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Notes
Gastrointestinal Assessment
History
Pain, bloating, changes in bowel pattern, diarrhea, constipation, changes in weight or appetite, indigestion, reflux, nausea, vomiting, stomach ulcers,
Helicobacter pylori
, hemorrhoids, GI bleed, UC, IBS, blood or mucus in stool, NSAID use.
Medication
Antacids, proton pump inhibitors, H2 antagonists, laxatives, antiemetics, antibiotics, antispasmodics.
Abdominal Pain(differential diagnosis)
RUQ:
Cholecystitis, hepatitis, MI, pancreatitis, perforated ulcer.
LUQ:
Gastritis, peptic ulcer, MI, pancreatitis, splenic enlargement.
RLQ:
Appendicitis, ectopic pregnancy, gynecological disease, renal calculi, testicular torsion, aortic dissection.
LLQ:
Diverticulitis, colitis, aortic dissection, renal calculi, ectopic pregnancy, gynecological disease, testicular torsion.
Epigastric:
MI, ulcer, pancreatitis.
Diffuse:
Gastroenteritis, IBS, ischemic bowel, diabetic ketoacidosis.
Inspect (abdomen)
Skin, distention, scars, obesity, herniations, bruising, pulsations.
Auscultate (bowel tones; before palpate)
Hypoactive:
Every minute.
Normal:
Every 15-20 sec.
Hyperactive:
As often as every 3 sec.
Percuss (abdomen)
Dullness:
Solid organ (liver).
Tympany:
Hollow organs (bowels).
Resonance:
Air-filled organs (lungs).
Flatness:
Dense tissue (muscle, bone).
Palpate (abdomen; after auscultate)
Pulsations (aortic aneurysm).
Masses (stool, tumors).
Tenderness (appendicitis).
Rigidity (GI bleeding, guarding).