Gastro Flashcards
Inspection?
Skin abnormalities
Scars
Masses
Hernias
Asymmetry
Obesity inspection?
Sunken umbillicus
Distended and everted abdomen?
Umbilical hernia
Right hypochondriac region?
Gallbladder
Epigastric region?
Stomach, duodenum, pancreas
Left hypochondriac region?
Pancreas
Right and left lumbar regions?
Kidneys
Umbilical region?
Small bowel
Caecum
Retroperitoneal structures
Right iliac region?
Appendix
Caecum
Hypogastric region?
Transverse colon
Bladder
Uterus
Adnexa
Left iliac region?
Sigmoid colon
Liver palpation?
Begin palpation in right iliac fossa (starting at edge of superior iliac spine)
use flat edge of hand
Ask patient to take deep breath then palpate to costal margin
Spleen palpation
Begin in right iliac fossa (starting at edge of superior iliac spine)
use flat edge of hand
Ask patient to take deep breath
Feel for splenic edge during inspiration
Move towards left costal margin
spleen is intraperitoneal within left hypochondriac region at ribs 9-11
Causes of splenomegaly?
Portal hypertension secondary to liver cirrhosis
Haemolytic anaemia
Congestive heart failure
Splenic metastases
Glandular fever
Kidney balloting?
- Place left hand behind patients back, below ribs and underneath right flank
- Place right hand on anterior abdo wall, below right costal margin on right flank
- Push fingers together - press upwards with left hand and downwards with right
- Ask patient to take deep breath, feel lower pole of kidney move down between fingers
Bilaterally enlarged kidneys?
Polycystic disease or amyloidosis
Unilaterally enlarged kidney?
Renal tumour
Tenderness in palpation?
Minimal pressure over wide area - peritonitis or anxiety
Guarding in palpation?
Contract voluntarily when palpating causes pain
Rigidity on palpation?
Inflammation of parietal peritoneum - reflex contraction - involuntary guarding - abdo wall may not show any movement of respiration
Rebound tenderness on palpation
Generalised or localised peritonitis, if abdominal wall is compressed slowly and then released - short stabbing pain
Abdominal aortic pulse
- Deep palpation suoerior to umbilicus at midline
- Note movement with fingers
healthy = hands move superiorly with each pulsation of aorta (pulsatile)
move outwards - presence of expansile mass - abdominal aortic aneurysm
Abdominal aorta bifurcation?
At L4 -> left and right common iliac artery
5 abdominal planes
Transpyloric
Subcostal
Supracristal
Intertubercular
Interspinous
Transpyloric vertebral level and organs?
L1
across tips of 9th costal cartilages
Pylorus of stomach
Neck of pancreas
Fundus of gallbladder
Renal hilum
Duodenojejunal flexure
End of spinal cord
Subcostal vertebral level and organs?
L3
Origin of inferior mesenteric artery
Supracristal vertebral level and organs?
L4
Bifurcation of aorta
Intertubercular vertebral level and organs?
L5
Tubercle of crest of ilium
Interspinous vertebral level and organs?
S2
Horizontal plane through anterior iliac spines, marking boundary of umbilical region superiorly and hypogastric region
Liver percussion
ask patient to hold breath in full expiration
Percuss downwards from right 4th rib along mid clavicular line
upper border - resonant to dull (5th ICS)
Percuss inferiority until end of dullness
Surface markings of liver
Right 5th rib at mid-clavicular line
Lower end of sternum
Left 5th rib at mid-clavicular line
Costal margin at right mid-axillary line
Percussion of spleen
Percuss upwards 1-2cm from left iliac fossa towards left costal margin (notice resonant to dull at anterior axillary line)
At 10th ICS percuss for splenic enlargement during expiration and full inspiration
What is shifting dullness?
To examine ascites (accumulation of fluid in peritoneal cavity due to liver cirrhosis)
Shifting dullness process?
patient lying supine
1. Percuss from midline out to flanks, noting change from resonant to dull
2. Mark spot and ask patient to turn to opposite side
3. Wait 10 secs for fluid to shift
4. Palpate spot -> area of dullness is now resonant -> ascites is present
Auscultation
Apply diaphragm of stethoscope to abdo wall
normal = gurgling due to peristalsis of GI tract
listen in 2 places (for 60 seconds), at least 3-4 mins before conclusion
Absent bowel sounds?
Paralytic ileus or peritonitis
Intestinal obstruction?
High pitched and frequent
3 regions where urinary tract stones reside?
Across sacroiliac joint
Pelvic-ureteric junction
Vesicoureteric junction
Gold standard imaging for diagnosis of urinary tract stones?
Ultrasound scan
Small vs large stones?
Small - <5mm pass
Large - stunting or lithotripsy
Non-contrast CT scan locations?
- Abdominal aorta - above and left of umbilicus
- SMA or coeliac arteries - epigastrium
- Renal arteries - 2-3cm superior and lateral to umbilicus
- Liver tumours - over liver
- Iliac arteries - in iliac fossa
Gallbladder location?
Tip of right 9th costal cartilage
Liver upper border?
Upper - right dome of diaphragm marked from right 5th rib and costal cartilage which extends across lower end of sternum
Liver oblique border?
Follows right costal margin (from right mid-axillary line through tip of right 9th costal cartilage through tip of left 8th costal cartilage to 5 ICS in mid clavicular line
Liver right border?
From right 5th rib at mid-clavicular line to costal margin at right mid-axillary line
Surface marking of spleen
Between mid-axillary line and lateral border of erector spinae muscles at ribs 9 and top of 11 (posteriorly)
Medial border (hila) of kidneys location?
4-5cm from posterior medial line
kidney is 9-12cm long and 5-7cm broad
Kidney superior poles?
12th ribs
Kidney inferior poles?
3-4cm above iliac crests, below 12th rib
Ureter surface markings?
- 5cm lateral to posterior median line at L1 level
- PSIS (skin dimple)
Ascites causes?
Decreased metabolism aldosterone and anti diuretic hormone by liver = retention of salt and water
Decreased production of albumin = reduced oncotic pressure = leakage of fluid into peritoneal space
