ADVANCED HEALTH ASSESSMENT

1
ADVANCED HEALTH ASSESSMENT

• Abdominal Assessment
• Heather Hull, ARNP

2
Abdominal Cavity

• Includes esophagus, stomach, intestines, liver,
  gallbladder, pancreas, spleen, kidneys, ureters,
  bladder, uterus, ovaries, fallopian tubes blood
  vessels

3
Abdominal Assessment
4
Most Common Gastrointestinal Problems in Adults

• Peptic Ulcer
• Diverticulitis
• Cancer
• Large bowel
• Colorectal cancer
• Always consider pregnancy in child-bearing age
  female

5
Anatomy Considerations

• GI tract is 27 long
• Mouth
• Esophagus
• 10 inches
• Stomach Fundus, Body Pyloris
• Small intestine 21
• Large intestine 4.5-5

6
Mouth

• Digestion starts in mouth
• Teeth tongue begin breakdown of food
• Salivary enzymes from parotid, sub maxillary
  sublingual glands, primarily begin digestion

7
Mouth
8
Esophagus

• Moves food down by smooth muscle contraction
• The lower esophageal sphincter prevents reflux of
  gastric content

9
EsophagusMost Common Problems

• Dysphagia Difficulty swallowing, may be due to
  obstruction
• Gastrointestinal reflux May lead to heartburn

10
Stomach

• Consists of
• Fundus
• Upper
• cardia
• Body
• middle, corpus
• Antrum
• lower
• Pyloris
• narrow sphincter

11
Stomach

• Acts as a food reservoir
• Secretes gastric juice 2-3 liters per day
• Provides peristaltic activity with muscular wall
• Mixes food with digestive enzymes hydrochloric
  acid
• Liquefies food into chyme - a partial digestion

12
Stomach Digestion

• Enzyme, Pepsin - acts on proteins
• Enzyme, Lipase - acts on emulsified fats
• Little absorption occurs in stomach

13
Timing of Digestion

• Secretion of hydrochloric acid may produce pain
  if gastric ulcer is present
• Gastric ulcer pain usually begins 1/2 hour after
  eating
• Obstruction - produces vomiting
• Stomach emptying time is 6 hours

14
Small Intestine

• Is 21 feet from pyloric sphincter - iliocecal
  valve
• Consists of 3 major sections
• Duodenum 12
• Jejunum 8
• Ileum 12

15
Duodenum

• Chyme enters the duodenum via the pyloric
  sphincter
• Acidity of chyme become more alkaline, due to
  bile pancreatic secretions
• Bile duct - empties bile into duodenum
• Pancreatic duct - empties pancreatic enzymes into
  duodenum, 2 hours after eating

16
Liver

• Weighs 3 lbs
• Produces secretes bile uses cholesterol to
  form bile salts
• Active in regulating blood glucose levels
  conversion of glycogen amino acids to glucose
• Active in protein, carbohydrate lipid
  metabolism
• Hepatic artery from aorta
• Portal vein from GI spleen
• 3 hepatic veins to inferior vena cava

17
Liver

• Stores vitamins (A, B12, B complex), minerals,
  iron, copper
• Synthesizes most plasma proteins (albumin,
  globulin, fibrinogen, prothrombin blood
  clotting factors)
• Conjugates excretes steroid hormones
• Active in antibody production

18
Liver

• Detoxifies secretes organic waste into bile
• Converts fat-soluble waste into water soluble
  waste urea

19
Liver Circulation

• Receives arterial blood supply from hepatic
  artery, from aorta
• Enteroheptic circulation via portal vein from
  gastrointestinal tract spleen
• Venous drainage from the liver through 3 hepatic
  veins, draining into the inferior vena cava

20
Liver Defective Function

• May result in
• jaundice
• coma
• ascities

21
Gallbladder

• Pear shaped, 4 long, located at liver
• Secretes 1 liter of bile per day - via bile ducts
  into duodenum
• Bile permits emulsification of fats maintain
  alkaline pH

22
Gallbladder

• Lack of bile leads to decreased digestion
  absorption of fats, leading to diarrhea
• Lack of bile its metabolite, stercobilin,
  produces clay colored or acholic stools

23
Pancreas

• Maximum output of pancreatic secretions occurs 2
  hours after eating
• 1-2 liters per day are produced
• Acidity of chyme is reduced
• Pancreatic enzymes active in digestion include
• Lipase - fats
• Amylase - starches
• Trypsin - proteins

24
Pancreatic Enzymes

• Lipase - active in fat digestion
• Amylase - active in carbohydrate digestion
• Trypsin - active in protein digestion

25
Pancreas

• Exocrine gland - (acinar cells) produce
  bicarbonate pancreatic enzymes for digestion
  absorption (fat, CHO protein)
• Endocrine - (Isles of Langerhans) produce
  insulin glucogon (glucose regulation)
• Insulin - is also major anabolic hormone

26
Pancreas Insufficiency

• Present in Cystic Fibrosis, Celiac Disease
  other digestive disorders
• Stools are
• Pale
• Bulky (fatty)
• Have foul odor

27
Acute Inflammation

• In duodenum, gall bladder or pancreas
• Pain worsens at this site during digestion
• Pain worsens 2-3 hours after eating

28
Jejunum Ileum

• Further digestion absorption of nutrients
• Bile acids vitamin B12 are absorbed in the ileum

29
Ileocecal valve

• Located at entrance into large intestine
• Prevents backward flow of fecal material

30
Large Intestine Landmarks

• Cecum - blind pouch
• located 2-3 into the large intestine
• Vermiform appendix - at base of cecum

31
Large Intestine Landmarks

• Ascending colon
• Hepatic flexure
• Transverse colon
• Splenic flexure
• Descending colon
• sigmoid colon
• Anal canal anus

32
Large Intestine

• 4.5 - 5 in length
• 2.5 in diameter
• Water electrolyte absorption occurs
• Secretions are more alkaline
• Bacterial purification occurs

33
Large Intestine

• 600 ml of fluid enter per day
• 200 ml of fluid are excreted in stool daily

34
Large IntestineAbnormal Function

• Diarrhea constipation
• Aneurismal pouches - may cause bleeding
• Infection - causes pain
• Obstruction - causes pain
• Tumors - may cause obstruction or bleeding

35
Large IntestineCommon Conditions

• Diverticulitis
• Colitis
• Inflammatory Bowel Disease

36
Spleen

• Located above left kidney, between 9 -11th ribs
  in right anterior axillary line
• White pulp - consists of lymphoid tissue
• Reticuloendothelial system
• filters blood
• makes lymphocytes
• makes monocytes

37
Spleen

• Red pulp - consists of a capillary network for
  storage release of blood
• Is a reservoir for 1-2 of RBC mass
• Removes old/agglutinated RBCs platelets
• Iron metatolism (partial)
• RBC production occurs outside of marrow in fetus
  during marrow depression

38
Kidneys

• Located at T12 - L3 vertebrae
• Right kidney is lower than left
• Glomerular filtration of blood
• Via renal arteries
• 110-125 ml per minute

39
Kidneys

• Urine volume control - ADH
• Endocrine function - Renin
• Aldosterone secretion from adrenals
• Erthropoietin production - adults
• Red cell mass
• Protoglandins
• Vitamin D

40
Ureters

• Peristalsis moves urine from kidney into bladder

41
Bladder

• Adult capacity 400-500 ml (max 1000-1800cc)

42
Vasculature

• Descending aorta
• A - aorta
• Renal arteries spleenic arteries
• R - renal
• Common iliac arteries
• I - iliac
• Femoral arteries
• F - femoral

43
Musculature

• Rectus abdominis - para midline, anterior
  vertical
• Internal external oblique
• Transverse abdominis
• Iliacus - oblique placement
• Psoas - oblique placement
• Iliopsoas test - a stretching of iliacus psoas
  is positive for pain with peritoneal irritation

44
History

• General PMH
• Present illness Nutrition, allergies, alcohol,
  medications, cigarette smoking, stools, Urine,
  exposures to infection, recent stressors,
  pregnancy (LMP)

45
Common Symptoms

• Pain
• Nausea vomiting
• Bowel habits
• Rectal bleeding
• Jaundice

46
Common Symptoms

• Abdominal distention
• Mass
• Puritis
• Urinary changes

47
Medial Family

• Past Medical History GI - ulcer, colitis,
  polyps, obstruction, pancreatitis, GB disease,
  hepatitis, cirrhosis of liver, surgery
• Family History Kidney problems, colon CA, mal
  absorption (CF, celiac), GB disease, colitis,
  familial polyposis