cremasteric reflex in infant, Importance of documentation of findings on palpation of testes, Careful inspection of inguinal area for bulge
  • Adolescents: Note normal development of genitals by using sexual maturity rating charts
  • Older adults: Thinner, greying pubic hair; decreased penis size, Excoriation of scrotal skin
• Cultural Considerations


  • Circumcision of male infants – religious and cultural values, No medical indication for male neonatal circumcision, Reduces infection by human immunodeficiency virus (HIV), herpes simplex virus type 2 (HSV-2), prevalence of human papilloma virus (HPV); decreases risk for sexually transmitted infections (STIs), Parental knowledge of care of uncircumcised penis, HPV vaccination approved for boys and men (in some countries)
• Health Promotion: Self-Care


  Testicular Self-Examination (TSE): Teach for testicular cancer, Early detection results in cure rate of almost 100%, Signs: lump, pain, heaviness, dull ache, Risk factors: Age 15 to 49 years old; delayed descent of testicles; family history; abnormal development of testicles, T = Timing, S = Shower, E = Examination
• Structure and Function


  • Surface anatomy: Location of breasts on chest wall, Axillary Tail of Spence, Nipple and areola
• Subjective Data: Health History

  • Breast: Pain, Lump, Discharge, Rash, Swelling or edema, Trauma, History of breast disease and risk factors, Surgery, Self-care behaviours (e.g. BSE; mammography)
  • Axilla: Tenderness, Lump, Swelling, Rash, Risk factors: Oral contraceptives, Steroids, Estrogen, Caffeine Intake, Level of activity, Alcohol intake, Weight
• Subjective Data: Additional Questions

  • Preadolescents/Adolescents: Female breast changes, Other puberty changes
  • Pregnant women: Breast changes, Plans to breastfeed
  • Menopausal women: Changes in breasts
• Objective Data: Physical Exam & Preparation

  • Preparation: Position, Draping, Equipment needed: Small pillow, Ruler marked in centimeters
• Objective Data: Inspect


  • Breasts: General appearance, Symmetry, Skin, Smooth and even in color, Nipple
  • Axillae: Skin
• Developmental Considerations


  • Adolescence: Puberty, Tanner's staging, Thelarche and menarche
  • Pregnant women: Breast changes are early sign of pregnancy, Collostrum
  • Older women: Menopause and atrophy of tissue
  • Male breast: Gynecomastia