Gastrointestinal Examination Flashcards
what can cause a flapping tremor?
hepatic encephalopathy
on examination, list changes which can be seen on the nails and what causes them?
clubbing (cirrhosis, IBD, coeliacs)
leukonychia -milk spots on nails - (hypoalbuminaemia in liver disease)
koilonychia - spooning of nails - (iron deficiency anaemia)
on examination, what changes can be seen on the hands and what causes them?
palmar erythema (hyperdynamic circulation from increased oestrogen in liver disease and pregnancy)
Dupuytren’s contracture (familial, liver disease)
fingertip capillary glucose monitoring marks (diabetes)
on examination, what changes can be seen in the eyes? causes?
sclera for jaundice (liver disease) conjunctival pallor (anaemia eg bleeding, malabsorption) periorbital xanthelasma (hyperlipidaemia in cholestasis)
what changes can be seen in the mouth?
glossitis/stomatitis (iron/B12 deficiency anaemia) aphthous ulcers (IBD) breath odor (eg faeculent in obstruction, ketotic in ketoacidosis, alcohol) lichen planus, xerostomia, angioedema
Virchow’s node?
shows gastric malignancy - found in the supraclavicular fossa
what may be present on back inspection?
spider naevi (>5 significant) skin lesions (immunosuppression)
what may be present on chest inspection?
spider naevi (>5 significant) gynaecomastia, loss of axillary hair (increase oestrogen in liver disease/pregnancy)
name so signs which may be present on abdominal inspection, and what may be the causes of these signs?
distension (5F’s)
incisional hernias - ask the patient to cough
scars, striae (pregnancy, Cushing’s)
spider naevi
distended portal-systemic anastomoses (portal hypertension)
on superficial palpation, what are we checking for?
tenderness
guarding and rebound tenderness (peritonitis)
on deep palpation, what are we checking for?
masses, deep tenderness
if relevant, Rovsing’s sign (appendicitis) and Murphy’s sign (cholecystitis)
hepatomegaly may indicate what?
metastasis/HCC cirrhosis hepatitis RVF leukaemia/lymphoma
splenomegaly may indicate what?
lymphoma/leukaemia myelofibrosis malaria portal hypertension haemolysis
spleen vs kidney
can’t get above it spleen
spleen notched
spleen not ballotable
spleen moves down on inspiration
kidney ballot occurs at the renal angle - true or false?
true
you ballot the kidney by flexing your metatarsophalangeal joint in your hand - true or false?
false. metacarpophalangeal joint in the hand.
- metatarsophalangeal joint is in your foot -
what type of mass is a AAA? pulsatile or expansile?
expansile
tympanic on percussion would suggest…
flatus
when is a dull percussion note heard on the spleen?
only when the spleen is enlarged
“tinkling noise on auscultation would be suggestive of obstruction” - true or false
true
where is aortic and renal bruits listened at?
1cm superior and lateral to umbilicus bilaterally
what would ankle oedema be suggestive of?
hypoalbuminaemia
what additional equipment is required for a PR examination?
apron and gloves
lubricant
gauze
on inspection of the buttocks, what would you be looking for?
any blood, rashes, fistulae, fissures, excoriations and wa
asking the pateint to squeeze their bottom checks for anal sphincter competency - true or false?
true
what additional surfaces would you check in a PR exam?
feel for prostate and cervix
how would you describe a hernia?
(SSSCCCTTT): Site, Size, Shape, Consistency, Contours, Colour, Tenderness, Temperature, (Transillumination)
why is it important to check dentition during a GI exam?
could be indicative of (excessive) vomiting
