Gastrointestinal and Gastrourinary Exam Flashcards
What position should the patient be in when conducting a GU/GI exam?
Ensure that the patient is lying flat on the couch, exposed from the waist upwards.
What should be inspected when inspecting the patient?
Skin abnormalities, surgical scars, masses hernia, and asymmetry and movement of the abdominal wall
In a patient with obesity, how is umbilicus viewed?
The umbilicus is sunken
A distended and everted umbilicus reveals what type of pathology?
An Umbilical hernia
What are the nine abdominal regions?
Right hypochondriac region Epigastric region Left hypochondriac region Right lumbar region Umbilical region Left lumbar region Right iliac region Hypogastric region Left iliac region
Describe how light palpation is performed on a patient
Light palpate, the nine abdominal regions, closely monitoring the face for pain , assess for tenderness
What abdominal organ is associated with the right hypochondriac region?
Gallbladder
In which abdominal region is the spleen and pancreas associated with?
Left hypochondriac region
Which organs are associated with the epigastric region?
Stomach, duodenum and pancreas
Which abdominal region is associated with the left and right kidney?
left and right lumbar region
Which organs are associated with the umbilical region?
Small bowel, caecum, retroperitoneal structures
The appendix and the caecum are associated with which abdominal region?
Right iliac region
Which organs are associated with the right iliac region?
Appendix
Caecum
Which organs are associated with the hypogastric region?
Transverse colon
Bladder
Uterus
Adnexa
Which organ is associated with the left iliac region?
Sigmoid colon
The sigmoid colon is associated with which abdominal region?
Left iliac fossa
How is deep palpation performed?
Palpate each of the nine abdominal region, applying greater pressure, warn the patient that this may feel uncomfortable
Where should liver palpation begin?
Right iliac fossa starting at the edge of the superior iliac spine
How is liver palpation performed?
Begin the palpation in the right iliac fossa, staring at the edge of the superior iliac spine.
• Use the flat edge of your hand (radial side of your right index finger).
N.B: Ask the patient to take a deep breath, and as they begin to do this, palpate the abdomen To the costal margin.
What should the patient be doing when palpating the liver?
Ask the patient to take a deep breath, as they do, palpate the abdomen to the costal margin
Where should palpation be until?
until the costal margin
A palpable liver will suggest what pathology?
Hepatomegaly
Where should spleen palpation begin?
Right iliac fossa
How should the spleen be palpated?
Begin palpation in the right iliac fossa, starting at the edge of the superior iliac spine – using the flat edge of your hand.
• Ask the patient to take a deep breath, and as they begin to do this palpate the abdomen.
• Feel for a step as the splenic edge passes below your hand during inspiration
• Repeat the process of palpation moving 1-2cm superiorly from the right iliac fossa each time towards the left costal margin
Where should spleen palpation be felt until?
The left costal margin
What type of organ is the spleen?
Intraperitoneal organ
Describe the borders of the spleen?
Ribs 9-11, lateral border of the erector spinae muscles and the mid axillary line
What are the common causes of splenomegaly (5)?
Congestive heart failure Portal hypertension secondary to liver cirrhosis Haemolytic anaemia Splenic metastases Glandular fever
What term describes the palpation of the kidneys?
Kidney balloting
How is kidney balloting performed?
- Place left hand behind patient’s back, below the ribs and underneath the right flank.
- Place right hand on the anterior abdominal wall, below the right costal margin in the right flank.
- Push fingers together Press upwards with your left hand and downwards with your right hand.
- Ask the patient to take a deep breath – feel the lower pole of the kidney move down between the fingers.
- Repeat process on the opposite side to ballot the left kidney
A bilaterally enlarged kidney suggests what cause?
Polycystic kidney disease and amyloidosis
What pathology is linked with a unilaterally enlarged kidney?
Renal tumour
What is the common cause of abdominal tenderness?
Peritonitis and sometimes anxiety
What is guarding?
Tends to contract voluntarily when palpation causes pain
What is rigidity?
Inflammation of parietal peritoneum, resulting in a reflex contraction - involuntary guarding - abdominal wall may not show any movements of respiration
Which term is associated with involuntary guarding?
Rigidity.
What is rebound tenderness?
Generalised or localised peritonitis, if the abdominal wall is compressed slowly and then released - sharp stabbing pain
How is the abdominal aortic pulse palpated?
Perform deep palpation superior to the umbilicus in the midline
Note the movement with your fingers
In healthy individuals how should an abdominal aortic pulse be felt?
Pulsatile
In patients with AAA, how would the abdominal aortic pulse be felt?
Expansile mass
An expansile mass when palpating the abdominal aorta suggests with what pathology?
Abdominal aortic aneurysm
Where does abdominal aorta bifurcate?
L4
The abdominal aorta bifurcates into what
Left and right common iliac artery
What vertebral level is the transpyloric plane?
L1
Which organs are associated with the transpyloric plane?
Pylorus of the stomach neck of the pancreas fundus of the gallbladder Renal hilum • Duodenojejunal flexure • End of spinal cord
At what vertebral level is the subcostal plane at?
L3
Which plane is associated with the L3 vertebral level?
The subcostal plane
Which structure is associated with the L3 subcostal plane?
The origin of the inferior mesenteric artery
At which plane does the aorta bifurcate at L4?
Supracristal plane
The supracristal plane is associated with which vertebral level?
L4
What vertebral level is the inter-tubercular plane associated with?
L5
Which vertebral level is the interspinous plane associated with?
S2
What is the interspinous plane?
Horizontal plane through the anterior superior iliac spine, marking the boundary of the umbilical region superiorly and the hypogastric region inferiorly
Where should the liver percussion begin at?
Percuss downwards from the right 4th rib along the mid-clavicular line.
Resonant till Dull (5th intercostal space)
What percussion changes are detected when percussion the upper border of the liver?
Resonant to dull
When percussing the lower border of the liver, where should you begin?
Right iliac fossa upwards until the right costal margin
What is the right upper border of the liver?
Right 5th rib at the mid-clavicular line
What is the left upper border of the liver?
Left 5th rib at the mid clavicular line
Where is the right lower border of the liver?
Costal margin at the right-mid axillary line
What are the borders of the liver?
Left 5th rib at the MCL
Right 5th rib at the MCL
Right costal margin at the right mid axillary line
Lower end of sternum
Where should the spleen be palpated?
At the 10th intercostal space (between the 10th and 11th ribs), percuss for splenic enlargement during expiration and full inspiration, at the anterior axillary line
Demonstrate how shifting dullness is performed
Percuss from the midline out to the flanks, nothing where the change from resonant to dull occurs - mark the spot
Ask the patient to turn onto the opposite side
Wait 10 seconds for the fluid to shift
Palpate the spot, area of dullness is now resonant, indicating ascites
What does shifting dullness detect?
Ascites- accumulation of fluid within the peritoneal cavity
Why does liver cirrhosis cause ascites?
Decreased metabolism of aldosterone and ADH - leading to a retention of salt and water
Decreased production of albumin
How does a decrease in albumin cause ascites?
Reduces oncotic pressure - resulting in a leakage of fluid into the peritoneal space
How can bowel sounds be auscultated?
• Apply the diaphragm of the stethoscope to the abdominal wall
Normal bowel sounds are heard as gurgling noises due to the peristalsis of the gastrointestinal tract.
• Listen in two places on the abdomen (60 seconds) and should listen for at least 3-4 minutes before coming to any conclusion that bowel sounds are absent.
What pathology is associated with absent bowel sounds?
Paralytic ileus and peritonitis
Paralytic ileus and peritonitis is associated with which type of bowel sounds?
Absent bowel sounds
What bowel sounds are associated with intestinal obstruction?
High pitched and frequent
What 3 regions are the common sites for urinary tract stones?
1) Across the sacroiliac joint
2) The pelvic-ureteric junction
3) Vesicoureteric junction
What is the gold standard scan for diagnosing urinary tract stones?
Ultrasound scan
At what size of renal stones are associated with stenting or lithotripsy?
> 5cmm
What is the treatment for large urinary tract stones?
Stenting
Lithotripsy
Urinary tract stones can cause what pathology proximal to the ureter obstruction?
Hydronephrosis
Where should the abdominal aorta be auscultated?
Just above and left of the umbilicus
Where should the superior mesenteric artery or coealic arteries be ausculated?
Epigastric region
Where should the renal arteries be auscultated for bruit?
2-3cm superior and lateral to the umbilicus
Where should iliac arteries be auscultated?
Iliac fossa
What are the surface markings for the gallbladder?
Gallbladder at the tip of the right 9th costal cartilage
What is the oblique border of the liver?
Left 5th intercostal space mid-clavicular line till the right costal margin (right 9th costal cartilage)
At which intersection is the gallbladder found?
Right mid-clavicular line and the transpyloric plane
Please state 2 places where pain from the gallbladder can be referred to
RUQ
Right shoulder
Right back
