Gastrointestinal Exam Flashcards
How do you divide the abdomen into quadrants?
Vertical and horizontal lines through umbilicus
Which quadrant is the liver in?
RUQ
Which quadrant is the gallbladder in?
RUQ
Where is the upper limit of the liver?
In plane between nipples
Where is the lower limit of the liver during deep inspiration?
Below the costal margin
Where does the gallbladder project to?
Just below the liver at the point where the midclavicular line crosses the costal margin
Which quadrant is the stomach in?
LUQ
Which quadrant is the caecum in?
RLQ
Which quadrant is the appendix in?
RLQ
Where is McBurney’s point?
1/3 of the way along the line from ASIS to umbilicus
What is found at McBurney’s point?
Base of appendix
Site of incision during appendicectomy
What quadrant is the descending colon in?
LLQ
What quadrant is the sigmoid colon in?
LLQ
Which ribs are palpable?
Lower ribs
Especially 11th and 12th
What are the kidneys related to?
Lower ribs
Which kidney is higher?
Left
At what level is the superior pole of the left kidney?
Rib XI
At what level is the superior pole of the right kidney?
Rib XII
At what level are the inferior poles of both kidneys?
L3
How do you find L4?
Line between iliac crests
Where is the spleen?
Posteriorly along line of left 9th to 11th rib
Follows contour of 10th rib
Antero-lateral to left kidney
Extends around midaxillary line
What are the main steps in the GI exam?
Prepare the patient Hand hygiene General inspection Hands Head, neck, and chest Abdomen Liver Spleen Kidneys Conclude and close assessment
How do you prepare the patient?
Introduction and consent
Explanantion
Exposure
Position: examine from the right; sitting initially
What do you inspect in the hands?
Nails - Leuconychia - Clubbing Palms - Palmar erythema - Pallor of palmar creases - Palmar fascia Asterixis = metabolic flap
What do you inspect in the head, neck, and chest?
Conjunctivae and eyes
Neck, chest, back for spider naevi
What do you inspect in the abdomen?
Reposition patient supine - 1 pillow Arms by side Inspection Enquire of abdominal pain Superficial palpation - 9 regions Deep palpation - 9 regions
What do you inspect in the liver?
Palpation
Percuss for inferior edge
Percuss for upper edge
Measure liver span in midclavicular line
What do you inspect in the spleen?
Palpation - supine
Palpation - 45 degrees
What do you inspect in the kidneys?
Ballot both kidneys
What might a change in alertness indicate?
If toxic substances not removed > cross BBB
Eg: in hepatic encephalopathy in end stage liver failure
What is cachexia?
Muscle wasting
How can you notice jaundice in a general inspection?
Yellow skin
What is leuconychia?
“White nail”
Liver can’t make albumin
What is palmar erythema?
Redness of palm
Happens in alcoholism
What does pallor of palmar creases indicate?
Anaemia
Why do you examine the palmar fascia?
For Dupuytren’s contracture
How do you test for metabolic flap?
Hold both arms up
Hands extended and arms outstretched
Keep there for 15 sec
Flap if flexion-extension movement at wrists
What does the metabolic flap indicate?
Advanced liver disease
Caused by hepatic encephalopathy
What is hepatic encephalopathy?
High levels of ammonia interfere with brain cell function
What are you looking for in the eyes?
Yellow sclera = jaundice When serum bilirubin >50 umol/L Conjunctivae for pallor = anaemia Keyser Fleisher ring = blue grin ring around iris - Cu deposition - In hepatitis
Where are spider naevi found?
Neck Chest Arms Back In distribution of SVC
What do spider naevi indicate?
Chronic liver disease
Also in other conditions
- Pregnancy
- Oral contraceptive pill use
Where should you expose the abdomen to?
Xiphisternum to pubic area
When do collateral vessels around the umbilicus develop?
Called caput medusae
In cirrhosis of liver with portal hypertension
Other than portal hypertension, when else do distension of abdominal wall veins happen?
Obstruction of inferior vena cava
What might be indicated in the RUQ?
Liver Biliary system Colicystitis Right kidney pain Right lower lobe of lung Pneumonia
What might be indicated in the LUQ?
Spleen Stomach pain Jejunum Descending colon Pancreas Left lower lobe of lung
What might be indicated in the RLQ?
Lat appendicitis Right ovary - Torsion - Cysts Ectopic pregnancy Referred pain of testes Diverticulitis Kidney stones
What might be indicated in the LLQ?
Left ovary Inflammatory conditions of bowel - Ulcerative colitis - Crohn's disease Renal pathology Ureter pathology
What might be indicated in the epigastrium?
Angina AAA Gastro-oesophageal reflux Ulcers Oesophageal pathology
What is the normal liver span?
12-13 cm
Whn is the spleen palpable?
When it doubles in size
What can ascites cause?
Bulging flanks because fluid gravitates to the flanks
