Abdominal / GI exam Flashcards
What is the general layout of an abdo exam?
1) WIPE
2) gen inspection
3) hands, face, neck inspection
4) abdo inspection
5) Palpation
4) Percussion
5) Ascultation
What do you look for on general inspection of the patient and bedside? (abdo exam)
Patient - alert, comfortable and well at rest.
Bedside - cather, Iv fluids, PEG feed, nil by mouth
What do you look for on inspection of the hands and nails (abdo exam)?
1) palmar erythema
2) pale palmar creases
3) duptyren’s contracture
4) spider naevi
5) leuconychia, koilonychia, clubbing
6) HEPATIC FLAP
7) Pulse
What are the 3 signs that constitute clubbing?
1) increased nail curvature
2) loss of hyponychial angle
3) fluctuance of nail bed
What can clubbing indicate?
GI:
- malabsorption
- Crohn’s / UC
- Cirrhosis
Lung disease:
- cancer
congenital heart disease.
What do you look for when inspecting the eyes in and abdo exam?
Eyes:
- conjunctival pallor
- jaundice (yellowed sclera)
- Keiser fletcher rings
What do you look for when inspecting the mouth in and abdo exam?
- angular stomatitis (iron deficiency)
- mouth ulcers (crohn’s / UC malnutrition)
- glossitis (anaemia / vitamin B def)
- candidiais
What do you look for when examining the neck in an abdo exam?
- Palpate for supraclavicular, axillary and inguinal lymphadenopathy
(Virchow’s node in the left supraclavicular fossa is suggestive of gastric cancer AKA trosier’s sign)
What is trosier’s sign?
Trosiers sign is a palpable virchow’s node in the left supraclavicular fossa - it is a sign of gastric malignancy
What do you look for on inspection of the abdomen?
1) scars anteriorly, posterio and flanks
2) distension of abdo (ascites, masses, organomegaly)
3) dilated veins (caput medusae) / aortic pulsatation
4) skin changes : spider naevi, grey-turner or cullen’s sign.
5) ask patient to cough - i in pain - sign of peritonitis
6) gynaecomastia
How do you palpate the abdomen in a GI exam?
ARE YOU IN ANY PAIN? I’m going to press your tummy now, please let me know if this is painful at anytime.*
1) get down to the level of abdomen.
2) light palpation of all nine regions
3) deep palpation of all nine regions - check for rebound tenderness
4) palpate for LIVER edge - ask patient to breathe in and out deeply (press down on inspiration) - hepatomegaly?
5) palpate for spleen edge - splenomegaly?
6) ballot kidneys
7) palpate for aortic aneurysm (pulsatile and expansile)
What do you percuss in a GI abdo exam?
1) percuss all 4 quadrants
2) percuss to find liver border
3) percuss to find spleen
4) percuss to find bladder
5) test for fluid thrill
6) Test for shifting dullness
What is rebound tenderness?
pain on removal of pressure - indicates peritonitis
How do you percuss for shifting dullness?
1) start in the midline and percuss away from you.
2) stop when it becomes dull
3) keep a finger at this point
4) roll patient towards you
5) percuss this point again - if the new note is resonant then it is a positive test - fluid present.
How do you test for fluid thrill
1) ask the patient to place their hand on their abdomen.
2) flick the side closest to you whilst you feel the other side for rippling of fluid
