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CPA > Gastrointestinal and Gastrourinary Exam > Flashcards

Gastrointestinal and Gastrourinary Exam Flashcards

1
Q

What position should the patient be in when conducting a GU/GI exam?

A

Ensure that the patient is lying flat on the couch, exposed from the waist upwards.

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2
Q

What should be inspected when inspecting the patient?

A

Skin abnormalities, surgical scars, masses hernia, and asymmetry and movement of the abdominal wall

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3
Q

In a patient with obesity, how is umbilicus viewed?

A

The umbilicus is sunken

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4
Q

A distended and everted umbilicus reveals what type of pathology?

A

An Umbilical hernia

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5
Q

What are the nine abdominal regions?

A 
Right hypochondriac region 
Epigastric region 
Left hypochondriac region 
Right lumbar region 
Umbilical region 
Left lumbar region 
Right iliac region 
Hypogastric region 
Left iliac region
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6
Q

Describe how light palpation is performed on a patient

A

Light palpate, the nine abdominal regions, closely monitoring the face for pain , assess for tenderness

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7
Q

What abdominal organ is associated with the right hypochondriac region?

A

Gallbladder

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8
Q

In which abdominal region is the spleen and pancreas associated with?

A

Left hypochondriac region

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9
Q

Which organs are associated with the epigastric region?

A

Stomach, duodenum and pancreas

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10
Q

Which abdominal region is associated with the left and right kidney?

A

left and right lumbar region

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11
Q

Which organs are associated with the umbilical region?

A

Small bowel, caecum, retroperitoneal structures

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12
Q

The appendix and the caecum are associated with which abdominal region?

A

Right iliac region

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13
Q

Which organs are associated with the right iliac region?

A

Appendix

Caecum

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14
Q

Which organs are associated with the hypogastric region?

A

Transverse colon
Bladder
Uterus
Adnexa

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15
Q

Which organ is associated with the left iliac region?

A

Sigmoid colon

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16
Q

The sigmoid colon is associated with which abdominal region?

A

Left iliac fossa

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17
Q

How is deep palpation performed?

A

Palpate each of the nine abdominal region, applying greater pressure, warn the patient that this may feel uncomfortable

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18
Q

Where should liver palpation begin?

A

Right iliac fossa starting at the edge of the superior iliac spine

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19
Q

How is liver palpation performed?

A

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.

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20
Q

What should the patient be doing when palpating the liver?

A

Ask the patient to take a deep breath, as they do, palpate the abdomen to the costal margin

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21
Q

Where should palpation be until?

A

until the costal margin

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22
Q

A palpable liver will suggest what pathology?

A

Hepatomegaly

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23
Q

Where should spleen palpation begin?

A

Right iliac fossa

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24
Q

How should the spleen be palpated?

A

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

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25
Q

Where should spleen palpation be felt until?

A

The left costal margin

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26
Q

What type of organ is the spleen?

A

Intraperitoneal organ

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27
Q

Describe the borders of the spleen?

A

Ribs 9-11, lateral border of the erector spinae muscles and the mid axillary line

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28
Q

What are the common causes of splenomegaly (5)?

A 
Congestive heart failure
Portal hypertension secondary to liver cirrhosis
Haemolytic anaemia
Splenic metastases
Glandular fever
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29
Q

What term describes the palpation of the kidneys?

A

Kidney balloting

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30
Q

How is kidney balloting performed?

A
  1. Place left hand behind patient’s back, below the ribs and underneath the right flank.
  2. Place right hand on the anterior abdominal wall, below the right costal margin in the right flank.
  3. Push fingers together  Press upwards with your left hand and downwards with your right hand.
  4. Ask the patient to take a deep breath – feel the lower pole of the kidney move down between the fingers.
  5. Repeat process on the opposite side to ballot the left kidney
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31
Q

A bilaterally enlarged kidney suggests what cause?

A

Polycystic kidney disease and amyloidosis

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32
Q

What pathology is linked with a unilaterally enlarged kidney?

A

Renal tumour

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33
Q

What is the common cause of abdominal tenderness?

A

Peritonitis and sometimes anxiety

34
Q

What is guarding?

A

Tends to contract voluntarily when palpation causes pain

35
Q

What is rigidity?

A

Inflammation of parietal peritoneum, resulting in a reflex contraction - involuntary guarding - abdominal wall may not show any movements of respiration

36
Q

Which term is associated with involuntary guarding?

A

Rigidity.

37
Q

What is rebound tenderness?

A

Generalised or localised peritonitis, if the abdominal wall is compressed slowly and then released - sharp stabbing pain

38
Q

How is the abdominal aortic pulse palpated?

A

Perform deep palpation superior to the umbilicus in the midline

Note the movement with your fingers

39
Q

In healthy individuals how should an abdominal aortic pulse be felt?

A

Pulsatile

40
Q

In patients with AAA, how would the abdominal aortic pulse be felt?

A

Expansile mass

41
Q

An expansile mass when palpating the abdominal aorta suggests with what pathology?

A

Abdominal aortic aneurysm

42
Q

Where does abdominal aorta bifurcate?

A

L4

43
Q

The abdominal aorta bifurcates into what

A

Left and right common iliac artery

44
Q

What vertebral level is the transpyloric plane?

A

L1

45
Q

Which organs are associated with the transpyloric plane?

A 
Pylorus of the stomach
neck of the pancreas
fundus of the gallbladder
Renal hilum 
•	Duodenojejunal flexure
•	End of spinal cord
46
Q

At what vertebral level is the subcostal plane at?

A

L3

47
Q

Which plane is associated with the L3 vertebral level?

A

The subcostal plane

48
Q

Which structure is associated with the L3 subcostal plane?

A

The origin of the inferior mesenteric artery

49
Q

At which plane does the aorta bifurcate at L4?

A

Supracristal plane

50
Q

The supracristal plane is associated with which vertebral level?

A

L4

51
Q

What vertebral level is the inter-tubercular plane associated with?

A

L5

52
Q

Which vertebral level is the interspinous plane associated with?

A

S2

53
Q

What is the interspinous plane?

A

Horizontal plane through the anterior superior iliac spine, marking the boundary of the umbilical region superiorly and the hypogastric region inferiorly

54
Q

Where should the liver percussion begin at?

A

Percuss downwards from the right 4th rib along the mid-clavicular line.

Resonant till Dull (5th intercostal space)

55
Q

What percussion changes are detected when percussion the upper border of the liver?

A

Resonant to dull

56
Q

When percussing the lower border of the liver, where should you begin?

A

Right iliac fossa upwards until the right costal margin

57
Q

What is the right upper border of the liver?

A

Right 5th rib at the mid-clavicular line

58
Q

What is the left upper border of the liver?

A

Left 5th rib at the mid clavicular line

59
Q

Where is the right lower border of the liver?

A

Costal margin at the right-mid axillary line

60
Q

What are the borders of the liver?

A

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

61
Q

Where should the spleen be palpated?

A

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

62
Q

Demonstrate how shifting dullness is performed

A

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

63
Q

What does shifting dullness detect?

A

Ascites- accumulation of fluid within the peritoneal cavity

64
Q

Why does liver cirrhosis cause ascites?

A

Decreased metabolism of aldosterone and ADH - leading to a retention of salt and water

Decreased production of albumin

65
Q

How does a decrease in albumin cause ascites?

A

Reduces oncotic pressure - resulting in a leakage of fluid into the peritoneal space

66
Q

How can bowel sounds be auscultated?

A

• 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.

67
Q

What pathology is associated with absent bowel sounds?

A

Paralytic ileus and peritonitis

68
Q

Paralytic ileus and peritonitis is associated with which type of bowel sounds?

A

Absent bowel sounds

69
Q

What bowel sounds are associated with intestinal obstruction?

A

High pitched and frequent

70
Q

What 3 regions are the common sites for urinary tract stones?

A

1) Across the sacroiliac joint
2) The pelvic-ureteric junction
3) Vesicoureteric junction

71
Q

What is the gold standard scan for diagnosing urinary tract stones?

A

Ultrasound scan

72
Q

At what size of renal stones are associated with stenting or lithotripsy?

A

> 5cmm

73
Q

What is the treatment for large urinary tract stones?

A

Stenting

Lithotripsy

74
Q

Urinary tract stones can cause what pathology proximal to the ureter obstruction?

A

Hydronephrosis

75
Q

Where should the abdominal aorta be auscultated?

A

Just above and left of the umbilicus

76
Q

Where should the superior mesenteric artery or coealic arteries be ausculated?

A

Epigastric region

77
Q

Where should the renal arteries be auscultated for bruit?

A

2-3cm superior and lateral to the umbilicus

78
Q

Where should iliac arteries be auscultated?

A

Iliac fossa

79
Q

What are the surface markings for the gallbladder?

A

Gallbladder at the tip of the right 9th costal cartilage

80
Q

What is the oblique border of the liver?

A

Left 5th intercostal space mid-clavicular line till the right costal margin (right 9th costal cartilage)

81
Q

At which intersection is the gallbladder found?

A

Right mid-clavicular line and the transpyloric plane

82
Q

Please state 2 places where pain from the gallbladder can be referred to

A

RUQ
Right shoulder
Right back

CPA (5 decks)

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