Introduction
As the gastrointestinal system (GI) is very much linked to other body systems, assessment of its disorders is a major part of a nurse’s daily activities. The gastrointestinal system can cause diseases in other systems such as the cardiac system and the immunological system and is also a determinant of the growth and development of children and adults alike. The process of digestion supplies nutrients to cells and tissues throughout the entire body. A detailed knowledge of the anatomy and physiology of the gastrointestinal system is key to performing a comprehensive assessment of the gastrointestinal system
Components of Gastrointestinal System Assessment
- History taking.
- Physical examination.
ARTICLES
- Gloves (optional).
- Drapes.
- Gown for patient.
- Stethoscope.
- Pen and paper to record.
Procedure
History Taking
Assessment begins with a focused history taking of the patient. History taking includes general information about the patient.
Chief Complaints
The common symptoms of the gastrointestinal system include:
- Abdominal pain (description, location, radiation, severity, precipitating factors, relieving factors)
- Nausea and vomiting
Diarrhea - Constipation
- Weight gain or loss
- Changes in appetite
- Food intolerance
- Changes in bowel pattern
- Upper/lower gastrointestinal bleeding
- Bloating
- Increased flatulence Swallowing difficulty.
All these symptoms may indicate an underlying gastrointestinal pathology. When collecting data on these symptoms, information must be obtained regarding nature of symptom, characteristics, severity, time of onset, precipitating and relieving factors. On many occasions, it is important to collect other general symptoms as they may be a result or an underlying gastrointestinal pathology. For example, acid reflux symptoms may often mimic a myocardial infarction. A detailed examination of other systems should be done to eliminate other serious illnesses.
Past Medical History
A comprehensive history of the medical conditions pertaining to the gastrointestinal system should be collected. Some of the common medical conditions of the gastrointestinal systems are:
- Gastric ulcer
- Gallbladder disorders
- Gastritis
- Acid reflux
- Hepatitis
- Inguinal hernia
- Umbilical hernia
- Cancer of stomach or intestine
- Intestinal obstruction
- Appendicitis
- Intestinal obstructions
- Gastric/intestinal surgeries
- GI specific infections.
Past medical history is not complete without a complete list of medication and food allergies. A complete social and personal history should also be included. Use of alcohol, smoking history, chronic use of medications such as pain medications, aspirin or nonsteroidal anti-inflammatory agents are also important data.
Nutritional Assessment
A detailed nutritional assessment is part of the GI assessment. Data should be collected based on the following aspects:
- Recent unintentional weight loss
- Nausea/vomiting
- Mobility problems
- Recent surgeries
- Recent history of chemotherapy or radiation therapy
- Substance abuse
- Socioeconomic status affecting nutritional availability
- Social independence and lack of support system.
- Food allergies
- Food intolerance
- Changes in appetite
- Polypharmacy
- Alteration in taste sensation
- Dieting patterns
- Difficulty in chewing or swallowing
Diagnostic Findings
Including diagnostic findings like upper endoscopy, colonoscopy, CT scans and abdominal X-rays, and laboratory results such as liver enzymes, lipase and amylase, will also help in identifying medical issues pertaining to the system.
Assessment of Abdomen
| Steps of procedure | Rationale |
| Inspection Assess the abdomen using all your senses. Inspection should include assessing for shape, symmetry, contour, texture of skin, color of skin, bulges, masses, hernias, ascites, spider nevi, visible pulsations, distention, filling of flanks, visible peristalsis, presence of surgical scars, percutaneous endoscopic gastrostomy tubes and ostomies. Inspect mouth for any disorders, inflammation, loose or broken tooth, dental caries, bleeding, halitosis and ulcerations. | Distention of abdomen indicates liver disorders or intestinal obstruction. It could also be caused by gaseous distention caused by inflammatory conditions of the GI system. Oral conditions can impact nutritional abnormalities and certain symptoms such as halitosis may be indicative of a more acute condition such as metabolic disorders or GERD. |
| Auscultation When assessing gastrointestinal system, it is important to perform auscultation before percussion or palpation as these methods may alter bowel sounds. The abdomen is divided into 4 quadrants for the purpose of assessment. Begin in the right lower quadrant and auscultate each quadrant for at least 5 minutes. | Bowel sounds are normally present one in every 5-15 seconds. If bowel sounds are present only one in every 20-30 seconds, then it is considered hypoactive. If bowel sounds are more frequent than one every 5 seconds, then it is hyperactive bowel sounds. Borborygmi is the high-pitched tinkling sound that is heard as a result of hyperperistalsis trying to push against an obstruction. Absent bowel sounds are an ominous sign of complete obstruction, perforation or peritonitis. |
| Percussion Percussion is done over all 4 quadrants of the abdominal cavity. The sounds that are heard when percussing are tympany and dullness. | Tympany is the percussion sound that is normally heard over the abdominal cavity. This is the sound heard over air-filled cavities. Dullness is heard over fluid filled cavities or a thick bladder. |
| Palpation Palpate and assess for texture, tenderness, temperature and moisture. Note for any muscle guarding or tenderness, rigidity or masses. Palpate tender areas last. | Understanding the underlying structures will help identify the abnormal findings that are obtained. |
| Measure abdominal girth at the level of the umbilicus. | An increase in the abdominal girth is indicative of ascites, obesity, etc., and is a useful indicator of underlying disease conditions. |
| Wash hands. | |
| Document the findings. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
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