Chapter 7: Assessment and Observation of the Gastrointestinal, Urinary and Reproductive Systems

Introduction

The gastrointestinal, urinary and reproductive systems are the key systems located in the abdominal region. It is important that nurses are able to accurately and comprehensively assess these systems, and this chapter introduces the fundamental knowledge and skills nurses require to do so. This chapter explores the fundamental anatomy and physiology of the gastrointestinal, urinary and male / female reproductive systems. This chapter also explains the processes involved in collecting a general health history for the gastrointestinal, urinary and male / female reproductive systems, and in performing a physical examination of these systems. This chapter also considers a number of special observation and assessment techniques which may be used in the physical examination of the gastrointestinal, urinary and male / female reproductive systems, and it discusses performing differential diagnosis relevant to these systems.

Learning objectives for this chapter

By the end of this chapter, we would like you:

To describe the basic anatomy and physiology of the gastrointestinal, urinary and male / female reproductive systems.
To explain how to collect a focused health history related to the gastrointestinal, urinary and male / female reproductive systems.
To explain how to undertake a physical examination of the gastrointestinal, urinary and male / female reproductive systems.
To recognise the common problems / conditions related to the gastrointestinal, urinary and male / female reproductive systems, and their typical clinical findings, to enable differential diagnosis.
To describe the variety of special assessment techniques which may be used in the physical examination of the gastrointestinal, urinary and male / female reproductive systems.

Important note

This section of the chapter assumes a basic knowledge of human anatomy and physiology. If you feel you need to revise these concepts, you are encouraged to consult a quality nursing textbook.

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Gastrointestinal and Urinary Systems

Fundamental anatomy and physiology of the gastrointestinal and urinary systems

Although the gastrointestinal and the urinary systems are two separate systems, they are studied together in this chapter. This is because they are the key systems located in the abdominal region, and they are often assessed together (particularly during the physical examination). The reproductive system, which is also located in the abdominal region, will also be studied in this chapter.

The abdomen is surrounded by a number of strong muscles - the abdominis muscles to the anterior, the lumbar muscles at the posterior, and the internal and external oblique muscles laterally. The abdomen is bordered by the diaphragm above, and the pelvis below. It is lined by a serous membrane called the peritoneum, a structure which helps to keep the abdominal organs in place and reduce friction between them.

The gastrointestinal system is one of the key body systems located in the abdomen. The purpose of the gastrointestinal system is to ingest and digest nutrients, electrolytes and water, and to excrete waste products. The structures which comprise the gastrointestinal system include the mouth, oesophagus, stomach, small intestine (duodenum), large intestine (colon) and the rectum, plus the accessory organs. The oesophagus carries food from the mouth to the stomach. The stomach is a hollow, muscular organ which breaks down food using gastric acid, a potent mix of digestive enzymes and hydrochloric acid, into a substance called chyme. The chyme is released progressively through the pyloric sphincter and into the duodenum, and subsequently the colon. It is moved through the intestines by rhythmic contractions of the intestinal muscles, called peristalsis. In the intestines, key nutrients, electrolytes and water are absorbed from the chyme, leaving nothing but waste products. These are eventually excreted from the body via the rectum, as stool.

There are a number of accessory organs which support the function of the digestive system. The liver, the largest organ in the body, is located directly beneath diaphragm, on the right hand side; it performs a number of key roles including:

Metabolising protein, carbohydrate and fat.
Storing glucose, a substance the body uses for energy.
Storing other vitamins and minerals, including iron, copper and B-complex vitamins).
Detoxification of substances (e.g. medication, alcohol).
Producing and secreting bile, which has a role in digestion.
The transfer of bilirubin, another substance with a role in digestion, from the blood.
Producing clotting factors and fibrinogen, which help the blood to clot.
Synthesis of many plasma proteins (e.g. albumin, globulin).

The gallbladder is another accessory organ of the gastrointestinal system; it stores bile produced by the liver. Another organ, the pancreas, secretes a number of substances (e.g. insulin, glucagon, gastrin, bicarbonate, enzymes) to support the metabolism of carbohydrates, proteins and fats. The last accessory organ in the abdomen, the spleen, has immune function and also supports the production and maintenance of the body's blood.

As mentioned earlier in this chapter, the abdomen also contains the urinary system. The urinary system functions to remove water-soluble wastes from the blood, and eventually from the body. The key organs in the urinary system are the kidneys, which filter the blood to remove waste products; the kidneys also have a role in the production of red blood cells, the secretion of a substance called renin to control blood pressure, and producing biologically-active Vitamin D. Once liquid waste, now in the form of urine, has been filtered by the kidneys, it travels down two muscular tubes called the ureters and into the bladder. When the bladder volume reaches between 300 millilitres and 450 millilitres, the person experiences the urge to void and urine exits the body via another tube called the urethra.

It is important for nurses to realise that there are a variety of other structures in the abdomen, including a number of large vessels such as the descending aorta, the iliac arteries, the renal arteries, the vena cava and the hepatic portal veins, etc.

The abdomen is divided into four quadrants, as illustrated in the following table:

Right Upper Quadrant	Left Upper Quadrant
Liver, gallbladder. Pylorus. Duodenum. Head of the pancreas. Right adrenal gland. Portion of the right kidney. Portion of the colon.	Left lobe of the liver. Spleen. Stomach. Body of the pancreas. Left adrenal gland. Portion of the colon.
Right Lower Quadrant	Left Lower Quadrant
Lower part of the right kidney. Cecum, appendix. Portion of the colon. Bladder (if full). Right ureter. Right ovary, uterus (in women). Right spermatic cord (in men).	Lower part of right kidney. Portion of the colon. Bladder (if full). Left ureter. Left ovary, uterus (in women). Left spermatic cord (in men).

Gastrointestinal and urinary systems - focused health history

As you have seen in previous chapters of this module, health observation and assessment involves three concurrent steps:

Health assessment diagram

When assessing a patient's gastrointestinal and urinary systems, the nurse must commence by collecting a health history. This involves collecting data about:

Component	Rationale
Present health status	Chronic illnesses, even if they are not related directly to dysfunction in the gastrointestinal or urinary system, can cause damage to this system. The nurse should be particularly interested in diseases such as diabetes mellitus, chronic hepatitis and cirrhosis. Current medications, either prescribed or over-the-counter, which: (1) may be taken to treat pre-existing gastrointestinal / urinary problems, and / or (2) may cause side effects which affect the gastrointestinal / urinary systems. It is important for nurses to bear in mind that many medications have side-effects which affect the gastrointestinal system. Alcohol consumption, as excessive alcohol intake, as per the UK national recommendations, is associated with a number of systemic diseases that may impact the gastrointestinal / urinary systems. Tobacco smoking (past and current), as the substances in cigarettes are associated with a number of systemic diseases that may impact the gastrointestinal / urinary systems. Bladder and bowel habits, including any recent changes in these (e.g. diarrhoea, constipation, light / dark stools, blood in the stool, urine incontinence, urine retention, etc.), as this can provide a nurse with important information about possible dysfunction in the gastrointestinal / urinary systems.
Past medical history	Injuries to, or illnesses of, the gastrointestinal or urinary system organs, as these may leave a client with deficits which a nurse can anticipate finding during the physical examination. Surgery on the gastrointestinal or urinary system organs, as this can provide a nurse with additional information on possible gastrointestinal / urinary system problems the client has or has had.
Family history	Family history of diseases affecting the gastrointestinal / urinary systems (e.g. gastro-oesophageal reflux disease [GORD], peptic ulcer, stomach / colon cancer, kidney stones, kidney / bladder cancer, etc.), especially among first-degree relatives, as this can provide important information about the types of disease for which a person may have a congenital risk.

In some cases, a person will present with a specific problem related to their gastrointestinal / urinary system/s (e.g. abdominal pain, nausea / vomiting, indigestion, abdominal distention, jaundice, change in bladder / bowel habits, problems with urination, etc.). Remember, nurses assess a patient's symptoms using the strategy remembered by the 'OLD CARTS' mnemonic (introduced in a previous chapter of this module).

Abdominal pain is a particularly significant symptom indicating dysfunction in the gastrointestinal / urinary systems. If a patient complains of pain, they should be rapidly assessed using the strategy remembered by the 'PQRST' mnemonic (introduced in a previous chapter of this module). The location, quality, quantity, chronology, associated manifestations and aggravating / alleviating factors a patient experiences can provide important information about the cause of this pain - and allow the patient's health care team to make a differential diagnosis. Review the information in the following table:

Cause of Pain	Factors Enabling Differential Diagnosis
Gastro-oesophageal reflux disease (GORD)	Pain is often described as "gnawing", "burning" pain is located in the mid-epigastric region, may radiate to the jaw; pain may be associated with weight loss; pain is aggravated by a recumbent position; pain is alleviated by a high-sitting position, antacids, etc.
Gastritis	Pain is often described as a "constant burning" pain is located in the epigastric region; pain may be associated with nausea / vomiting, diarrhoea, fever; pain is aggravated by alcohol, food, salicylates; pain is alleviated by antacids; on assessment, a nurse will often find hyperactive bowel sounds.
Peptic ulcer	Pain is often described as "gnawing", "burning" pain is located in the epigastric, back and upper abdominal regions; pain may be associated with nausea, vomiting, weight loss; pain is aggravated by stress, alcohol, food (if ulcer is in the stomach) or an empty stomach (if ulcer is in the duodenum); pain is alleviated by antacids; on assessment, a nurse will often find epigastric tenderness.
Pancreatitis	Pain is often described as "knife-like", it may be mild to severe, usually has a sudden onset; pain is located in the left upper quadrant and epigastric regions, may radiate to the back; pain may be associated with nausea / vomiting, diaphoresis; pain is aggravated by lying supine; pain may be alleviated by leaning forward; on assessment, a nurse will often find abdominal distention, hyperactive bowel sounds, diffuse abdominal rebound, etc.
Appendicitis	Pain is often described as "colicky", progressing to constant; pain is located in the umbilical region, progressing to the right lower quadrant; pain may be associated with vomiting, constipation, fever; pain is aggravated by movement, coughing; pain may be relieved by lying still.
Cholecystitis / cholelithiasis	Pain is often described as "colicky", progressing to constant; pain is located in the right upper quadrant, may radiate to the scapula; pain is associated with nausea / vomiting, jaundice; pain may be aggravated by fatty foods, medications; on assessment, a nurse will often find tenderness in the right upper quadrant.
Diverticular disease	Pain is often described as "intermittent cramping" pain is located in the left lower quadrant; pain is often associated with constipation, diarrhoea; pain is aggravated by eating; pain may be relieved by defecation, passing flatus.
Irritable bowel disease	Pain is often described as "crampy", "sharp" or "burning" pain is usually located in the left and right lower quadrants; pain is often associated with mucus in the stools; pain may be relieved by defecation; on assessment, a nurse will often find the colon is tender on palpation.
Intestinal obstruction	Pain is often described as "colicky", with a sudden onset; pain may be localised or generalised; pain may be associated with vomiting, constipation; on assessment, a nurse will often find hyperactive bowel sounds (in a small obstruction) or hypoactive bowel sounds.
Urinary tract infection	Pain is often described as "colicky", with a progressive onset; pain may be localised or generalised; pain may be associated with nausea / vomiting, fever, haematuria, urge / frequency of urination, urination, etc.; pain is relieved by antibiotic administration.
Nephrolithiasis	Pain is often described as "colicky", with a progressive onset; pain may be localised or generalised; pain may be associated with nausea / vomiting, haematuria; pain is relieved by the passing of the calculus (if possible).

A number of common diseases related to the gastrointestinal / urinary systems are listed in the above table; if you are unfamiliar with these diseases, you are encouraged to study them further.

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Gastrointestinal and urinary systems - physical examination

Once a health history of the gastrointestinal / urinary systems has been obtained, as described in the previous section of this chapter, a nurse may commence a physical examination of the patient's gastrointestinal / urinary systems. A stepwise process of physically examining the patient's gastrointestinal / urinary systems, with normal (expected) and common abnormal findings, is presented in the following table:

Component	Normal (Expected) Findings	Abnormal Findings
Observe the client's general behaviour and positioning.	The client should be relaxed, sitting / lying quietly, with no guarding of their abdominal region.	Rigid posture; restlessness OR sitting / lying very still; guarding of the abdominal region; knees drawn up; facial grimacing. The nurse should also note marked emaciation or obesity.
Inspect the abdomen for surface characteristics, contour, surface movements,	The abdomen should be smooth; a fine vascular network may be visible; the umbilicus should be centrally-located; contour is sunken (except in overweight / obese or pregnant clients); contour is symmetric; no movements should be visible (except with respiration).	Engorgement of the vessels; glistening / taut appearance of the skin; displacement / inflammation of the umbilicus; distention of the abdomen (or a part of it); marked concavity; visible peristalsis / marked pulsations, etc. The nurse should also note jaundice (yellowing of the skin, which can indicate liver dysfunction).
Auscultate the abdomen for bowel sounds.	High-pitched gurgles, each lasting approximately 1 second, should be heard every 5 to 15 seconds.	Hyperactive bowel sounds; hypoactive (including absent) bowel sounds.
Palpate the abdomen for tenderness, muscle tone.	The abdomen should be relaxed; no pain should be present; no masses should be felt.	Tenderness (e.g. pulling away, grimacing, guarding); hypersensitivity, masses; localised areas of rigidity.
Percuss the abdomen.	Percussion tone should be fairly consistent throughout the abdomen; the liver, spleen, gallbladder should be of the expected sizes and in the expected locations.	Dullness (indicating distention of an organ); tympany (indicating large areas of gas), etc.

Special assessment techniques for the gastrointestinal and urinary systems

There are a number of special assessment techniques particular to the gastrointestinal and urinary systems:

Testing for rebound tenderness. The nurse presses their fingers deeply (but gently) into the client's abdomen, and then rapidly withdraws their fingers. The client should not experience any pain as the abdominal wall rebounds.

Ballottement, to identify a floating mass. If a nurse palpates a mass in the abdomen, the nurse should place one hand perpendicular to the patient's abdomen and push towards the mass with their fingertips at a 90 angle. If the mass if freely movable, it will 'float' upwards and against the fingertips.

Reproductive System

Fundamental anatomy and physiology of the reproductive system

The fundamental purpose of the reproductive system is to facilitate reproduction. The reproductive system is the only system in the body where there are marked differences between males and females:

Male reproductive system: The male reproductive system consists of the penis, scrotum, testes and a series of associated ducts and glands. Like the female reproductive system, described following, the male reproductive system is under hormonal control; from puberty and for the remainder of his life, a male produces hormones which stimulate spermatogenesis (i.e. the production of sperm). Spermatogenesis occurs in the testes, which are suspended outside the body cavity to ensure sperm production occurs at an ideal temperature, slightly below body temperature. Sperm, mixed with a variety of substances from the ducts and glands, leaves the body via the urethra during ejaculation.
Female reproductive system: The female reproductive system consists of the vagina, uterus, fallopian tubes and ovaries, and external structures (collectively referred to as the vulva). As with the male reproductive system, the female reproductive cycle is under hormonal control; from the time of puberty, in a regular twenty-eight day cycle, the lining of the endometrium in the uterus progressively thickens, ovulation (release of an oocyte, or 'egg', from an ovary) occurs, and if no fertilisation takes place the endometrium and oocyte are shed during menstruation. By the age of approximately 50 years, levels of the key female reproductive hormone oestrogen decline markedly and the woman enters menopause, where the reproductive cycle ceases. However, females of any age - including children and the elderly - can develop problems with their reproductive system.

During sexual intercourse, or via artificial insemination, the meeting of a sperm and oocyte, and the implantation of this fertilised oocyte in the endometrium in the uterus, may result in pregnancy. If a fertilised oocyte implants in another part of the female reproductive system (e.g. a fallopian tube), an ectopic pregnancy is said to have occurred; these are usually considered non-viable pregnancies, and may result in serious complications for the woman.

Reproductive system - focused health history

As always, when assessing a patient's reproductive system, the nurse must commence by collecting a health history. This involves collecting data about:

Component	Rationale
Present health status	Chronic illnesses, even if they are not related directly to dysfunction in the reproductive system, can cause damage to this system. The nurse should be particularly interested in disorders related directly to the male / female reproductive systems, endocrine disorders, and cardiac and respiratory disease. Current medications, either prescribed or over-the-counter, which: (1) may be taken to treat pre-existing reproductive system problems, and / or (2) may cause side effects which affect the reproductive system. Self-examination, or professional examination, of the genitalia: if a person self-examines their own genitalia, they may have noticed problems or changes. Furthermore, many people receive regular examinations of parts of their reproductive systems by a health care professional (e.g. Pap smears and pelvic examinations for women, testicular and prostate examinations for men, etc.). The results of such examinations can provide a nurse with important information about the possible causes of the problems a patient is experiencing.
Past medical history	Injuries to, or illnesses of, the reproductive system organs, as these may leave a client with deficits which a nurse can anticipate finding during the physical examination. Surgery on the reproductive system organs, as this can provide a nurse with additional information on possible reproductive system problems the client has or has had.
Family history	Family history of diseases affecting the reproductive systems (particularly cancer [e.g. women: cervix, ovary, uterus, breast; men: prostate, testicular, etc.]), especially among first-degree relatives, as this can provide important information about the types of disease for which a person may have a congenital risk.
Sexual history	If a nurse suspects a patient may have a sexually-transmitted infection (STI), or other problem with their reproductive system related to sexual intercourse, it may be appropriate to ask about the person's sexual history. This may include questions about the person's sexual partners (including gender and number), the type of intercourse in which the person engages, whether the person protects themselves from STIs and / or uses birth control measures, and use of drugs / alcohol during sexual activity (which increases the likelihood of high-risk sexual behaviour), etc.
Obstetric history	This section of the health history is for women only. Women may be asked about menstruation (e.g. first day of their last menstrual period; normal frequency and length of menstruation; heaviness of menstrual flow; changes in periods; age of menarche), and about pregnancy (e.g. number of pregnancies, live births, still births, miscarriages, abortions; difficulties becoming pregnant; possibility of current pregnancy). Again, this information is only collected if it may be appropriate to diagnosing and treating the problem with which the woman has presented.

In some cases, a person will present with a specific problem related to their reproductive system (e.g. pain, genital lesions / discharge, erectile dysfunction, problems falling pregnant, problems with the menstrual cycle / menopause, etc.). Remember, nurses assess a patient's symptoms using the strategy remembered by the 'OLD CARTS' mnemonic (introduced in a previous chapter of this module).

It is important for nurses to bear in mind that sexually transmitted infections (STIs) are among the most common problems with the reproductive system seen in clinical practice in the UK. The risk factors for STIs are modifiable - that is, a person is capable of making changes to them to reduce their risk. As part of their fundamental health promotion role, it is important that nurses are able to provide patients with advice about how to address the risk factors identified during assessment.

Activity

You are encouraged to explore the information on the National Health Service's (NHS) Health Choices STIs (Sexually Transmitted Infections) website. This website can be accessed online, by searching for its title.

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Reproductive system - physical examination

Once a reproductive health history has been obtained, as described in the previous section of this chapter, a nurse may commence a physical examination of the patient's reproductive system. A stepwise process of physically examining the male and female reproductive systems, with normal (expected) and common abnormal findings, is presented in the following table:

For the male reproductive system:

Component	Normal (Expected) Findings	Abnormal Findings
Inspect and palpate the external structures - including the penis surface, scrotum and perineum.	Hair (if present) should be evenly distributed; the appearance of the external structures is highly variable (for example: note that the penis may be uncircumcised or circumcised), but they should be roughly symmetric; tissues should feel smooth and soft; no tenderness; no masses in the scrotum.	Patchy hair loss; lesions; infestations; tenderness; inflammation; oedema; excoriation; irritation; asymmetrical enlargement / atrophy; discolouration; discharge (particularly that which is discoloured or foul-smelling); fissures; lumps, etc.
Palpate the internal structures - including the testes, epididymis, vas deferens.	These areas should be smooth; non-tender; no masses.	Tenderness; masses; marked atrophy; marked enlargement; tortuosity; nodular areas; fixed structures; irregular placement, etc.

For the female reproductive system:

Component	Normal (Expected) Findings	Abnormal Findings
Inspect and palpate the external structures - including the labia majora, labia minora, clitoris, urethral meatus, vaginal introitus, perineum.	Hair (if present) should be evenly distributed; the appearance of the external structures is highly variable, but they should be roughly symmetric; the inner structures should appear slightly moist; tissues should feel smooth and soft; no tenderness.	Patchy hair loss; lesions; infestations; tenderness; inflammation; oedema; excoriation; irritation; asymmetrical enlargement / atrophy; discolouration; discharge (particularly that which is discoloured or foul-smelling); fissures; lumps, etc.
Inspect and palpate the internal structures - including the glands (e.g. if the nurse suspects a glandular abscess or other dysfunction) and the vaginal wall / uterus (e.g. if the patient complains of incontinence, prolapse). As internal structures, these are ONLY assessed if indicated.	The glands should be non-tender; there should be no oedema and no discharge. The vaginal wall should have good tone (though this may decline according to the number of vaginal childbirths a woman has had); no bulging.	Gland tenderness; discharge; glands that are 'hot to touch'; swelling / oedema. Bulging of the anterior / posterior wall; prolapse; urinary incontinence, etc.

Special assessment techniques for the reproductive system

There are a number of special assessment techniques particular to the reproductive system:

For women, a speculum examination; this involves inserting a plastic or metal speculum into the vaginal introitus to separate the vaginal walls and visualise - and, perhaps, obtain smears for further testing from - the internal structures below the uterus (including the cervix). Prior to performing this assessment, a nurse must ensure they have received appropriate training in the use of a speculum, and that a speculum examination is indicated. When visualising the cervix during a speculum examination, a nurse should note any reddened / granular / friable areas, lesions, red or white patches, deviation to the left / right, extension of the cervix, lacerations, odour and / or discharge, as all indicate possible problems.
For men, an internal examination of the prostate gland. This involves a clinician inserting a finger into the rectum to assess the location and size of the prostate gland. Note, however, that in most clinical settings in the UK this assessment is performed by a doctor or an appropriately-trained advanced practice nurse.

Differential diagnosis in the reproductive system

When assessing a patient's reproductive system, there are a number of common problems and conditions a nurse may identify. Consider the conditions and their key clinical findings, outlined in the following table. This information can be useful in assisting a nurse to make a differential diagnosis of a reproductive condition:

Respiratory Problem or Condition	Typical Clinical Findings
Bacterial vaginosis (females) - a condition resulting in an alteration in normal vaginal flora, including its replacement with pathogenic bacteria.	Malodorous vaginal discharge, vulvular itching, irritation.
Chlamydia - an infection with the Chlamydia trachomatis bacteria. May occur in males or females.	Often asymptomatic; urinary symptoms (e.g. dysuria, frequency, urgency); haematuria; purulent / mucopurulent discharge; abdominal tenderness; itch; infection of the higher reproductive structures; etc.
Gonorrhoea - an infection with the Neisseria gonorrhoeae bacteria. May occur in males or females.	In women: yellow / green vaginal discharge; dysuria; pelvic / abdominal pain; abnormal menstruation. In men: urethritis; epididymitis; purulent / mucopurulent discharge.
Syphilis - an infection with the Treponema pallidum bacteria. May occur in males or females.	The manifestation varies depending on the phase of the infection; primary syphilis: a chancre (i.e. a single firm, painless sore with indurated borders on the genitals or the mouth); secondary syphilis: a rash on the palms of the hands / soles of the feet; greyish lesions in the genital area; tertiary syphilis: significant neurologic, cardiovascular, ophthalmic, musculoskeletal dysfunction.
Herpes genitalis - an infection with the Herpes simplex virus, Type 1 or Type 2. May occur in males or females.	Burning or pain with urination; pain in the genital area; fever; vesicles / ulcers in the genital area.
Pelvic inflammatory disease (females) - a polymicrobial infection of the upper reproductive tract structures (e.g. endometrium, fallopian tubes, ovaries, uterine wall, ligaments, etc.)	May be acute or chronic; very tender ovaries / fallopian tubes; fever; chills; dysparenuria; abnormal vaginal discharge, etc.
Epididymitis (males) - inflammation of the epididymis and the vas deferens.	Dull, unilateral scrotal pain; scrotal erythema; scrotal oedema; ever; dysuria; hydrocele, etc.
Endometriosis (females) - the growth of uterine tissue outside the uterus.	Pelvic pain; dysmenorrhoea; heavy / prolonged menstrual flow; tender uterus, etc. Nurses should note that a physical examination may not detect any abnormalities.
Uterine leiomyomas / fibroids (females) - benign overgrowths of tissue in / around the uterus.	Many women are asymptomatic; may experience pelvic pressure / heaviness; urinary frequency; dysmenorrhoea; pelvic / back pain; abdominal enlargement; etc. Large leiomyomas may be palpated as a firm, smooth, irregular mass.
Testicular torsion (males) - twisting of the testicle and spermatic cord, resulting in acute tissue hypoxia.	Sudden onset of severe scrotal pain; scrotal swelling; oedema; discolouration, etc.
Hydrocele (males) - an accumulation of fluid in the scrotum.	Gradual scrotal enlargement; oedema; possible tenderness, etc.
Benign prostatic hyperplasia (males) - the enlargement of the prostate without the presence of cancer.	Difficulty voiding; enlargement of the prostate (i.e. where the prostate projects more than 1 centimetre into the rectum).

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Conclusion

As you have seen in this chapter, the gastrointestinal, urinary and reproductive systems are the key systems located in the abdominal region. It is important that nurses are able to accurately and comprehensively assess these systems, and this chapter has introduced the fundamental knowledge and skills nurses require to do so. This chapter has explored the fundamental anatomy and physiology of the gastrointestinal, urinary and male / female reproductive systems. This chapter has also explained the processes involved in collecting a general health history for the gastrointestinal, urinary and male / female reproductive systems, and in performing a physical examination of these systems. This chapter also considered a number of special observation and assessment techniques which may be used in the physical examination of the gastrointestinal, urinary and male / female reproductive systems, and it discussed performing differential diagnosis relevant to these systems.

Reflection

Now we have reached the end of this chapter, you should be able:

To describe the basic anatomy and physiology of the gastrointestinal, urinary and male / female reproductive systems.
To explain how to collect a focused health history related to the gastrointestinal, urinary and male / female reproductive systems.
To explain how to undertake a physical examination of the gastrointestinal, urinary and male / female reproductive systems.
To recognise the common problems / conditions related to the gastrointestinal, urinary and male / female reproductive systems, and their typical clinical findings, to enable differential diagnosis.
To describe the variety of special assessment techniques which may be used in the physical examination of the gastrointestinal, urinary and male / female reproductive systems.

Reference list

Cox, C. (2009). Physical Assessment for Nurses (2nd edn.). West Sussex, UK: Blackwell Publishing, Ltd.

Howard, P.K. & Steinmann, R.A. (Eds.). (2010). Sheehy's Emergency Nursing: Principles and Practice. Naperville, IL: Mosby Elsevier.

Jensen, S. (2014). Nursing Health Assessment: A Best Practice Approach. London, UK: Wolters Kluwer Publishing.

National Health Service. (2016). Smokefree. Retrieved from: https://quitnow.smokefree.nhs.uk/

National Health Services (NHS) Choices. (2016). STIs (Sexually Transmitted Infections). Retrieved from: http://www.nhs.uk/livewell/stis/Pages/STIs-hub.aspx

Wilson, S.F. & Giddens, J.F. (2005). Health Assessment for Nursing Practice (4th edn.). St Louis, MI: Mosby Elsevier.

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