1. Gastro examination Flashcards
general inspection gastro
colour (jaundice? anaemia?), perspiration, build
(wasting? obesity?), discomfort, breathing (rate, diaphragmatic or chest wall
breathing?), conscious level
Nail changes iron defieceny anaemia
longitudinal ridging
koilonychia (spoon-shaped nails).
mouth changes iron deficiency anaemia
Angular cheilitis
Atrophic glossitis
hand signs gastro
Pallor of the palmar creases suggests anaemia
Palmar erythema (2° to increased circulating oestrogens in liver
disease)
Dupuytren’s contracture
Asterixis (liver flap)
nail signs gastro
leukonycia partalis - usually normal or after chemo
leukonycia totalis - hypoalbuminaemia (e.g. nephrotic syndrome, liver failure, protein malabsorption and protein-losing enteropathies).
Koilonychia (spoon-shaped nails, suggesting chronic iron-deficiency)
longitudinal ridging suggesting IDA
examination of forearms gastro
muscle wasting and for scratches suggestive of pruritis
(itching).
examination of the eyes gastro
o Jaundice
o Anaemia (subconjunctival pallor)
o Xanthelasma
o Corneal Arcus
o Kayser-Fleischer rings (Wilson’s disease). These are brown rings that encircle
the iris, resulting from copper deposition.
examination of skin gastro
telangectasia (HHT)
spider naevi
skin folds
stretch marks
examination of mouth gastro
Telangiectasia
o Pigmentation (Peutz-Jegher syndrome, associated with small bowel
hamartomas)
o Angular stomatitis
o Glossitis
o Dehydration
o Halitosis (bad breath)
o Dental caries
o Ulcers
how to ddx glossitis causes
Painful glossitis is seen in Vitamin B12 or folate deficiency whereas glossitis due to iron-
deficiency tends to be painless.
causes angular stomatitis
caused by deficiency of Vitamin B6, B12, folate or iron.
mouth ulcers cause gastro
can be associated with Vitamin B12 deficiency, iron-deficiency, Crohn’s disease, Coeliac disease
chest wall examiantion gastro
Spider naevi
o Gynaecomastia (male breast development) – may be due to increased
circulating oestrogens in liver failure.
what lymph node are you looking for gastro
Troisier’s sign is an enlarged left supraclavicular lymph node (Virchow’s node) due to a metastasis
from an intra-abdominal malignancy
inspection of abdomen gastro
scars
skin folds
stretch marks
distension
Movement during breathing
Visible swellings and masses
o Visible peristalsis
o Visible aortic pulsation
o Distended veins (may indicate inferior vena cava obstruction or portal
hypertension)
Caput medusae
Hernias
cullens sign
grey-turners sign
5Fs of abdominal distension
Fluid (ascites)
▪ Faeces (constipation)
▪ Flatus (subacute intestinal obstruction)
▪ Foetus (pregnancy)
▪ Fat (obesity)
how do you determine if a mass is intra-abdominal
Determine whether masses are intra-abdominal by asking the patient to raise their head and shoulders off the pillow. Masses within the abdominal wall become more prominent when the recti are contracted, whereas intra-
abdominal masses become less prominent.
what is courvosiers law
Courvoisier’s Law states that in the presence
of a palpable gallbladder, jaundice is not likely to be due to gallstones).
normal palpation of liver
The liver can normally be palpated up to 1 cm below the right costal margin on deep inspiration.
The gallbladder is not usually palpable unless enlarged.
normal palpation of spleen
not normally palpable unless enlarged.
Splenomegaly only becomes palpable once the spleen has enlarged
to 2-3 times its normal size.
how to distinguish a kidney from spleen
To distinguish a palpable kidney from a spleen, you should attempt to insert
your hand between the upper pole of the kidney and the costal margin, which
can be done if the mass is renal but not if it is the spleen. Also, the spleen has
a notch which may be palpable; and the spleen is not ballotable.
what is a positive murphys sign
If inspiration is prevented by the inflamed gallbladder
coming into contact with the examiner’s fingers, the test is considered positive.
A positive test also requires no pain on performing the manoeuvre on the patient’s left
hand side. This test is done when suspecting acute cholecystitis in a patient.
what is castels method of assessing splenomegaly
With the patient in full inspiration and then full
expiration, percuss the area of the lowest intercostal space (eighth or ninth) in the left anterior axillary line. If the note changes from resonant on full expirationto dull on full inspiration, the sign is regarded as positive.
to complete gastro exam…
Inguinal lymph nodes
o Stools – examine the stools if clinically indicated
o Hernial orifices (femoral and inguinal) (e.g. if there are signs of bowel obstruction).
o Rectal examination (always with a chaperone) (e.g. if there is suspicion of gastrointestinal bleeding).
o Urine – obtain urinalysis
o Genitalia (examine the male external genitalia). (e.g. to rule out testicular torsion as a cause of referred abdominal pain or an indirect inguinal hernia).A vaginal examination may beindicated in parous or sexually active females (only when clinically indicated
and always with a chaperone)
