Odielon C.
Filomeno, RN, MPH
THE GASTROINTESTINAL
AND RENAL SYSTEMS
(PART 1)
Learning Targets:
At the end of the module, students will be able
to:
1. Identify the structures and function of the
gastrointestinal and renal systems;
2. Identify the four quadrants and the organs in
each quadrant;
3. Collect an accurate health history of the GI
and renal systems; and,
4. Describe the physical examination
techniques and the orderperformed to evaluate
the GI and renal systems
SENSORY ALTERATIONS
Quadrant
In the right upper quadrant, the soft consistency of the liver
makes it difficult to feel through the abdominal wall.
The lower margin of the liver, the liver edge, is often palpable
at the right costal margin.
The gallbladder, which rests against the inferior surface of
the liver, and the more deeply lying duodenum are generally
not palpable.
At a deeper level, the lower pole of the right kidney may be
felt, especially in thin people with relaxed abdominal muscles.
Moving medially, the examiner encounters the rib cage, which
protects the stomach; the xiphoid process lies in the midline.
The abdominal aorta often has visible pulsations and is
usually palpable in the upper abdomen.
Quadrant
The Left Upper Quadrant:
the spleen is lateral to and behind the stomach, just above the left
kidney in the left midaxillary line. Its upper margin rests against the
dome of the diaphragm.
The 9th, 10th, and 11th ribs protect most of the spleen. The tip of the
spleen may be palpable below the left costal margin in a small
percentage of adults.
The pancreas in healthy people escapes detection.
The Left Lower Quadrant:
the firm, narrow, tubular sigmoid colon is often felt and portions of the
transverse and descending colon may also be palpable.
The Right Lower Quadrant
the bladder may be palpated. In the right lower quadrant are bowel
loops and the appendix at the tail of the cecum near the junction of the
small and large intestines. In healthy people, there will be no palpable
findings.
Quadrant
The Urinary Bladder
A distended bladder may be palpable above the symphysis
pubis. The bladder accommodates roughly 300 ml of urine
filtered by the kidneys into the renal pelvis and the ureters.
Bladder expansion stimulates contraction of bladder smooth
muscle, the detrusor muscle, at relatively low pressures.
Rising pressure in the bladder triggers the conscious urge to
void.
The Kidneys
The kidneys are posterior organs. The ribs protect their upper
portions.
The costovertebral angle—the angle formed by the lower border
of the 12th rib and the transverse processes of the upper lumbar
vertebrae—defines the region to assess for kidney tenderness
(flank area).
THE HEALTH HISTORY
Gastrointestinal:
Abdominal pain, acute and chronic
Indigestion, nausea, vomiting including blood,
loss of appetite, early satiety
Dysphagia and/or odynophagia
Change in bowel function
Diarrhea, constipation
Jaundice
Urinary and Renal:
Suprapubic pain
Dysuria, urgency, or frequency
Hesitancy, decreased stream in males
Polyuria or nocturia
Urinary incontinence
Hematuria
Kidney or flank pain
Ureteral colic
Patterns and Mechanisms of Abdominal Pain
Visceral Pain:
Occurs when hollow abdominal organs such as the intestine or
biliary tree contract unusually forcefully or are
distended or stretched.
Parietal Pain:
Originates from inflammation in the parietal peritoneum. It is a
steady, aching pain that is usually more severe than visceral pain and
more precisely localized over the involved structure.
Referred Pain:
This is felt in more distant sites, which are innervated at
approximately the same spinal levels as the disordered structures.
Referred pain often develops as the initial pain becomes more
intense and thus seems to radiate or travel from the initial site. It may
be felt superficially or deeply but is usually well localized
History of Abdominal Pain or
Discomfort:
Onset: First determine the timing of the pain. Is it acute or chronic? Acute abdominal pain has many
patterns. Did the pain start suddenly or gradually? When did it begin?
Location: Then ask the patient to point to the pain. Patients are not always clear when they try to describe
in words where pain is most intense. The quadrant where the pain is located can be helpful. Often
underlying organs are involved. If clothes interfere, repeat the question during the physical examination.
Duration: How long does it last? What is its pattern over a 24-hour period? Over weeks or months? Are
you dealing with an acute illness or a chronic and recurring one?
Characteristic Symptoms: Ask patients to describe the pain in their own words. Pursue important details:
“Where does the pain start?” “Does it radiate or travel anywhere?” “What is the pain like?”
If the patient has trouble describing the pain, try offering several choices:
“Is it aching, burning, gnawing . . . ?”
Ask the patient to rank the severity of the pain on a scale of 1 to 10. Note that severity does not always help
you to identify the cause. Sensitivity to abdominal pain varies widely and tends to diminish in older patients,
masking acute abdominal conditions. Pain threshold and how patients accommodate to pain during daily
activities also affect ratings of severity.
Associated Manifestations: Ask the patient if he or she is experiencing any other symptoms (e.g.,
nausea, vomiting, or indigestion).
Relieving Factors: As you probe factors that aggravate or relieve the pain, pay special attention to any
association with meals, alcohol, medications (including aspirin and aspirin-like drugs and any over-the-
counter medications), stress, body position, and use of antacids. Ask if indigestion or discomfort is related
to exertion and relieved by rest.
Treatment: Determine what remedies the patient has tried and the results of each.
Thank You!
