gastrointestinal system assessment, an evaluation of the patient’s digestive system and symptoms. ▪ METHOD: Discussion of symptoms is encouraged. The patient is asked whether there is or has been pain or tenderness in the oral cavity, gums, tongue, lips, abdomen, or rectum, and whether there have been instances of dysphagia, belching, heartburn, anorexia, nausea, vomiting, constipation, diarrhea, or painful defecation. Information is elicited about changes in eating; bowel habits; the color, character, and frequency of stools and urine; the use of laxatives or enemas; and the occurrence of fatigue, hemorrhoids, and edema of the extremities. The patient’s general appearance, weight, and temperature are noted; the blood pressure, pulse, and respirations are checked in the supine, sitting, and standing positions; and the urinary output and color are determined. The presence of allergies, stomatitis, and halitosis and the condition of the tongue, gums, oral mucosa, and teeth are recorded. The abdomen is examined for distension, rigidity, ascites, symmetry, organomegaly, keloid tissue, visible peristalsis, bowel sounds, masses, and the presence of an ostomy. The perianal area is inspected for its general condition, color, odor, and hemorrhoids; the sclera for signs of jaundice; and the skin for pruritus, spider angioma, purpura, palmar erythema, peripheral edema, jaundice, and distended, tortuous blood vessels. Relevant to the assessment are concurrent endocrine, cardiovascular, and neurological disorders; severe burns; psychological problems; carcinoma; alcohol or drug abuse; and previous GI surgery and illnesses such as hepatitis, liver cirrhosis, or pancreatitis. The patient’s personality type; attitude toward work; and use of tobacco, antacids, laxatives, anticholinergics, steroids, antidiarrheals, antiemetics, sedatives, tranquilizers, barbiturates, antihypertensives, antibiotics, and aspirin are investigated. The family history, especially of GI disease, carcinoma, and diabetes mellitus, is an important aspect of the evaluation. Diagnostic aids include a complete blood count, stool examination, prothrombin time, and determinations of levels of alkaline phosphatase, serum and urine bilirubin, aspartate aminotransferase, alanine aminotransferase, lactic acid dehydrogenase, blood urea nitrogen, serum lipase, cholinesterase, calcium, albumin, and glucose. Additional laboratory studies for evaluation are total protein level; serum electrolyte profile; serum carotene, delta-xylose tolerance, galactose tolerance, hippuric acid, and bromsulphalein tests; the albumin-globulin ratio, serum flocculation, and thymol turbidity tests; urobilinogen level; the polyvinylpyrrolidone test for protein loss; Sulkowitch’s test for calcium in urine; and Schilling’s test for GI absorption of vitamin B12. Procedures that may be required for the diagnosis include upper GI, small bowel, and gallbladder series; esophageal and gastric endoscopy and biopsy; scans of the liver and pancreas; biopsy of the liver, colon, or rectum; gastric analysis, sigmoidoscopy, abdominal x-ray films, ultrasound, fluoroscopy, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, hepatobiliary iminodiacetic acid scan, splenoportography, and digital rectal examinations. ▪ INTERVENTIONS: The physician or other health care provider conducts the interview, records observations of the patient, and assembles the results of the diagnostic laboratory studies and procedures.
