HA LEC GASTRO

• Abdomen


  • Large, oval cavity extending from the diaphragm down to the brim of the pelvis
• Linea alba


  • Midline tendinous seam joining abdominal muscles
• Rectus abdominis


  • Forms a strip extending the length of the midline, and its edge is often palpable
• Anorexia


  Loss of appetite from GI disease as a side effect to some medications, with pregnancy, or with mental health disorders
• Dysphagia


  Difficulty swallowing
• Pyrosis (heartburn)


  Burning sensation in esophagus and stomach, from reflux of gastric acid
• Hematemesis


  Vomiting of blood
• Melena


  Black tarry stool from GI bleeding or nontarry from iron medications
• Hematochezia


  Bright red blood from GI bleeding
• Visceral pain


  Occurs when hollow abdominal organs such as the intestine or biliary tree contract unusually forcefully or are distended or stretched, difficult to localize, palpable near the midline, gnawing, burning, cramping, or aching

  
• Parietal pain


  Steady, aching pain that is usually more severe than visceral pain, more precisely localized over the involved structure, aggravated by movement or coughing

  
• Referred pain


  Felt in more distant sites, which are innervated at approximately the same spinal levels as the inflamed structures, pain of duodenal or pancreatic origin may be referred to the back, pain from the biliary tree, to the right scapular region or the right posterior thorax

  
• Appetite assessment


  1. Any change in appetite?

  2. Is this a loss of appetite?

  3. Any change in weight?

  4. How much weight gained or lost?

  5. Over what time period?

  6. Is the weight loss due to diet?
• Dysphagia assessment


  1. Any difficulty swallowing?

  2. When did you first notice this?
• Food intolerance assessment


  1. Are there any foods you cannot eat?

  2. What happens if you do eat them: allergic reaction, heartburn, belching, bloating, or indigestion?

  3. Do you use antacids? How often?
• Nausea and vomiting assessment


  1. Any nausea or vomiting?

  2. How often?

  3. How much comes up?

  4. What is the color?

  5. Is there an odor?

  6. Is it bloody?

  7. Is nausea and vomiting associated with colicky pain, diarrhea, fever, or chills?

  8. What foods did you eat in last 24 hours?

  9. Where did you eat? At home, school, restaurant?

  10. Is there anyone else in family with same symptoms in last 24 hours?
• Bowel habits assessment


  1. How often do you have a bowel movement?

  2. What is the color and consistency?

  3. Any diarrhea or constipation? How long?

  4. Any recent change in bowel habits?

  5. Use laxatives? Which ones? How often do you use them?

  
• Medications & vices assessment


  1. What medications are you currently taking?

  2. How much alcohol do you drink each day? Each week? When was your last alcoholic drink?

  3. Do you smoke? How many packs per day? For how long?
• Nutritional assessment


  Please tell me all food you ate yesterday, starting with breakfast
• Inspection: Contour


  Describes the nutritional state and normally ranges from flat to rounded
• Inspection: Symmetry


  Shine a light across the abdomen toward you or lengthwise across the person, symmetric bilaterally, note any localized bulging, visible mass, or asymmetric shape
• Hernia


  Protrusion of abdominal viscera through abnormal opening in muscle wall
• Sister Mary Joseph nodule


  A hard nodule in umbilicus that occurs with metastatic cancer of stomach, large intestine, ovary, or pancreas
• Inspection: Skin


  Surface is smooth and even, with homogeneous color, striae (lineae albicantes)—silvery white, linear, jagged marks, no lesions, (+) well-healed surgical scars, veins usually are not seen, but a fine venous network may be visible in thin persons, increased peristaltic waves (intestinal obstruction), increased pulsations of an abdominal aortic aneurysm (AAA) or of increased pulse pressure

  
• Bowel sounds


  High-pitched, gurgling, cascading sounds, occurring irregularly anywhere from 5 to 30 times per minute, not necessary to listen to all quadrants, borborygmi -occasionally you may hear the prolonged gurgles of hyperperistalsis from "stomach growling", a perfectly "silent abdomen" is uncommon - listen for 5 minutes by your watch before deciding if bowel sounds are completely absent
• Vascular sounds


  Normal: None, presence of any vascular sounds or bruits, using firmer pressure, check over the aorta, renal arteries, iliac, and femoral arteries, use the bell of the stethoscope
• Percussion


  Assess the relative density of abdominal contents, to locate organs, and to screen for abnormal fluid or masses, assess the amount and distribution of gas in the abdomen and viscera
• Percussion: General tympany


  Percuss lightly in all four quadrants to determine the prevailing amount of tympany and dullness, move clockwise, tympany should predominate because air in the intestines rises to the surface when the person is supine, hyperresonance is present with gaseous distention
• Percussion: Liver span


  Measure the height of the liver in the right MCL, begin in the area of lung resonance and percuss down the interspaces until the sound changes to a dull quality, mark the spot, usually in the 5th intercostal space, find abdominal tympany and percuss up in the MCL, mark where the sound changes from tympany to a dull sound, normally at the right costal margin, measure the distance between the two marks, the normal liver span in the adult ranges from 6 to 12 cm
• Percussion: Splenic dullness


  Often the spleen is obscured by stomach contents, but you may locate it by percussing for a dull note from the 9th to 11th intercostal space just behind the left midaxillary line, normally is not wider than 7 cm in the adult, now percuss in the lowest interspace in the left anterior axillary line and tympany should result, ask the person to take a deep breath and normally tympany remains through full inspiration
• Percussion: Costovertebral angle tenderness


  To assess the kidney place one hand over the 12th rib at the costovertebral angle on the back, thump that hand with the ulnar edge of your other fist, the person normally feels a thud but no pain, sharp pain occurs with inflammation of the kidney or paranephric area
• Light palpation


  First four fingers close together, depress the skin about 1 cm, make a gentle rotary motion, sliding the fingers and skin together, then lift the fingers (do not drag them) and move clockwise to the next location around the abdomen, form an overall impression of the skin surface and superficial musculature
• Involuntary rigidity


  A constant, boardlike hardness of the muscles. It is a protective mechanism accompanying acute inflammation of the peritoneum
• Deep palpation


  1. Press down about 5 to 8 cm (2 to 3 inches) in all four quadrants

  2. Identify any masses and note their location, size, shape, consistency, tenderness, pulsations, and any mobility with respiration or with the examining hand
• Palpation of the liver


  1. Place your left hand under the person's back parallel to the 11th and 12th ribs and lift up to support the abdominal contents

  2. Place your right hand on the RUQ, with fingers parallel to the midline

  3. Push deeply down and under the right costal margin

  4. Ask the person to breathe slowly

  5. With every exhalation, move your palpating hand up 1 or 2 cm
• Splenomegaly


  An enlarged spleen is friable and can rupture easily with over palpation
• Palpation of the right kidney

  1. Place your hands together in a "duckbill" position at the person's right flank

  2. Press your two hands together firmly and ask the person to take a deep breath
• Palpation of the left kidney


  1. Reach your left hand across the abdomen and behind the left flank for support

  2. Push your right hand deep into the abdomen and ask the person to breathe deeply
• Aortic aneurysm


  Prominent lateral pulsation pushes the examiner's two fingers apart
• Positive fluid wave test


  Blow will generate a fluid wave through the abdomen, and you will feel a distinct tap on your left hand