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MD1 PCP > Gastrointestinal Exam > Flashcards

Gastrointestinal Exam Flashcards

1
Q

How do you divide the abdomen into quadrants?

A

Vertical and horizontal lines through umbilicus

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2
Q

Which quadrant is the liver in?

A

RUQ

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3
Q

Which quadrant is the gallbladder in?

A

RUQ

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4
Q

Where is the upper limit of the liver?

A

In plane between nipples

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5
Q

Where is the lower limit of the liver during deep inspiration?

A

Below the costal margin

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6
Q

Where does the gallbladder project to?

A

Just below the liver at the point where the midclavicular line crosses the costal margin

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7
Q

Which quadrant is the stomach in?

A

LUQ

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8
Q

Which quadrant is the caecum in?

A

RLQ

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9
Q

Which quadrant is the appendix in?

A

RLQ

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10
Q

Where is McBurney’s point?

A

1/3 of the way along the line from ASIS to umbilicus

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11
Q

What is found at McBurney’s point?

A

Base of appendix

Site of incision during appendicectomy

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12
Q

What quadrant is the descending colon in?

A

LLQ

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13
Q

What quadrant is the sigmoid colon in?

A

LLQ

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14
Q

Which ribs are palpable?

A

Lower ribs

Especially 11th and 12th

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15
Q

What are the kidneys related to?

A

Lower ribs

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16
Q

Which kidney is higher?

A

Left

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17
Q

At what level is the superior pole of the left kidney?

A

Rib XI

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18
Q

At what level is the superior pole of the right kidney?

A

Rib XII

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19
Q

At what level are the inferior poles of both kidneys?

A

L3

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20
Q

How do you find L4?

A

Line between iliac crests

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21
Q

Where is the spleen?

A

Posteriorly along line of left 9th to 11th rib
Follows contour of 10th rib
Antero-lateral to left kidney
Extends around midaxillary line

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22
Q

What are the main steps in the GI exam?

A 
Prepare the patient
Hand hygiene
General inspection
Hands
Head, neck, and chest
Abdomen
Liver
Spleen
Kidneys
Conclude and close assessment
23
Q

How do you prepare the patient?

A

Introduction and consent
Explanantion
Exposure
Position: examine from the right; sitting initially

24
Q

What do you inspect in the hands?

A 
Nails
- Leuconychia
- Clubbing
Palms
- Palmar erythema
- Pallor of palmar creases
- Palmar fascia
Asterixis = metabolic flap
25
Q

What do you inspect in the head, neck, and chest?

A

Conjunctivae and eyes

Neck, chest, back for spider naevi

26
Q

What do you inspect in the abdomen?

A 
Reposition patient supine - 1 pillow
Arms by side
Inspection
Enquire of abdominal pain
Superficial palpation - 9 regions
Deep palpation - 9 regions
27
Q

What do you inspect in the liver?

A

Palpation
Percuss for inferior edge
Percuss for upper edge
Measure liver span in midclavicular line

28
Q

What do you inspect in the spleen?

A

Palpation - supine

Palpation - 45 degrees

29
Q

What do you inspect in the kidneys?

A

Ballot both kidneys

30
Q

What might a change in alertness indicate?

A

If toxic substances not removed > cross BBB

Eg: in hepatic encephalopathy in end stage liver failure

31
Q

What is cachexia?

A

Muscle wasting

32
Q

How can you notice jaundice in a general inspection?

A

Yellow skin

33
Q

What is leuconychia?

A

“White nail”

Liver can’t make albumin

34
Q

What is palmar erythema?

A

Redness of palm

Happens in alcoholism

35
Q

What does pallor of palmar creases indicate?

A

Anaemia

36
Q

Why do you examine the palmar fascia?

A

For Dupuytren’s contracture

37
Q

How do you test for metabolic flap?

A

Hold both arms up
Hands extended and arms outstretched
Keep there for 15 sec
Flap if flexion-extension movement at wrists

38
Q

What does the metabolic flap indicate?

A

Advanced liver disease

Caused by hepatic encephalopathy

39
Q

What is hepatic encephalopathy?

A

High levels of ammonia interfere with brain cell function

40
Q

What are you looking for in the eyes?

A 
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
41
Q

Where are spider naevi found?

A 
Neck
Chest
Arms
Back
In distribution of SVC
42
Q

What do spider naevi indicate?

A

Chronic liver disease
Also in other conditions
- Pregnancy
- Oral contraceptive pill use

43
Q

Where should you expose the abdomen to?

A

Xiphisternum to pubic area

44
Q

When do collateral vessels around the umbilicus develop?

A

Called caput medusae

In cirrhosis of liver with portal hypertension

45
Q

Other than portal hypertension, when else do distension of abdominal wall veins happen?

A

Obstruction of inferior vena cava

46
Q

What might be indicated in the RUQ?

A 
Liver
Biliary system
Colicystitis
Right kidney pain
Right lower lobe of lung
Pneumonia
47
Q

What might be indicated in the LUQ?

A 
Spleen
Stomach pain
Jejunum
Descending colon
Pancreas
Left lower lobe of lung
48
Q

What might be indicated in the RLQ?

A 
Lat appendicitis
Right ovary
- Torsion
- Cysts
Ectopic pregnancy
Referred pain of testes
Diverticulitis
Kidney stones
49
Q

What might be indicated in the LLQ?

A 
Left ovary
Inflammatory conditions of bowel
- Ulcerative colitis
- Crohn's disease
Renal pathology
Ureter pathology
50
Q

What might be indicated in the epigastrium?

A 
Angina
AAA
Gastro-oesophageal reflux
Ulcers
Oesophageal pathology
51
Q

What is the normal liver span?

A

12-13 cm

52
Q

Whn is the spleen palpable?

A

When it doubles in size

53
Q

What can ascites cause?

A

Bulging flanks because fluid gravitates to the flanks

MD1 PCP (43 decks)

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