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MD3002 - GI Clinical > Clinical Examination: Abdomen and GU System > Flashcards

Clinical Examination: Abdomen and GU System Flashcards

1
Q

What are the main principles of examiantion?

A
  • Introduction and explanation
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
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2
Q

What must you always establish before starting an examination?

A

if the patient is in any pain or discomfort

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3
Q

How should the patient be positioned for the examination of the abdomen and GU system?

A
  • Comfortably supine with head resting on only 1 or 2 pillows
  • Expose abdomen from xiphisternum to symphysis pubis
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4
Q

General Inspection:

What to look for when looking around the patient?

A
  • Sick bowls
  • Empty bottles/cans
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5
Q

General inspection:

What to look for when looking at the patient

A
  • Does the patient look well or not?
  • In pain?
  • Nutritional state; cachectic or obese?
  • Signs of liver disease e.g. bruising, spider naevi
  • Oedema (GI/GU causes = cirrhosis, pelvic mass, nephrotic syndrome, renal failure)
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6
Q

What are the GI/GU causes of oedema?

A

hosis, pelvic mass, nephrotic syndrome, renal failure

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7
Q

What are the main GI causes of finger clubbing?

A
  • Malabsorption (e.g. coeliac)
  • Inflammatory bowel disease (UC + Crohn’s)
  • Lymphoma
  • Cirrhosis
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8
Q

What are the main GI causes of asterixis? (coarse flapping tremour)

A

hepatic encephalopathy (build up of toxins in the liver)

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9
Q
A

Leukonychia

  • white deposits indicating low albumin
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10
Q
A

Koilonychia

  • iron deficiency and potential GI tract bleeding
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11
Q
A

Palmer erytherma

  • indication of chronic liver diease (high oestrogen levels)
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12
Q
A

Duputuyrens Contracture

  • thickening of tendons in the fingers
  • Associated with chronic liver disease and alcoholism
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13
Q
A

Spider Naevus

  • superifical blood vessels
  • increase oestrogen
  • follow the path of the SVC (upper part of the body)
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14
Q
A

Purpura

  • Rash that temains even when pressure is applied (non blanching)
  • low platelets
  • chronic liver disease
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15
Q
A

Jaundice and anaemia

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16
Q

What possibilities should you look for in the patients mouth?

A

Stomatitis, glossitis, candidiasis, ulcers, pigmentation (Peutz-Jeghers syndrome – very rare), telangiectasias, dentition, gingivitis and “mousy” odour (fetor hepaticus)

17
Q

What should the chest be inspected for?

A

Inspect chest for spider naevi, gynaecomastia in men, and both axillae for loss of axillary body hair

18
Q

What to look for in close inspection of the abdomen?

A
  • Movement, distension, scars, herniae, masses, striae, dilated veins “Caput medusae)
  • Distention
  • Fat, fluid, faeces, flatus, foetus (“5 Fs”)
  • Remember the abdomen is divided into 9 regions (or quadrants)
19
Q

What should you palpate for in the abdominal examination?

A

Tenderness (including guarding or re-bound tenderness)/ masses/organomegaly (spleen, liver, kidneys)/abdominal aorta

20
Q

How to palpate for liver hepatomegaly

A
  • Begin in right iliac fossa
  • Ask the patient to breath in and out deeply
  • Palpate upwards to right costal margin
  • Feel for liver edge as it descends on inspiration and move hand between each breath
21
Q

Potential causes of hepatomegaly

A
  • Hepatitis
  • Alcoholic liver disease
  • Right heart failure
  • Fatty infiltration
  • Biliary tract obstruction
  • Malignancy (metastatic/primary)
  • Haematological disorders
22
Q

How to test for Murphy’s sign

A
  • Feel for gall bladder tenderness (e.g. acute cholecystitis)
  • Patient breaths in while you gently palpate RUQ in mid clavicular line
  • On liver descent contact with inflamed gallbladder causes tenderness and sudden arrest of inspiration
23
Q

How to feel for courcoisier’s sign

A
  • Painless jaundice and a palpable gallbladder
  • Likely due to extrahepatic obstruction
  • E.g. Pancreatic Cancer
  • UNLIKELY to be gallstones
24
Q

Potential causes of splenomegaly

A
  • Haematological – haemolytic anaemias / leukaemia’s / polycythaemia ruba vera / lymphoma/ myeloproliferative disease / myelofibrosis
  • Infection – infective mononucleosis / infective endocarditis / TB / malaria
  • Portal hypertension
  • Rheumatological disorders – rheumatoid arthritis (Felty’s syndrome / SLE
  • Rare causes – sarcoidosis / amyloidosis / glycogen storage diseases
25
Q

Causes of renal enlargement

A
  • Hydronephrosis
  • Polycystic kidney disease
  • Renal cell carcinoma
  • In children, nephroblastoma (Wilm’s tumour)
  • Solitary cysts
26
Q

What is ascites?

A

abnormal collection of fluid in peritoneal cavity

27
Q

Causes of ascites

A
  • Hepatic cirrhosis
  • Intra-abdominal malignancy
  • Nephrotic syndrome
  • Cardiac failure
  • Pansteatitis
  • Constrictive pericarditis
28
Q

How to percuss ascites?

A
  • Start in midline
  • Percuss towards flanks
  • Shifting dullness and fluid thrill
29
Q

What can palpation of the cervical lymph nodes indicate?

A
  • May indicate local disease
  • May indicate more distant disease:
    • Tumours of the upper GI tract may metastasise to the lower part of the left posterior cervical triangle
    • Virchow’s node/Troisier’s sign
30
Q

What other areas should you offer to examine?

A

Offers to examine groin

Offers to examine genitalia

Requests to do digital rectal examination (DRE)

31
Q

What are the indications for a rectal examination?

A

Rectal bleeding

Prostatic symptoms

Change in bowel habit

Possible spinal cord injury

32
Q

What should be offered for a rectal examiantion?

A

chaperone

33
Q

What pathologies can be identified through a DRE?

A
  • Haemorrhoids
  • Rectal prolapse
  • Anal fissure
  • Skin tags
  • Anal carcinoma
  • Anal fistula
  • Prostatic enlargement
    • Benign prostatic hyperplasia
    • Prostatic carcinoma
    • Prostatitis (tender prostate)
34
Q

What are the indications for a pelvic reproductive examination?

A
  • Pelvic pain
  • Abdominal vaginal bleeding
  • Abdominal vaginal discharge
  • If considering vaginal or uterine prolapse
35
Q

What are the main pelvic pathologies likely to be identified by examination?

A
  • Ovarian pathology
    • E.g. ovarian cyst, malignancy
  • Uterine pathology
    • E.g. uterine prolapse, fibroids, cervical carcinoma, carcinoma of body of uterus
  • Vaginal pathology
    • E.g. vaginitis, prolapse
  • Pelvic infection (pelvic inflammatory disease)
  • Ectopic pregnancy – do a pregnancy test
  • Always consider a pelvic ultrasound scan
36
Q

What are the main pathologies associated with male reproductuve examination?

A
  • Infection (epididymitis, orchitis, epidimyo-orchitis)
  • Testicular torsion
  • Epididymal cysts
  • Testicular tumours
  • Indirect inguinal hernia

MD3002 - GI Clinical (3 decks)

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