alimentary examination

Question 1

overview

Answer 1

1. intro
2. general observation
3. general examination
4. inspection
5. palpation
6. percussion
7. auscultation

Question 2

2. general observation x7

Answer 2

Initial Assessment:
Do you need to make an immediate intervention?

General observations:
Assess how comfortable/distressed, drowsy
Consider nutritional status: Weight & BMI
body habitus -presence of cachexia/obesity

Environment Check:
vomit bowl
iv line for fluids
nil by mouth

CHECK CHARTS

Question 3

3.General examination: hands and arms x16

Answer 3

• Tar staining
• Nail colour
• anaemia
• leukonychia
• Nail shape
• clubbing
• koilonychia
• Palms
• palmar erythaema
• pale palmar creasees
• Dupuytren’s contracture (alcohol)

Look at arms for:
* Bruising
* Scratch marks/pruritus
* Muscle wasting
* Track marks
* Check forearm for loss of skin turgor

Look for tremor:
* flapping tremor (“liver flap” - liver failure)
* fine tremor (alcohol & alcohol withdrawal -
delirium tremens)

Check Pulse, respiratory rate

Question 4

3.General examination: head x3

Answer 4

Face:
* e.g. Parotid swelling (alcohol)

eyes:
* Jaundice
* Anaemia

Question 5

3.General examination: mouth and neck x7

Answer 5

mouth:
swelling
bleeding
ulcers

neck:
* lymph
* Spider naevi (oestrogen sensitive - can suggest liver failure)
* Gynaecomastia
* Loss of body hair in males

Question 6

3.General examination: legs x3

Answer 6

• Peripheral oedema (hypoalbuminaemia/liver failure)
• Loss of body hair
• Erythaema nodosum (eg IBD)

Question 7

4.inspection x5

Answer 7

• scars
• stoma
• distension
• pulsation
• caput medusa

Question 8

5.palpation

Answer 8

ask if in any pain
check if in any pain for whole procedure
get to height of patient

• hard 9 regions
  soft 9 regions
  “no guarding, tendorness or masses”
• liver and spleen breath in each time
  liver- fan like movement from iliac fossa to costal margain
  using wrong side of hand

spleen- iliac fossa to right costal margain

• kidneys
  one hand on one under breath in twice

Question 9

6.percussion

Answer 9

• liver and spleen:
  same place as palpation
• shifting dullness
  from belly button to far side stop when dull
  get patient to roll towards you while keeping finger there
  hold for 30s
  tap again

*thrill
get patient to put hand in middle of abdo
place hand on far side
flick on other

Question 10

7.auscultation

Answer 10

• bowel sounds
  left lower quadrant
• arterial bruis
  epigastric- just above belly button
• renal brui
  either side of belly button
• hepatic and plenic brui
  where liver and spleen are
• hepatic and splenic rubs
  liver and spleen area with breath