GI 1 - Examination for Extra Abdominal Signs and Inspection of the Abdomen Flashcards
nspects CNS for orientation in time, place and person. Inspects the face and eyes (lifts eyelids or asks patient) and examines the mucosa, look for periorbital edema, inspect and palpate for parotid enlargement, etc. Inspects the mouth’s odor and mucosa. Comment on findings
**In the beginning of exam say: **“I know these questions may seem silly, but I just want to make sure that nothing is affecting your brain/thought processes. What is your name? What time is it? Where are you right now?”
“I’ve assessed my patient’s CNS for orientation in time, place, and person.” Do this by asking the patient general questions and observing.
“Next, I will look at my patient’s face and eyes for periorbital edema, which is swelling around the eyes due to nephrotic syndrome, Jaundice, which is due to increase bilirubin causing yellow sclera and skin *(ask patient to look down, and you pull their eyelids up looking for yellowing of their sclera; ALWAYS ask for permission to touch the patient). *
I will also be looking for signs of dehydration like dry skin, dry mouth, and poor skin elasticity, and parotid enlargement (seen in alcoholism). I’m noting no signs of dehydration or parotid gland enlargement.”
Positions appropriately and drapes (re-drapes as needed).
Explain the procedure to your patient:
“During my examination, I’ll be performing a generalized inspection, that includes inspecting your upper and lower limbs, and your central nervous system. Is that ok with you? If you feel uncomfortable anytime during my examination, please let me know.”
DRAPE:
“I am draping my patient to cover any areas that I will not be examining, and for privacy. I’m also going to adjust their gown to ensure that they are comfortable.”
STAND ON THE RIGHT SIDE OF THE PATIENT
Inspects and palpates neck for Supraclavicular lymphadenopathy. Inspects the chest for Gynecomastia, Spider naevi, Loss of hair, Reduced skin turgor. Comment on findings.
Ask patient to lower gown to nipple line (normally it would be to below breasts but for patient comfort we ask only to nipple line):
Palpate the supraclavicular nodes and say, “Does this hurt? I do not note any enlargement of the supraclavicular lymph nodes or tenderness both of which, if present, would indicate gastric malignancy.”
“Now, I’m going to be inspecting the chest for Gynecomastia, which is overdevelopment of the male mammary glands (pseudo-feminization) d/t liver cirrhosis/digoxin/spironolactone, Spider naevi, which are central red spots with reddish extensions (>5 significant) d/t chronic liver disease, Hair loss, due to pseudo-feminization/malnourishment/ or iron deficiency, and a reduction in skin turgor. I’m noting no signs of gynecomastia, spider naevi, hair loss, or reduced skin turgor.
If female say: “I would normally inspect the patient for gynecomastia which is overdevelopment of the mammary glands. Gynecomastia is more evident in males, however, since my patient is female, I would not easily be able to differentiate gynecomastia from her normal breasts, although it is possible to have gynecomastia as a female.”
**Adjust gown/drape to cover chest and reveal lower limbs.
**“Lastly, I’ll be inspecting the lower limbs for peripheral edema. I’m noting no signs of peripheral edema (explain possible causes if peripheral edema were present).
Inspects the hands for Clubbing, Palmar erythema, Flapping tremor (asterixis), Dupuytren’s contracture. Inspects arms for Bruising, Scratch marks. Inspects Lower limbs for Peripheral edema (press the bony prominences). Comment on findings.
“First, I’ll begin by looking for generalized swelling (explain findings).”
“Next, I’ll be looking for clubbing can you make a heart with your fingers for me (demonstrate to patient what you would like them to do)? Ok, I do not see Schamroth’s window which is negative for clubbing (explain findings-should see schamroth’s window which is negative for clubbing in a healthy patient). If clubbing were present, it would be indicative of various chronic respiratory or cardiac conditions such as congenital heart defects, pulmonary fibrosis, lung infections, etc.”
“I’m also noting no signs of palmar erythema, which is reddening of the palms at the thenar and hypothenar (d/t COPD).”
“Next, I’ll check for asterixis (Flapping Tremor), which is tremor of the hand when the wrist is extended (sometimes said to resemble a bird flapping its wings). Can you please hold your hands out for me, and extend your wrist? I’m noting no signs of asterixis. Due to hepatic encephalopathy (spectrum of neuropsychiatric abnormalities due to liver failure like cirrhosis). Hands would be shaking/tremor if positive for asterixis.”
“I’m also looking for Dupuytren’s contracture. Can you please hold out your hands for me?”
Inspects the contour of the abdomen (size and shape), look for scars, asymmetry, visible peristalsis, striae, bruising, distention e.g. in ascites, full flanks, everted umbilicus, caput medusa etc. Comment on findings.
“I’m going to begin by observing the general appearance of my patient lying quietly. (Standing on the right of the patient; you should be bending down so that you can view the abdomen tangentially)
I will be inspecting the surface contours, and movements of my patient’s abdomen, looking for bulges or peristalsis. My patient’s abdomen appears (say what you see- symmetric, flat, rounded, protuberant, or scaphoid-markedly concave or hollow). There is no visible peristalsis (normally peristalsis is visible in very thin people). Visible peristalsis could suggest intestinal obstruction. *(Color) *I’m noting no bruises, erythema, or jaundice.
No scars are visible which could be due to any trauma or past surgeries. I’m noting no striae* (stretch marks).* Abnormally colored striae (pink-purple) are a hallmark of Cushing syndrome.
I’m also noting no signs of engorged veins (a few small veins may be visible normally). Visibly engorged veins could suggest portal hypertension from cirrhosis (caput medusa) or inferior vena cava obstruction. Also, the umbilicus doesn’t appear everted. An everted umbilicus suggests a ventral hernia. There appears to be no bulging of the flanks (full flanks are present). If bulging of the flanks were present this could suggest ascites.”
Asks patient to raise both head and shoulders off table to demonstrate any ventral hernia and rule out any masses in the abdominal wall. Comment on findings.
“Can you please raise both your head and shoulders off the table? Ok, thank you. You can lay down. The abdomen appears symmetrical. An asymmetrical abdomen suggests a hernia, enlarged organ, or mass in the abdominal wall (an enlarged liver may descend below the rib cage).”
