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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
What do you inspect in the head, neck, and chest?
Conjunctivae and eyes | Neck, chest, back for spider naevi
26
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 ```
27
What do you inspect in the liver?
Palpation Percuss for inferior edge Percuss for upper edge Measure liver span in midclavicular line
28
What do you inspect in the spleen?
Palpation - supine | Palpation - 45 degrees
29
What do you inspect in the kidneys?
Ballot both kidneys
30
What might a change in alertness indicate?
If toxic substances not removed > cross BBB | Eg: in hepatic encephalopathy in end stage liver failure
31
What is cachexia?
Muscle wasting
32
How can you notice jaundice in a general inspection?
Yellow skin
33
What is leuconychia?
"White nail" | Liver can't make albumin
34
What is palmar erythema?
Redness of palm | Happens in alcoholism
35
What does pallor of palmar creases indicate?
Anaemia
36
Why do you examine the palmar fascia?
For Dupuytren's contracture
37
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
38
What does the metabolic flap indicate?
Advanced liver disease | Caused by hepatic encephalopathy
39
What is hepatic encephalopathy?
High levels of ammonia interfere with brain cell function
40
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 ```
41
Where are spider naevi found?
``` Neck Chest Arms Back In distribution of SVC ```
42
What do spider naevi indicate?
Chronic liver disease Also in other conditions - Pregnancy - Oral contraceptive pill use
43
Where should you expose the abdomen to?
Xiphisternum to pubic area
44
When do collateral vessels around the umbilicus develop?
Called caput medusae | In cirrhosis of liver with portal hypertension
45
Other than portal hypertension, when else do distension of abdominal wall veins happen?
Obstruction of inferior vena cava
46
What might be indicated in the RUQ?
``` Liver Biliary system Colicystitis Right kidney pain Right lower lobe of lung Pneumonia ```
47
What might be indicated in the LUQ?
``` Spleen Stomach pain Jejunum Descending colon Pancreas Left lower lobe of lung ```
48
What might be indicated in the RLQ?
``` Lat appendicitis Right ovary - Torsion - Cysts Ectopic pregnancy Referred pain of testes Diverticulitis Kidney stones ```
49
What might be indicated in the LLQ?
``` Left ovary Inflammatory conditions of bowel - Ulcerative colitis - Crohn's disease Renal pathology Ureter pathology ```
50
What might be indicated in the epigastrium?
``` Angina AAA Gastro-oesophageal reflux Ulcers Oesophageal pathology ```
51
What is the normal liver span?
12-13 cm
52
Whn is the spleen palpable?
When it doubles in size
53
What can ascites cause?
Bulging flanks because fluid gravitates to the flanks

MD1 PCP (43 decks)

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