Alimentary - Examination

Question 1

Name the 4 quadrants of the abdomen

Name the 9 regions of the abdomen

Answer 1

Quadrants: Right Upper, Left Upper, Right Lower, Left Lower

Regions: Epigastrium, Right Hypochondrium, Left Hypochondrium, Umbilical Region, Right Flank/Lateral, Left Flank/Lateral, Hypogastrium/Suprapubic, Right Illiac Fossa/Inguinal, Left Illiac Fossa/Inguinal.

Question 2

What features do you use to describe an abdominal mass?

Answer 2

Question 3

Perform the Peripheral Examination of an Alimentary System examination.

Answer 3

Peripheral Examination

Hands: Tar Staining, Nail Colour (anaemia, leukonychia), Nail Shape (clubbing, koilonychia), Palms (palmar erythema, palmar creases, Dupuytrens contractures).

Arms: Bruising, Scratch Marks, Muscle wasting, Track marks, Skin Turgor/Dehydration. Tremor: Flapping in liver failure, Fine in alcohol withdrawal.

Pulse, RR, BP.

Head: Parotid swelling, Jaundice, Anaemia pallor in eyes, angular stomatitis, sore red tongue, odour of foetor hepaticus

Question 4

Examine the mouth in an Alimentary System examination.

Answer 4

Gums for swelling/bleeding, dentition, salivary glands and ducts, floor of mouth and tongue, mouth (aphthous) ulcers, Infection (e.g. oral candidiasis).

Question 5

Examine the lymph nodes in an Alimentary System examination.

Answer 5

• Usual full routine
• Examine Virchow’s Node Carefully (same site as left scalene node)

Question 6

Inspect the Necklace region and Legs in an Alimentary System examination.

Answer 6

Necklace: Spider Naevi, Gynaecomastia, Loss of Body Hair

Legs: Peripheral Oedema, Loss of Body hair, Erythema Nodosum

Question 7

Inspect the Abdomen in an Alimentary System examination.

Answer 7

Question 8

Palpate the abdomen generally in an Alimentary System examination.

Answer 8

Ask if in any pain

Lie examining hand flat against abdomen in line with forearm and examine 9 regions with MCP joints. Start away from site of any pain and keep an eye on patients response.

Light Palpation: Look for Superficial Masses, Tenderness (response in patient), Guarding, Rebound Tenderness, Rigidity.

Deep Palpation: Ask patient to comment if it isn’t too sore, palpate for areas of tenderness. May be able to feel pulsation of abdominal aorta, Caecum is RLQ, Descending and Sigmoid colon on left, Liver edge.

Question 9

Palpate to identify the Liver in an Alimentary System examination.

Answer 9

Question 10

Palpate the spleen in an Alimentary System examination.

Answer 10

Question 11

Palpate the Kidneys in an Alimentary System examination.

Answer 11

Question 12

Percuss the Liver and Spleen in an Alimentary System examination.

Answer 12

Question 13

Use Percussion to detect free fluid (ascites) in the Abdomen in an Alimentary System examination.

Answer 13

Question 14

Perform the Auscultation part of an Alimentary System examination.

Answer 14

In addition to picture. Rubs (Hepatic and Splenic). Rub indicates inflammation of capsule surrounding the organ and sound is made when rubbing against peritoneum. More easily heard if patient takes a deep breath

Question 15

What are the additional parts you would include in a full Alimentary System examination?

Answer 15

Examination of the groins, hernial orifices, male genitalia and a digital rectal examination.

Question 16

Perform a Digital Rectal Examination.

Answer 16

ID yourself + Patient

Explain and Introduce Chaperone. Gain Consent

Position patient on left side with hips and knees flexed, Buttocks at edge of bed

Ensure appropriate exposure. Wear PPE and apply lubricant to tissue so you don’t contimate gloves/gel after examination

Perianal Area: Separate buttocks to inspect, observe for normal anal tone

Apply lubricant to examining finger, comfort patient. Gentle pressure until relaxation and insert through the anal canal.

Anal Tone: Ask patient to squeeze your finger with their anal muscles to assess tone

Move finger further in and follow sacral curve. Gently sweep 90 right and left to explore quadrants of rectum.

Palpatte anterior well and then other walls in turn. Prostate gland will be palpable through the anterior wall of the rectum, may feel cervix in woman.

Note absence or presence of faecus and stool consistency. Examine any palpable abnormalities. Slowly withdraw finger feeling for any irregularities. Examine glove for stool colour, blood, mucus and pus.

Close with patient and wipe any excess gel, cover patient appropriately.