THIS IS ABOUT GASTROINTESTINAL ASSESSMENT

1. WEL COME
PRESENTEDBY
Mr. CHETAN R SANGATI
First YEAR MSc NURSING
Dept OF MEDICAL SURGICAL
SURSING

2. GASTROINTESTINAL ASSESSMENT

3. INTRODUCTION
• The functions of the gastrointestinal (GI) tract
and its accessory organs are essential for life.
• The process of digestion supplies nutrients to
each and every cell in our body. If there is a
disruption in any of these mechanisms, the
whole body suffers.

4. • Once the person get disturbance they will
show symptoms related to GI then the doctor
will go for the physical examination by
fallowing techniques.
• Physical exam techniques such as inspection,
palpation, percussion, and auscultation will
be highlighted.

5. Glossary
• Ascites - An abnormal accumulation of serous
fluid in the abdominal cavity containing large
amounts of protein and electrolytes.
• Bulge - A protruding part; an outward curve or
swelling.
• Cirrhosis - Cirrhosis of the liver is a chronic
disease of the liver characterized by the
replacement of normal tissue with fibrous tissue
and the loss of functional liver cells.

6. • Digestion - The process by which food is
converted into substances that can be absorbed
and assimilated by the body.
• Dysphagia - Difficulty in swallowing.
• Esophageal varices - Abnormally dilated or
swollen vessels in the esophagus, which can
lead to bleeding.
• Food allergy - An abnormally high sensitivity to
certain foods.

7. • Food intolerance - Inability to completely
digest a type of food, usually due to an enzyme
deficiency.
• Hernia - The protrusion of an organ or other
bodily structure through the wall that normally
contains it; a rupture.
• Mass - An aggregate of cells clumped together,
such as a tumor.

8. • Referred pain - Pain sensation
experienced in one part of the body that
is different to the actual area of
pathology.
• Spider nevi (or angioma) - A dilation of
superficial capillaries with a central red
dot from which blood vessels radiate.
• Visceral pain - Pain related to the
internal organs.

9. FOCUSSED GASTROINTESTINAL ASSESSMENT
• While conducting the physical examination on
a patient we should collect the subjective and
objective data of the patient.
• Componentsmayinclude:
• Chief complaint
• Present health status
• Past health history
• Current lifestyle

10. • Psychosocial status
• Family history
• Physical assessment

11. • Communication during the history and physical
must be respectful and performed in a
culturally-sensitive manner. Privacy is vital, and
the healthcare professional needs to be aware of
posture, body language, and tone of voice while
interviewing the patient . Take into
consideration that a patient’s ethnicity and
culture may affect the history that the patient
provides.

12. Gastrointestinal history tacking
• Gastrointestinal disease usually manifests as the
presence of one or more of the following:
•Change in appetite
•Weight gain or loss
•Dysphagia
•Intolerance to certain foods
•Nausea and vomiting
• Changing in bowel movement
• Abdominal pain

13. APPETITE
• Ask your patients if they have had any changes in
appetite or food intake. If they have, ask for more
information about the change. Appetite and eating can
be influenced by many factors that may indicate
gastrointestinal disease or that can be attributed to
socioeconomic considerations such as food availability,
family norms, peers, and cultural practices. A loss of
taste sensation can contribute to loss of appetite and
potentially result in poor nutrition, especially in older
individuals

14. Weight Loss or Gain
• Weight loss may be associated with
illness and weight gain may associated
with fluid retention.

15. Dysphagia
• Ask your patient if they have any difficulty
swallowing and when the difficulty first
occurred. More than 50 pairs of muscles and
many nerves work to move food from the mouth
to the stomach. It is important to note what the
patient has difficulty swallowing (e.g. solids
versus liquids), and the area that the patient feels
is where food gets “stuck

16. • People with nervous system problems and head
injuries ,cerebral palsy , Parkinson's disease
will leads to dyspegia.

17. Intolerance to food
• Food intolerance may be related to disorders such
as celiac disease, insulin-dependent diabetes, and
inflammatory bowel disease. Symptoms of
intolerance to a particular food might include
stomach discomfort, gas, bloating, flatulence,
pain, and diarrhea.

18. NAUSEA AND VOMITING
• Nausea and vomiting can be side effects of
medications, a manifestation of many diseases,
and can occur frequently in early pregnancy. Ask
your patients about the frequency of these
symptoms. Nausea and vomiting may also
indicate food poisoning. Questions about types of
food eaten in the past 24 hours should be asked to
rule out potential poisoning.

19. • If vomiting is present, you will want to ask
about the amount, frequency, color, and
odor of the vomitus.
• Ask if there is any blood in the vomit or if
the vomit appears to be like coffee grounds.
• Hematemesis, or blood in the vomitus, is a
common symptom of gastric or duodenal
ulcers and may also indicate esophageal
varices.

20. PAST GI DISEASE
• Ask about any past history of gastrointestinal
disorders such as ulcers, gall bladder disease,
hepatitis, appendicitis, hernias.
• Ask the patient if they received treatment and if
the treatment was successful.
• History should also include past abdominal
surgeries, any abdominal problems after the
surgery, and abdominal x-rays or tests (including
colonoscopy) and their results .

21. Medication history
• Many medications can produce gastrointestinal
symptoms. Almost every class of drugs has the
potential for gastrointestinal side effects. Most of
the side effects include nausea, vomiting,
diarrhea, and/or constipation.
• Aspirin and non-steroidal anti-inflammatory
drugs (NSAIDs) may cause abdominal pain and
may increase the likelihood of gastrointestinal
bleeding.

22. SOCIAL HISTORY AND LIFE RISK FACTORS
• In taking a complete history, it is important to
address lifestyle risk factors and social behaviors
that may contribute to unhealthy lifestyles and
increase the risk of gastrointestinal disorders.
• Ask your patients about the frequency and
duration of alcohol consumption, caffeine intake,
and cigarette smoking at this time.

23. Nutritional assessment
Nutritional assessment should be done for the
patient
• Recent unintentional weight loss
• Chemotherapy or radiation
• Recent weight gain
• Food allergies or intolerance
• Decreased appetite
• Multiple medications
• Alterations in sense of taste

24. Physical examination
• Inspection is first, as it is non-invasive.
Auscultation is performed following inspection;
the abdomen should be auscultated before
percussion or palpation to prevent production of
false bowel sounds.
• For accurate assessment of the abdomen, patient
relaxation is essential.
• The patient should be comfortable with knees
supported and arms at the sides, and should have
an empty bladder.

25. • The environment should include a comfortable
temperature, with good light.
• INSPECTION:
 Visualization of the entire of the abdomen.
The abdomen divided in to four or nine
quadrants.

26. Inspect for the abdomen for
• Bulges
• Masses
• Hernias
• Ascites
• Spider nevi
• Enlarged veins
• Pulsations or movements
• Inability to lie flat

27. • Normally, blood vessels are not evident on the
abdomen. However they may be present in the
elderly or pregnant client due to the loss of
subcutaneous fat.
• During inspection ask your patient to lift their
head slightly. If you notice a protrusion around
the umbilicus or any incisions, a hernia may be
present

28. Auscultation
• You should always auscultate the abdomen after
inspection and before percussion or palpation so
you do not produce false bowel sounds by
percussion or palpation.

30. Physical examination percussion
• Percussion is used to elicit tenderness or sounds
that give clues to underlying problems. When
percussion directly over suspected areas of
tenderness, monitor the patient for signs of
discomfort.

31. • “Press the distal part of the middle finger of your
non-dominant hand firmly on the body part.
• Keep the rest of your hand off the body surface.
• Flex the wrist, but not the forearm, of your
dominant hand.
• Using the middle finger of your dominant hand,
tap quickly and directly over the point where your
other middle finger contacts the patient’s skin,
keeping the fingers perpendicular. Listen to the
sounds produced.”

32. Percussion of the abdomen
• When examining the abdomen, percuss for
general tympany, liver span, and splenic
dullness.
• Tympany should be the predominant sound
when percussing the abdomen.
• Air “floats” to the top of the abdomen in the
supine position and tympany reflects a drum-like
sound
• Dullness is usually heard over solid organs or
masses such as the liver, spleen, or a full bladder

33. Percussion of kidney
• Percussing over the kidneys does not usually
produce pain or discomfort.
• If tenderness is present, a urinary tract infection
or kidney inflammation may be present.
• Costovertebral angle tenderness may be elicited
when the patient is in a standing or upright
position.
• Place the palm of your non-dominant hand near
the posterior costovertebral margin over the
kidney.

34. Physical examination palpation
• Palpation is another commonly used physical
exam technique that requires you to touch your
patient with different parts of your hand using
different strength pressures. During light
palpation, you press the skin about ½ inch to ¾
inch with the pads of your fingers.

35. • Palpation allows you to assess for tenderness,
temperature, moisture, pulsations, masses, and
internal organs.

36. Abdominal Pain
Introduction
• If your patient is experiencing abdominal
pain, have them point to the exact location of
the pain.
• Abdominal pain can be classified as:
• Visceral
• Parietal
• Referred

37. Visceral Pain
• Visceral pain is usually described as dull, crampy,
squeezing, or aching. It can be constant or
intermittent.
Parietal Pain
• Parietal pain is usually from inflammation over
the peritoneum. Peritoneal inflammation usually
indicates an underlying emergency and should be
assessed quickly. Parietal pain is usually intense,
constant, and on one side.

38. Mnemonic for pain assessment (pqrst)
• P- Provocative or Palliative: What makes the pain
or symptom(s) better or worse?
• Q- Quality: Describe the pain or symptom(s)
(burning, dull, sharp)
• R- Region or Radiation: Where in the body does
the pain or symptom(s) occur? Is there radiation
or extension or the pain or symptom(s) to another
area of the abdomen?

39. • S-Severity: On a scale of 1-10, (10 being the
worst) how bad is the pain or symptom(s)?
Another visual pain scale may be appropriate
for patients that are unable to identify with this
scale.
• T- Timing: Does it occur in association with
something else? (e.g. eating, exertion,
movement)

40. Assessing Abdominal Pain:MuscleTests
• The patient history is extremely important in
assessing abdominal pain. Pain may be chronic or
acute and related to inflammation, infection,
allergy, or food intolerance.

41. • Iliopsoas Muscle Test
• The iliopsoas muscle test is used most often when
acute abdominal pain is present and appendicitis is
suspected.
• When your patient is lying in the supine position
ask him or her to lift their right leg straight up,
flexing only at the hip. Push down on the lower
part of the thigh when your patient is trying to
hold their leg up. If the patient feels pain in the
iliopsoas muscle (the right lower quadrant of the
abdomen) the test is positive and may indicate a
perforated or inflamed appendix.

42. • The Obturator Test
• The obturator muscle test is also performed when
acute abdominal pain is present and appendicitis
is suspected. When your patient is lying in the
supine position ask him or her to lift their right
leg straight up, flexing at the hip, and 90 degrees
at the knee. Hold the ankle and rotate the leg
internally and externally. If the patient feels pain
in the area of the internal obturator muscle (the
right lower quadrant of the abdomen and pelvis)
the test is positive and may also indicate a
perforated or inflamed appendix

43. COMMON LABRORATRY VALVUES

44. • Conclusion
• Digestion, transport, and absorption are the
processes by which the digestive system supplies
nutrients to each and every cell of our body. If
there is a disruption to this process, the whole
body suffers.
• By asking specific questions about a patient’s
gastrointestinal history and performing focused
abdominal exam techniques for your adult patient,
you will be able to assess for the slightest changes
in gastrointestinal function.

45. • Alterations in your gastrointestinal assessment
findings could indicate potential problems.
• Being knowledgeable about the focused,
gastrointestinal assessment will allow you to
intervene quickly and appropriately for
gastrointestinal disorders.

46. • REFERENCES
• Caple, C. (2011). Physical assessment:
Performing- cultural considerations. Glendale,
CA: Cinahl Information Systems.
• Jarvis, C. (2011). Physical examination and health
assessment, (6th ed.). St. Louis: W.B. Saunders.
• Merck Manual Online (2013). Retrieved August
2013 from www.merck.com.
• National Institute of Health [NIH] (2011).
Dysphagia. Retrieved August, 2014 from:
http://www.nidcd.nih.gov/health/voice/pages/dys
ph.aspx.

47. • Mosby Company. (2012). Mosby’s medical
dictionary (9th ed.). New York: Elsevier.
• Shaw, M. (2012). Assessment made incredibly easy
(5th ed.). Philadelphia, PA: Lippincott Williams &
Wilkins.
• Venes, D. (ed.) (2013). Tabers® cyclopedic medical
dictionary (22nd ed.). Philadelphia: F.A. Davis Co.
• At the time this course was constructed all URL's in
the reference list were current and accessible.
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