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MD2 Gastrointestinal > Gastrointestinal examination > Flashcards

Gastrointestinal examination Flashcards

1
Q

What hand signs should be looked for in the GI exam?

A
  • leukonychia
  • clubbing
  • pallor of the palmar creases
  • palmar erythema
  • Dupuytren’s contracture
  • asterixis
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2
Q

What is the mechanism of leukonychia?

A

hypoalbinaemia -> decreased plasma oncotic pressure -> increased extracellular fluid -> compression of capillaries -> pallor of nail beds

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3
Q

What is the mechanism of encephalopathy?

A

porto-systemic shunt -> nitrogen compounds in systemic circulation -> cross BBB -> astrocytes take up ammonia -> used to make glutamine -> increased osmotic pressure -> swelling -> decreased cerebral perfusion

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4
Q

What to look for in the arms?

A
  • bruising: decreased clotting factor synthesis
  • petechiae (small pin-head sized bruises): chronic excessive alcohol consumption -> bone marrow suppression -> thrombocytopaenia -> petechiae
  • muscle wasting
  • scratch marks
  • spider naevi (more than 2 is abnormal)
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5
Q

What to look for in the eyes?

A
  • sclera: jaundice

- conjunctiva: anaemia

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6
Q

What to look for in the mouth?

A
  • breath: fetor hepaticus
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7
Q

What to look for in the neck?

A
  • palpate the cervical lymph nodes, espec supraclavicular on left side as these may be enlarged in advanced gastric or other GI malignancy
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8
Q

What is Troisier’s sign?

A
  • combination of enlarged left supraventricular lymph node (Virchow’s node) and carcinoma of the stomach
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9
Q

What to look for in the chest?

A
  • Inspection: spider naevi, bruises
  • in males: look for gynaecomastia (due to cirrhosis or autoimmune hepatitis) which is thought to be as a result of high oestrogen:testosterone ratio
  • note also: gynaecomastia may occur in alcoholics without liver disease due to damage to Leydig cells
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10
Q

What to look for in inspection?

A
  • pt with acute abdomen will lay very still with shallow breathing
  • look for scars which may indicate previous surgery or trauma
  • look for the presence of stomata or fistula
  • look for striae (following weight loss)
  • distension
  • look for hernias
  • look for prominent veins (caput medusae)
  • pulsations
  • skin lesions (radicular pattern for herpes zoster)
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11
Q

What are the causes of abdo distension?

A
  • Fat
  • Foetus
  • Flatus
  • Faeces
  • Fluid
  • Fecking big tumour
  • Phantom pregnancy
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12
Q

What is guarding of the abdomen?

A
  • when resistance to palpation occurs due to contraction of the abdominal muscles
  • may be as a result of tenderness or anxiety
  • is voluntary
  • may be overcome by reasurence and tenderness
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13
Q

What is rigidity of the abdomen?

A
  • constant involuntary reflex contraction of the abdominal muscles
  • always associated with tenderness and indicates peritoneal irritation or inflammation (peritonitis)
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14
Q

What is rebound tenderness?

A
  • present when the abdo wall is compressed slowly and when released rapidly causes a sudden stab of pain
  • strongly suggests the presence of peritonitis
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15
Q

If the liver edge is felt, what should be noted?

A
  • hard or soft
  • tender or non-tender
  • regular or irregular
  • pulsatile or non-pulsatile
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16
Q

How to palpate for the gallbladder?

A
  • orientate hand perpendicular to costal margin feeling from medial to lateral
  • if palpable it will feel like a bulbous, focal, rounded mass that moves downwards on inspiration
17
Q

What is Murphy’s sign?

A
  • on taking a deep breath, the pt catches their breath when an inflamed gallbladder presses on the examiners hand at the costal margin
  • positive indicates probably cholecystitis
18
Q

What is Courvoisier’s law?

A
  • states that if the gallbladder is enlarged and the patient is jaundiced, the cause is unlikely to be gallstones
  • carcinoma of the pancreas or lower biliary tree resulting in obstructive jaundice is the more likely cause
  • reason: gallbladder with stones is usually fibrosed and thus difficult to enlarge
19
Q

How big must the spleen become before it is detectable?

A

1.5 o 2 times normal

20
Q

How to test for ascites?

A
  • dull percussion note in the flanks (which may be bulging)
  • if dullness is detected in the flanks, look for shifting dullness
  • > roll the patient for a minute or so and percuss again -> if resonant -> shifting dullness

MD2 Gastrointestinal (1 decks)

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