Health assessment and clerkship

Abdomen and GIT

GROUP 8 Presentation
Lecturer; Mr Clifton Irahuka
 Group members

NAME REGISTRATION NUMBER

NAMBUUSI AIDAH VU-BMS-2309-0011-WEE
PARICIA JOAN SHEEVON VU-BMS-2309-0204-WEE
CHEPKWEMBOI KEREN VU-BMS-2309-0239-WEE
TUMUSIIME JUDITH VU-BMS-2309-0173-WEE
AKAO SEMMY VU-BMS-2309-0649-WEE
 outline

 Anatomy and physiology

 Changes in pregnancy
 Complications
 Abnormalities
 Management of complications
GASTROINTESTINAL TRACT
ANATOMY AND PHYSIOLOGY:

The gastrointestinal tract in humans begins at

the mouth, continuing through the
oesophagus, stomach, and small and large
intestines. The GI tract is about 9 meters in
length.
 divisions

The human GI tract can be divided into two halves, namely:

 Upper GI tract
 Lower GI tract
UPPER GASTROINTESTINAL TRACT:
The upper GI consists of the following organs:
 CONT,

1. Mouth
 includes the teeth, tongue, and buccal mucous membranes containing the
ends of the salivary glands that continue with the soft palate, floor of the
mouth, and underside of the tongue.
Mouth functions by chewing the food, constantly by the muscular action of
the tongue, cheeks, and teeth through the lower jaw and upper jaw
2 Pharynx
 The pharynx is enclosed in the neck and functions as part of both the
digestive system and the respiratory system. It protects the food from
entering the trachea and lungs.
 Cont.,

3 Oesophagus
 A muscular tube-like structure that functions by carrying food to the
stomach. Once the chewed food reaches the oesophagus from the mouth,
the action of swallowing becomes involuntary and is controlled by the
oesophagus.
4 Stomach
 This is where most of the digestion takes place.
 The stomach is a J-shaped bag-like organ that stores the food temporarily,
breaks it down, mixes and churns it with enzymes and other digestive
fluids and finally, passes it along to the small intestine.
 Lower Gastrointestinal Tract

1. Small Intestine
 The small intestine is a coiled thin tube, about 6 meters in length,
where most of the absorption of nutrients takes place.
 Food is mixed with enzymes from the liver and the pancreas in the
small intestine.
 The surfaces of the small intestine function by absorbing the
nutrients from the food into the bloodstream, which carries them to
the rest of the body.
 Cont,

2 Large Intestine
 Also known as the Colon, is a thick tubular organ wrapped around
the small intestine.
 Its primary function is to process the waste products and absorb
any remaining nutrients and water back into the system.
 The remaining waste is then sent to the rectum and discharged from
the body as stool.
Abdominal changes that occur
in pregnancy

During pregnancy, the

abdominal region
undergoes various
changes to
accommodate the
growing fetus
 cont,

Belly Button
a belly button that was formerly an “innie” may “pop out.”
This occurs when the uterus enlarges and places pressure on the abdominal
wall.
Stretch Marks
Stretch marks, also called striae gravidarum, are common and natural
occurrences throughout pregnancy that affect up to 90% of people.
result from connective tissue changes as your body’s size rapidly changes
throughout pregnancy.
These occur most commonly along belly, breasts, thighs, and other areas.
 Cont,

Dark Line
This dark line is called the Linea nigra,
The Linea nigra is a vertical line about 1 centimeter (0.4 inches) wide.
 It typically runs from the belly button down to the pubis.
 Its an early sign of pregnancy, it thickens and darkens through pregnancy
Muscle and ligament stretching.
The abdominal muscles and ligament stretch to support the expanding uterus. This
sometimes results in discomfort or mild pain.
Organ displacement.
As the uterus expands, it displaces other abdominal organs, potentially causing in bowel
habits or increased pressure on the bladder
 Cont,

Diastasis recti
The separation of the abdominal muscles (rectus abdominis) can occur especially
in later stages of pregnancy. This may contribute to protruding belly.
Increased blood flow
There is increased blood volume flowing during pregnancy to support the
growing fetus leading to engorgement of blood vessels in the abdominal region.
 Stretching of the skin on your abdomen, which may feel tight and itchy.
 Aching on one side or the other as the ligaments that support your uterus are
stretched.
Changes that occur in the GIT
during pregnancy

• As the uterus enlarges it rises

out of the pelvic cavity
displacing the stomach,
intestines and other adjacent
organs
• The hormonal changes
especially the high levels of
progesterone contribute to
most of the changes which is
abit discomforting and yet
normal changes
 Cont,
Nausea and vomiting
particularly in the mornings (morning sickness)
 They may be caused by the high levels of estrogen and human chorionic
gonadotropin, two hormones that help maintain the pregnancy
Heartburn and Belching
the ringlike muscle (sphincter) at the lower end of the esophagus tends to
relax, allowing the stomach's contents to flow backward into the
esophagus.
 Cont,
Constipation
 pressure from the enlarging uterus on the rectum and the lower
part of the intestine may cause constipation.
 high level of progesterone during pregnancy slows the automatic
waves of muscular contractions in the intestine, which normally
move food along.
 Cont,
Hemorrhoids
Hemorrhoids, a common problem, may result from the pressure of the
enlarging uterus or from constipation. Stool softeners, an anesthetic gel, or
warm soaks can be used if hemorrhoids hurt.
Pica
Pica, a craving for strange foods or nonfoods (such as starch or clay), may
develop.
Excess Saliva
Occasionally, pregnant women, usually those who also have morning
sickness, have excess saliva. This symptom may be distressing but is
harmless.
 Cont,

 Gallbladder problems .
 Elevated hormones during pregnancy cause the gallbladder to function
more slowly, less efficiently and is more likely to lead to gallbladder
stone issues
 Complications that occur within the abdomen and git

1. Liver.
 Hepatitis
 is an inflammation of the liver that is caused by a variety of
infectious viruses and noninfectious agents leading to a range of
health problems.
 The liver is a vital organ that processes nutrients, filters the blood,
and fights infections
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SIGNS AND SYMPTOMS OF INFECTIOUS
HEPATITIS
SUBJECTIVE DATA OBJECTIVE DATA
 Fatigue  dark urine
 abdominal pain  yellow skin and eyes,
 loss of appetite which may be signs of
jaun
 Unexplained weight loss.
 flu-like symptoms
 Pale stool
 OESOPHOGUS

 SIGNS AND SYMPTOMS (SUBJECTIVE DATA)

 A burning sensation in your chest (heartburn), usually after eating, which might
be worse at night or while lying down
 Backwash (regurgitation) of food or sour liquid
 Upper abdominal or chest pain.
 Trouble swallowing (dysphagia).
 Sensation of a lump in your throat.
 An ongoing cough.
 Inflammation of the vocal cords (laryngitis).
 New or worsening asthma.
GALLBADDER
SUBJECTIVE DATA OBJECTIVE DATA

 Patient might feel a sharp, sudden pain in  Vomiting

the upper right side of your belly.  Yellow skin or eyes (jaundice)
 Patient may also feel pain in his or her
back or below the right shoulder blade.
Deep breaths may make it worst.
 Nausea
 Fever
 Bloating
 Bowel movements that are loose and
light-colored.
 PANCREASE

 PANCREATITIS
An inflammation of the organ lying behind the lower part of the
stomach (pancreas).
It can be;
Acute or chronic pancreatitis
Signs and symptoms
Subjective data Objective data

 Abdominal pain  Fast heart rate.

 Nausea and vomiting.  Fast, shallow breathing.
 Indigestion and pain after eating.  Fever.
 Loss of appetite and unintended weight
loss.
 Lightheadedness (from low blood
pressure).
 duodenum

 Duodenal ulcers
 occur when there is a disruption to the surface of the mucosa of the
duodenum. These ulcers are part of peptic ulcer disease, which
involves the stomach and first part of the duodenum
 stomach

 Gastric ulcer:
 A sore that develops on the lining of the oesophagus, stomach or small
intestine.
 Ulcers occur when stomach acid damages the lining of the digestive tract.
 Signs and symptoms
 Burning stomach pain.
 Bloated stomach.
 Indigestion, especially of fatty foods.
 Nausea and vomiting
 appendix

 Appendicitis: condition in which the appendix becomes inflamed and filled with
pus, causing pain.
 Signs and symptoms
 Sudden pain that begins on the right side of the lower abdomen.
 Sudden pain that begins around the navel and often shifts to the lower right
abdomen.
 Pain that worsens with coughing, walking or making other jarring
movements.
 Nausea and vomiting.
 Loss of appetite
 Small intestines

 Gastroenteritis
 is a short-term illness triggered by the infection and inflammation
of the digestive system.
 has diffuse, generalized abdominal pain with nausea,
 Marked by diarrhea, cramps, nausea, vomiting and fever
 SIGNS AND SYMPTOMS

 Diarrhea.
 Nausea and vomiting.
 Loss of appetite.
 Abdominal pain and cramping.
 Fever.
 Chills.
 Fatigue.
 Body aches
 COLON

 Large bowel obstruction:

 has moderate, colicky pain of gradual onset in lower abdomen and
bloating.
 Irritable bowel syndrome (IBS) has sharp or burning cramping pain
over a wide area; does not radiate.
 Brought on by meals; relieved by bowel PROMOTION
 SIGNS AND SYMPTOMS

 Loss of appetite.
 Constipation.
 Vomiting.
 Inability to have a bowel movement or pass gas.
 Swelling of the abdomen.
 Abnormalities in the abdomen and GIT
On inspection

Umbilical Hernia:

This is a soft, skin covered mas, protrusion of the intestine through a weakness in
the umbilical ring.

It is more noticeable during increased intra-abdominal pressure while crying,

coughing, vomiting and stretching.

More common in preterm infants, and most resolves spontaneously by 1year. In

adults it occurs with pregnancy, chronic ascites.
 Cont,

Incisional Hernia:

A bulge near an old operative scar that may not show when person is supine but is
apparent when the person increases intra-abdominal pressure by a sit-up or by standing.

Epigastric Hernia:

Protrusion of abdominal structures present as small, fatty nodule at epigastrium in

midline, through the linea alba. Usually one can feel it rather than observe it. May be
palpable only when standing.
 On Auscultation

Abnormal bowel sounds

 Succussion splash

Unrelated to peristalsis, this is a very loud auscultated over the upper abdomen when infant is
rocked on side. It indicates air and fluid in the stomach, as seen with obstruction.

 Hypoactive Bowel sounds

 Diminished or absent bowel sounds signal decreased motility as a result of inflammation as

seen with peritonitis; from paralytic ileus as following abdominal surgery, or from late
bowel obstruction. Occurs also with pneumonia
 Cont.

 Hyperactive Bowel Sounds

Loud, gurgling sounds, "borborygmi,” signal increased motility. They occur with early
meconium bowel obstruction [high pitched], gastroenteritis, brisk diarrhea and laxative
use.

 Peritoneal Friction Rub

A rough, grating sounds, like pieces of leather rubbed together, indicates peritoneal
inflammation. Occurs rarely. Usually occurs over organs with large surface area in contact
with the peritoneum.
 Cont.,

 Liver- Friction rub over lower left rib cage from abscess or metastatic tumor.

 Spleen-Friction rub over lower left rib cage in the left anterior axillary line
from abscess, infection, or tumor.

 Vascular Sounds

Arterial- A bruit indicates turbulent blood flow, as found in constricted,

abnormally dilated, or tortuous vessels. Listen with the bell. Occurs with the
following:
 cont.,

 Aortic aneurysm- Murmur is harsh, systolic or continuous and accentuated with

systole. Note in person with hypertension.

 Renal artery stenosis- Murmur is midline or toward flank, soft, low to medium pitch.

 Partial occlusion of femoral arteries.

Venous hun- Occurs rarely. Heard in periumbilical region. Originates from inferior
vena cava. Medium pitch, continuous sound, pressure on bell may obliterate it. May
have palpable thrill. Occurs with portal hypertension and cirrhotic liver
 ON PALPATION

Enlarged liver

An enlarged, smooth, nontender liver occurs with fatty infiltration, portal obstruction or cirrhosis,
high obstruction of inferior vena cava, and lymphocytic leukemia. The liver feels enlarged and
smooth but is tender to palpation with early heart failure, acute hepatitis, or hepatic abscess.

Enlarged Nodular Liver

An enlarged and nodular liver occurs with late portal cirrhosis, metastatic cancer, or tertiary
syphilis. Often with cirrhosis the liver is smaller, but the edge is firmer than normal, and the edge
is easily palpable.
 Cont.,

Enlarged Gallbladder

An enlarged, tender gallbladder suggests acute cholecystitis.

The area is exquisitely painful to fist percussion, and inspiratory arrest [Murphy
sign] is present. An enlarged, nontender gall bladder also feels like a smooth,
sausage like mass.

It occurs when the gallbladder is filled with stones, as with common bile duct
obstruction.
 Cont.,

Enlarged Spleen

 Because any enlargement superiorly is stopped by the diaphragm, the spleen

enlarges down and to the midline. When extreme, it can extend down to the
left pelvis.
 It retains the splenic notch on the medial edge.
 When splenomegaly occurs with acute infections [mononucleosis], it is
chronic cause, the enlargement is firm or hard, with sharp edges.
 An enlarged spleen is usually not tender to palpation; it is tender only if the
peritoneum is also inflamed
 Cont.,

Enlarged Kidney

Enlarged with hydronephrosis, cyst, or neoplasm. May be difficult to

distinguish an enlarged kidney from an enlarged spleen because they have
similar shape. Both extend forward and down. However, the spleen may have a
sharp edge, whereas the kidney never does. The spleen retains the splenic
notch, whereas the kidney has no palpable notch. Percussion over the spleen is
dull, whereas over the kidney it is tympanitic because of the overriding bowel.
VIDEO

1- https://youtu.be/ZyLCrf44i48?si=ZNOAHlypF2SoFwjv
 Management of complications

Nausea and vomiting

 drinking and eating small portions frequently

Heartburn and Belching

 Eating smaller meals
 Avoid bending or lying flat for several hours after eating
 CONT,

Heartburn during the night can be relieved by the following:

 Eating several hours before going to bed
 Raising the head of the bed or using pillows to raise the head and
shoulders
Constipation
. Eating a high-fiber diet
 Drinking plenty of fluids
 Exercising regularly
 References

 . Anatomy and physiology by Gerald J. Tortora/Bryan Derrickson 14th

Edition
 2. Carolyn Jarvis 8th Edition