Assessment of the gastro intestinal system instrumental methods of examination
Download
1 / 37

Assessment of the gastro-intestinal system. Instrumental methods of examination. - PowerPoint PPT Presentation


  • 121 Views
  • Uploaded on

Assessment of the gastro-intestinal system. Instrumental methods of examination. Introduction. why assess the abdomen in the prehospital setting? abdominal pain accounts for up 10% of emergency visits 15-30% of patients with an acute abdomen will require a surgical procedure. Anatomy.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Assessment of the gastro-intestinal system. Instrumental methods of examination.' - iman


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Introduction methods of examination.

  • why assess the abdomen in the prehospital setting?

  • abdominal pain accounts for up 10% of emergency visits

  • 15-30% of patients with an acute abdomen will require a surgical procedure


Anatomy methods of examination.

  • Gastrointestinal system involves the esophagus ,stomach, small and large intestines

  • They work with the pancreas liver and gallbladder to convert nutrients from food into energy.

  • Waste is then excreted.


Right Upper Quadrant (RUQ) methods of examination.

  • diaphragm

  • liver

  • gallbladder

  • kidney

  • Hepatic flexure -large colon

  • small intestine

Left Upper Quadrant (LUQ)

  • spleen

  • kidney

  • pancreas

  • stomach

  • Splenic Flexure –large colon

  • small intestine

Right Lower Quadrant (RLQ)

  • appendix

  • large ascending colon

  • ovary

  • uterus

  • bladder

  • small intestine

Left Lower Quadrant (LLQ)

  • descending colon

  • ovary

  • uterus

  • bladder

  • small intestine

Anatomy - 4 Quadrant System


Right Hypochondriac methods of examination.

Epigastric

Left Hypochondriac

Right Lumbar

Umbilical

Left Lumbar

Right Iliac

Hypogastric

(suprapubic)

Left Iliac

Anatomy - 9 Quadrant System

See graphic on next slide


Anatomy - 9 Quadrant System methods of examination.


Assessment of Abdominal pain methods of examination.O-P-Q-R-S-T

ONSET

  • rapid onset of severe pain is more consistent with a vascular catastrophe, passage of a ureteral or gallbladder stone, torsion of the testes or ovaries, rupture of a hollow, viscous, ovarian cyst, or ectopic pregnancy

  • slower onset is more typical of an inflammatory process such as appendicitis or cholecystitis


Assessment of Abdominal pain methods of examination.O-P-Q-R-S-T

Provokes / palliates

  • pain provoked/aggravated by movement, such as hitting bumps on the road or walking is typical of somatic (parietal) peritoneal pain such as that seen in pelvic inflammatory disease or appendicitis

  • eating often relieves ulcer related pain

  • eating exacerbates biliary colic – especially fatty foods (usually 1-4 hours following a meal)

  • Pancreatitis is palliated (relieved) by curling up in a fetal position

  • frequent movement or writhing in pain is more typical of renal colic


Assessment of Abdominal pain methods of examination.O-P-Q-R-S-T

Quality

  • dull, achy or crampy is more likely to be visceral

  • sharp, stabbing pain is more likely to be somatic or peritoneal

  • severe tearing pain is classic of dissecting aneurysm


Assessment of Abdominal pain methods of examination.O-P-Q-R-S-T

Region / radiation

  • location of pain can vary with time

  • periumbilical pain that migrates to the right lower quadrant is classic of appendicitis

  • epigastric pain localizing to the right upper quadrant for several hours is typical of cholecystitis


Assessment of Abdominal pain methods of examination.O-P-Q-R-S-T

Severity

  • the patient’s quantification of severity of pain is generally unreliable for distinguishing the benign from the life-threatening

  • assigning a 1-10 pain scale rating does however allow for a baseline to gauge the patient’s response to treatment

  • pain that increases in severity over time suggests a surgical condition

  • Severe epigastric or mid-abdominal pain out of proportion to physical findings is classic for mesenteric ischemia or Pancreatitis


Assessment of Abdominal pain methods of examination.O-P-Q-R-S-T

Timing

  • crampy pain that comes in waves is generally associated with obstruction of a viscous

  • constant pain has a worse diagnostic outcome


Associated signs & symptoms methods of examination.

Nausea & vomiting (N/V)

  • N/V generally associated with visceral disorder

  • excessive vomiting should raise suspicion of a bowel obstruction or Pancreatitis

  • lack of vomiting is common in uterine or ovarian disorders

  • pain present before vomiting is more likely caused by a disorder that will require surgery

  • vomiting that precedes Abdo pain is more likely a gastroenteritis or other non-surgical condition


Associated signs & symptoms methods of examination.

Urgency to defecate

may suggest…

  • intra-abdominal bleeding

  • inflammation/irritation in the recto sigmoid area

  • ectopic pregnancy

  • abdominal aortic aneurysm (AAA)

  • retro peritoneal hematoma

  • omental vessel hemorrhage


Associated signs & symptoms methods of examination.

Anorexia

  • intra-abdominal inflammation

  • common in appendicitis


Associated signs & symptoms methods of examination.

Change in bowel habits

  • diarrhea with vomiting is almost always associated with gastroenteritis

  • diarrhea may occur with Pancreatitis, Diverticulitis and occasionally Appendicitis

  • bloody stool indicates GI bleed

  • constipation or difficulty passing stool or gas may be due to an ileas (impairment in paristalsis) of bowel obstruction


Associated signs & symptoms methods of examination.

Genitourinary symptoms

  • dysurea, urgency and frequency are suggestive of cystitis (inflammation of the bladder), salpingitis, diverticulitis or appendicitis

  • Hematurea with pain suggests urinary tract infection, but can also indicate renal colic, prostatitis or cystitis


Associated signs & symptoms methods of examination.

Extra-abdominal symptoms

  • myocardial infarction

  • pneumonia

  • pulmonary embolus

can present with abdominal pain


Assessment techniques
Assessment techniques methods of examination.

  • History

  • Demographic data

  • Family history and genetic risk

  • Personal history

  • Diet history

  • -anorexia

  • -dyspepsia


Physical assessment
Physical assessment methods of examination.

  • Mouth and pharynx

  • Abdomen and extremities

  • -inspection

  • -auscultation

  • -percussion

  • -palpation


Laboratory tests
Laboratory tests methods of examination.

  • Complete blood count

  • Clotting factors

  • Electrolytes

  • Assays of liver enzymes-aspartat and alanin aminotransferase

  • Serum amylase and lipase

  • Bilirubin:the primary pigment in bile


Laboratory tests continued
Laboratory tests ( methods of examination.continued)

  • Evaluation of oncofetal antigens CA19-9 and CEA

  • Urine tests-amylase, urine urobilinogen

  • Stool tests-fecal occult blood test,ova parasites, Clostridium difficile infection.

  • Radiographic examination.


Upper gastrointestinal series and small bowel series
Upper gastrointestinal series and small bowel series. methods of examination.

  • Before test:

  • -maintain NPO for 8 hr

  • -withhold analgesics and anticholinergics for 24 hr.

  • Client drinks 16 ounces of barium.

  • Rotate examination table.

  • After the test:

  • -give plenty of fluids

  • -administer mild laxative or stool softener; stools may be chalky white for 24 to 72 hr.


Barium enema
Barium Enema methods of examination.

  • Barium enema enchances radiographic visualization of the large intestine.

  • Only clear liquids are given 12 to 24 hr before the test; NPO the night before; bowel cleansing is done.

  • After the test,expel the barium:drink plenty of fluids; stool is chalky white for 24 to 72 hr.


Percutaneous transhepatic cholangiography
Percutaneous Transhepatic Cholangiography methods of examination.

  • X-ray study of the biliary duct system

  • Laxative before the procedure

  • NPO for 12 hr before test

  • Coagulation tests, intravenous infusion

  • Bedrest for several hours after procedure

  • Assessment of vital signs

    (Continued)


Percutaneous transhepatic cholangiography continued
Percutaneous Transhepatic Cholangiography methods of examination.(Continued)

  • Client positioned on right side with a firm pillow or sandbag placed against the lower ribs and abdomen


Other tests
Other Tests methods of examination.

  • Computed tomography

  • Endoscopy: direct visualization of the gastrointestinal tract by means of a flexible fiberoptic endoscope


Esophagogastroduodenoscopy
Esophagogastroduodenoscopy methods of examination.

  • Visual examination of the esophagus, stomach, and duodenum

  • NPO for 6 to 8 hr before the procedure

  • Conscious sedation

  • After the test, assessment of vital signs every 30 min

  • NPO until gag reflex returns

  • Throat discomfort possible for several days


Endoscopic retrograde cholangiopancreatography
Endoscopic Retrograde methods of examination.Cholangiopancreatography

  • Visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas

  • NPO for 6 to 8 hr before test

  • Access for intravenous sedation

  • After the test, assessment of vital signs every 15 min

    (Continued)


Endoscopic retrograde cholangiopancreatography continued
Endoscopic Retrograde Cholangiopancreatography methods of examination.(Continued)

  • Return of gag reflex checked

  • Assessment for pain

  • Colicky abdominal pain


Small bowel capsule enteroscopy
Small Bowel Capsule Enteroscopy methods of examination.

  • Visualization of the small intestine

  • Only water for 8 to 10 hr before test

  • NPO for first 2 hr of the testing

  • Application of belt with sensors


Colonoscopy
Colonoscopy methods of examination.

  • Endoscopic examination of the entire large bowel

  • Liquid diet for 12 to 24 hr before procedure, NPO for 6 to 8 hr before procedure

  • Bowel cleansing routine

  • Assessment of vital signs every 15 min

  • If polypectomy or tissue biopsy, blood possible in stool


Proctosigmoidoscopy
Proctosigmoidoscopy methods of examination.

  • Endoscopic examination of the rectum and sigmoid colon

  • Liquid diet 24 hr before procedure

  • Cleansing enema, laxative

  • Position client on left side in the knee-chest posture.

    (Continued)


Proctosigmoidoscopy continued
Proctosigmoidoscopy methods of examination.(Continued)

  • Mild gas pain and flatulence from air instilled into the rectum during the examination

  • If biopsy was done, a small amount of bleeding possible


Gastric analysis
Gastric Analysis methods of examination.

  • Measurement of the hydrochloric acid and pepsin content for evaluation of aggressive gastric and duodenal disorders (Zollinger-Ellison syndrome)

  • Basal gastric secretion and gastric acid stimulation test

  • NPO for 12 hr before test

  • Nasogastric tube insertion


Other tests1
Other Tests methods of examination.

  • Ultrasonography

  • Endoscopic ultrasonography

  • Liver-spleen scan


ad