GI/GU

• • •measuring the tube from the tip of the patient’s nose to the tip of the earlobe and then from the tip of the earlobe to the xiphoid process.
• Ng placement

  ***X-ray- most reliable
• liver


  right upper abd.
• spleen


  left upper abd.
• gallbladder


  under the liver
• appendix


  at the end of large intestine right lower abd
• inspection of abd

  
• • Symmetry- should be symmetric
  • ➢Umbilicus- Normally it is midline and inverted, with no sign of discoloration, inflammation, or hernia
  • ➢Becomes everted and pushed upward with pregnancy
  • ➢Umbilicus is common site for piercings in young women; site should not be red or crusted
• • Pulsation or movement
  • ➢Normally you may see pulsations from aorta beneath skin in epigastric area, particularly in thin persons with good muscle wall relaxation
• Auscultate the abdomen is performed before palpation for bowel sounds.  
• Vascular sounds (bruits)

  • Use the bell of your stethoscope 
  • Usually, not present (normal). 
• Percuss the abdomen

  • General tympany
•  Splenic dullness

  • Locate it by percussing for a dull note from the 9th to 11 th  intercostal space just behind the left midaxillary line. 
  • In adults, < 7 cm 
• Costovertebral angletenderness (kidneys)

  • Your client may feel the thump, but should not experience pain. 
• DISTENTION

  Inspection: Single round curve.

  Auscultation: Depends on cause of gas; 

  hyperactive with early intestinal 

  obstruction. 

  Percussion: Tympany over large area.

  Palpation: May have muscle spasm of 

  abdominal wall.+
• DISTENTION

  Auscultation: Depends on cause of gas; 

  hyperactive with early intestinal 

  obstruction. 

  Percussion: Tympany over large area.

  Palpation: May have muscle spasm of 

  abdominal wall.

  
• OBESITY

  Inspection : Uniformly rounded. 

  Umbilicus sunken.

  Auscultation: Regular bowel sounds.

  Percussion: Tympany. Scattered dullness  over adipose tissue. 

  Palpation: Unremarkable. May be hard 

  to feel through thick abdominal wall.

  
• Abnormal Findings

  • Abdominal distention- air, gas, obesity, ascites (fluid collects in spaces within your abdomen), feces
  • Hernia- umbilical, epigastric, incisional
  • Organomegaly- enlarged liver, enlarged spleen 
• 
  

  Inspection

  Contour, symmetry, umbilicus, skin, pulsation or movement, hair distribution, and demeanor

  Auscultation

  Bowel sounds; note any vascular sounds

  Percussion

  All four quadrants and borders of liver and spleen

  Palpation

  Light and deep palpation in all four quadrants, and palpate for liver and spleen
• Urinary Elimination Problems

  • Nocturia- awakening to void one or more times at night 
  • Dysuria- (painful urination)may cause hesitancy 
  • Urinary incontinence (functional, reflex, stress, total, urge)
  • Urinary retention- may have overflow incontinence 
  • Neurogenic bladder