Gastrointestinal Physical Examination Flashcards
Order of areas in examination
General Inspection Hands Arms Face Neck Axillae Chest Abdomen Groin (mention only) Rectal Examination (mention only) Legs Other
General Inspection?
Patient looks well Mental State Weight Muscle Wasting Pigmentation - jaundice Telangectasia (spider veins)
Hands?
Nails: Clubbing and Leukonychia
Pamls: erythema, pallor of palmar creases
Signs of Dupuytren’s Contracture
Cause of leukonychia
Damage to the nail bed resulting in ‘milk spots’. Most commonly due to hypoalbuninaemia as a consequence of chronic liver disease
Nail clubbing indicates what?
Can indicate heart, lung or gastrointestinal pathologies
What is dupuytren’s contracture
Palmar fascia becomes abnormally thickened and can result in reduced function of the fingers. Result is abnormally contracted fingers: usually affecting the little and ring fingers. Middle fingers affected in extreme cases
Arms?
Asterixis - hepatic flap
Skin markings: ecchymoses, petichiae, scratch marks, spider naevia
Muscle Wasting
Causes of asterixis
Usually hepatic encephalopathy
Primarily related to abnormal ammonia metabolism
(believed to affect brain cells)
Face?
Eyes: Jaundice and pallor. xanthelasma, parotids
Mouth: Dentition, Fetor, Gum hypertrophy, Ulceration, Pigmentation
Neck?
Nodes: Cervical and Supraclavicular lymph nodes
Axillae?
Lymph nodes: Lateral, Posterior, Anterior, Middle, Central
Chest?
Skin markings: ecchymoses, petichiae, scratch marks, spider naevi
Palpate for gynacomastia in males
Cause of gynacomastia?
Liver failure or cirrhosis: Liver’s ability to metabolise oestrogen is impaired.
Also risk associated with alcoholic liver disease: ethanol may directly disrupt the synthesis of testosterone, leading to higher oestrogen levels than testosterone
Leads to development of uni- or bilateral breast tissue.
Abdomen - inspection
(Exposure) INSPECTION: Scars Striae Distension Masses Abnormal pulsations Visible peristalsis Obvious cutaneous veins
Abdomen: Palpation
Reassure patient, inform of potential discomfort, and check re tenderness
Light palpation of the 9 regions: looking for tenderness, masses, or guarding
Deep palpation of the 9 regions: looking for tenderness, masses, or guarding
Liver span: feel with respiration, percuss down to top edge, measure span (should be <11cm)
Spleen: palpate from lower-right. THEN ALSO roll patient onto their R side
Kidneys: Palpate bimanually
Abdomen: Percussion & Auscultation
Percuss spleen if impalpable: From L costal margin in AAL in complete expiration
Percuss bladder
Percuss for ascites: Midline to flanks, then roll patient to check for shifting dullness
Auscultate bowel sounds
Groin, Rectal Examination and Legs.
Groin: mention only - Palpation of testes, palpate for inguinal and femoral hernias, and inguinal lymph nodes
Rectal Examination: Including prostate
Legs: Inspect for skin changes - ecchymoses, petichiae, scratch marks, spider naevi
Palpate for oedema
Other information I’d like to know>
Actual weight and BMI
Temperature charts
Would like to perform a urine dipstick
Would perform CVS and inspect JVP if found hepatomegaly
