Alimentary FoCM 2, 4, 5 & 6 Flashcards
What are the initial 8 steps in every consultation?
- Wash your hands
- Introduce yourself
- Patient’s ID, CHECK BAND ON WRIST
- Explain why your there/what you will be doing
- GAIN CONSENT !!!
- Pain, especially in areas you are going to examine
- Position the bed to 45 degrees, and adjust bed height
- Exposure: ask the patient to remove any clothes which as necessary for examination.
In regards to initial & environmental assessment, what do we look for ?
- General obs: patient comfort, State of patient (consciousnesses(hepatic enecepha, pain relieving position)
- Look for any equiptment near bed, i.e. sick bowls, iv line etc.
- NEWS CHARTS: Temp, pulse, BP, RR
When moving onto the peripheral examination what do we start with?
Hands & Arms
When accessing hands what do we look for ?
- Tar staining
- Nail colour (anaemia , leukonychia (hypoalbuminaemia ))
- Nail Shape (Clubbing, koilonychia (iro deficiency anaemia)
- Palms (Palmar erythema, pale creases & dupuytren’s contracture (Sing finger towrd palm (alcohol)
When accessing the arms what do we look for ?
- Bruising (liver dysfucntion)
- Scratch marks / pruritus (chronic cholestasis)
- Muscle wasting (inadequate nutrition, poss. sepsis)
- Forearm loss of turgour (dehyrdation)
When accessing tremor what things do we look for ?
Flapping Tremor (indicative of CO2 retention => Liover failure - “liver flap”)
What is the most important and final aspect of initial peripheral examination ?
PULSE
RR
BP
When accessing the head what do we first observe ?
The face
In regards to GI what signs do we look for in the face?
Parotid swelling - Alcohol
In the eyes: yellow (jaundice) & anaemia (GI blood loss/pernicious/iron deficiency)
NOTE for anaemia and jaundice ask the patient to look down then up and pull eyelids down (look for pale eyelids i.e. loss of blood)
And in the mouth?
Angular stomatitis & sore red tongue (Fe deficiency anaemia)
Detect the odour of foetor hepaticus if present (“mouldy hay’ - liver failure)
If there is time which further examination can be done?
Using a torch and tongue depressor.
What things can be examined using a torch & tongue depressor ?
- Swelling and/or bleeding
- Dentition
- Glands & ducts
- Infection (e.g. candidaisis/tonsilitis)
What disease should indicate this examination as a necessity?
Inflammatory Bowel Disease
REVIEW LYMPH NODES DIAGRAM
Do it, learn names of them!!
What drains into the Virchow’s node?
Thoracic duct