Clerical 3: Abdominal, testicular and rectal Flashcards
What routine should you follow at the start of every exam?
Choice
C consent
H hygiene and ppe
O offer assistance and privacy
Instruct and inform
Competence - position patient and perform exercises
Elicit and present findings
What does IPPA stand for in clinical exam?
Inspection
Palpation
Percusión
Auscultation
How should a chaperone be used for clinical exams?
Must be offered for all intimate exams
May be used for others
Must be a quila field healthcare professional
Is patient declines a chaperone this should be recorded in the patient notes
How exposed should the patient be for an abdominal exam?
Nipple to knee - underwear allowed to be kept on
How should the patient be positioned in an abdominal exam?
Fully flat on back
Head supported by pillow
Arms by side
If the patient is is pain now should this influence the palpitation of the abdomen
Start palpitation in the area furthest away from pain
What should be checked in the vernal examination for the abdominal exam?
Hands
Wrist - pulse
Arms
Face - eyes and mouth/tongue
Neck - lymph nodes
Chest
Legs
What are the different parts of the abdominal exam?
Inspection
Palpitation
Percussion
Auscultation
Hernial orifices, rectal examination, consider external genital exam
Always offer urinalysis and consider vaginal, penile swabs and faeces analysis if indicated
What is the general examination can indicate liver disease?
Jaundice
Pitting oedema
Heoatomegaly
Splenimegaky or small spleen
Palmar erythema
What can cause pain in the right hyperchondriac region?
Gall stones
Stomach ulcer pancreatitis
What can cause pain in the epigastric region?
Stomach ulcer
Heartburn indigestion
Pancreatitis
Gallstones
Epigastric hernia
What can cause pain in the left hyoerchondriac region?
Stomach ulcer
Duodenal ulcer
Biliary colic
Pancreatitis
What cause pain in the right lumbar region?
Kidney stones
Urine infection
Constipation
Lumbar hernia
What causes pain in the umbilicus region?
Pancreatitis
Early appendicitis
Stomach ulcer
Inflammatory bowel disease
Small bowel
Umbilical hernia
What cause pain in the left lumbar regikn?
Kidney stones
Constipation
Inflammatory bowel disease
Diverticula’s disease
What cause pain in the right inguinal region?
Appendicitis
Constipation
Pelvic pain
Groin pain
Inguinal hernia
What causes pain in the hypigasgric region?
Urine infection
Diverticula’s disease
IBD
Pelvic pain
What causes pain in the left inguinal region?
Diverticula’s disease
Pelvic pain
Groin pain
Inguinal hernia
What should you look for on the abdomen inspection?
Shape - normal or distended
Scars or stoma sites
Movement with respiration
Visible pulsation or peristalsis
Skin changes - erythema ab igne, spider naevi, caput medusae and stretch marks
Obvious swelling or organ megaly
Hernia
Symmetry
How do you palpate the abdomen?
Ask if in any pain
Warm hands using flat of fingers
Light then deep palpitation in all nine areas - watch face for sign of uncomfortable throughout
Palpate for liver ( time with deep inspiration)
Palpate for spleen
Palpate for kidney
Palpate for aorta
Palpate for bladder
What is being palpated for in abdominal exam?
Organ size
Muscle tone
tenderness Or pain
Pathological signs
* murohys sign and rovsing sign
Cough impulse at hernia orifice
What is murphys sign?
Indicative of acute cholecystitis
Curl fingers/thumb around the right costal margin whilst the patient is exhaling.
Ask the patient to inhale deeply if the patient feel pain that means they need to stop inhalation - the sign is positive
What is rovsing sign?
Sign of acute appendicitis
When palpating the left illiac fossa causes pain in the right illiac fossa
What sould you percuss for in an abdominal exam?
Check all quadrants for normal pattern of resonance
Sidtinguish fluid from faltus is distended abdomen
Check margin of:
Liver - RIF upwards
Spleen -RIF diagonal
Bladder - downwards in the midline from the umbilical region
Test for shifting dullness
What are you auscultating for in the abdomen?
Bowel sounds - should hear within 30seconds
Should listen for 3 minutes before can declare the bowel sounds absent
Listen for the character
Listen for vascular buits from the abdomen aorta and the kidneys
What are the causes of abdomen distention?
Fluid
Flatus
Foetus
Faeces
What exams may you request to finish the abdominal examination?
Examine the external genitalis
Examine hernial orifice including checking for cough impulses
Examine the einguinal lymph nodes
Offer urinalysis and a pregnancy test in acute setting
record vital signs
What would you consider in a urinalysis?
Consider gross appearance (colour, turgidity and suspended soilds)
Perform a dipstick test and if positive send for microscopy, culture and sensitivities
What would you consider in a faeces analysis?
Colour
Consistency
Blood
Mucus
How do you prepare for a digital rectal exam?
Offer a chaperone
Position patient - left lateral, knees drawn up
Wash hands and wear gloves
Lubricate finger.
What is part of a digital rectal exam?
Inspect for skin changes such as swellings, fistulae and external haemorrhoids
Palpate - use lubrication and insert with a gentle rocking notation
What should you be looking for when palpating the rectum?
Anal tone/spasm (ask patient to clench around finger)
Pain
Feel wall of anal canal
Masses (feel for prostate)
Contents - stool,blood or melaena
Inspet glove on removal - colour/consitentncy of faeces
Describe the potision, shape and consistency of any mass
What are the different types of hernia?
Incisional - anywhere on the abdomen
Groin - inguinal (above and medial to pubic tubercle)
- Femoral - below and lateral to pubic tubercle
Direct inguinal hernia - directs through posterior wall of the inguinal canal directly through the abdominal muscles
Indirect inguinal hernia - through deep inguinal ring and follows inguinal canal
How do you set up for the male external genitalis examination?
Wear gloves and an apron
Chaperone
Patient should be positioned to start sitting/standing then lie flat
What are you looking for on insepction of the rectum?
Skin excoriation
Rashes
haemorrhoids
Anal fissure.
Bleeding
Fistula
Absecesses
How do you assess for rectal tone?
Ask patient to squeeze finger breifly.
How to prepare for a testicilar exam?
Wear apron
Wash hands
Normal comms intro (identity, explain exam, consent)
Offer chaperone
How do you prepare a patient for a testicular examination?
Get behind sheet to get ready
Remove underwear and trousers
Lie on back - use sheet to cover
Ask for permition to come back into the room, ask for permission to lift the sheet up
What is a good way to describe the testicular and rectal exam to a patient?
Look and a feel of your backpassage and surrounding area
Look and feel of your penis, testicules and surrounding area.
What do you look for in the general examination of the genitalia?
Skin changes
Rashes
Ulcers
Obvious deformity
(ask patient to extract foreskin)
Look for redness, rashes and ulcers
(ask patient to lift testes up)
Check for symmetry, rashes, redness and skin changes
How do you palpate the testicle?
Start at the right begin at top and role the testical
Repeat on other side.
Starting and posterior lateral side examine for epididymis and follow up for spermatic duct
May perform prehns test and cremasteric reflex.
How do you examine the penis
Look underneath
What do you perform on the external genital exam when the patient is standing up?
Repeat observation
Pen torch look for translumination.
What is meant by tenesus?
Feeling the urge to fo to the toiler but then not actually needing to go
What questions are important to ask about abdominal pain?
above or below the belly button, ask patient to point. Onset related to food,bowel changes, duration, how long it lasts for. timing - sleep. worse with motion.
