GI Flashcards
Position of patient
General exam: sat upright
Close exam: supine
General Inspection
Bedside treatment Patients appearance Body habitus (obese etc.) Scars Jaundice Anaemia Abdo distention Masses Dressings Needle track marks Excoriations
Jaundice indicates..
cirrhosis/hepatitis
Anaemia indicates..
pallor > GI bleeding
Abdo distention indicates..
ascites/bowel obstruction/large masses
Masses indicate..
malignancy / organomegaly
Excoriations indicate..
pruritus, which is a sign of cholestasis
Signs on hands
clubbing koilonychia leukonychia palmar erythema Dupuytren's contracture Hepatic flap
Clubbing indicates..
IBD, cirrhosis, coeliac disease
Koilonychia indicates..
spooning of nails > chronic iron deficiency
leukonychia indicates..
whitened nail bed > hypoalbuminemia (liver failure)
palmar erythema indicates..
reddening of palms > liver disease, pregnancy
Dupuytren’s contracture indicates..
thickening of palmar fascia > alcohol excess, or family history
Hepatic flap
hold hands dorsiflexed for 15 seconds
+ve test= hands will flap irregularly
Causes= hepatic encephalopathy, uraemia, CO2 retention
Signs on arms and what they represent
Bruising: abnormal coagulation, secondary to liver failure
Petechiae: low platelets e.g. splenomegaly
Excoriations: cholestasis
Track marks: IV drug use > hepatitis/HIV
Signs in axillae and what they represent
Lymphadenopathy: malignancy/infection
Hair loss: malnourishment / iron deficiency anaemia
Acanthosis nigricans: GI adenocarcinoma / obesity
Signs in eyes
Jaundice
Conjunctival pallor
Xanthelasma
What does jaundice suggest?
haemolysis, hepatitis, cirrhosis, biliary obstruction
Conjunctival pallor
anaemia
xanthelasma
raised yellow deposits surrounding eyes > hyperlipidaemia
Signs around the mouth
angular stomatitis
oral candidiasis
mouth ulcers
glossitis
Angular stomatitis
inflamed red areas at the corners of the mouth: iron / B12 deficiency
oral candidiasis
white slough on oral mucous membranes: iron deficiency/immunodeficiency
mouth ulcers
crohn’s or coeliac
glossitis
smooth swelling of tongue with associated erythema: iron/B12/folate deficiency
Virchows nodes
left supraclavicular fossa suggest gastric malignancy
Chest signs
Spider naevi
Gynaecomastia
Hair loss
Spider naevi
central red spot with reddish extensions (>5 suggest chronic liver disease)
Causes of gynaecomastia
liver cirrhosis, digoxin, spironolactone
Pulsation on abdo inspection suggests
AAA
Cullen’s sign
bruising around umbilicus > retroperitoneal bleed e.g. pancreatitis or ruptured AAA
Grey-Turners sign
bruising in flanks > retroperitoneal bleed e.g. pancreatitis or ruptured AAA
Abdominal distention
5 F’s:
Fat, fluid, faeces, fetus, flatus
Striae indicate
abdominal distention
caput medusae
engorged paraumbilical veins > portal hypertension
Setting up for palpation
Ask if the patient is in pain
Kneel so you are level with the patient
Observe patients face when palpating
Rebound tenderness
pain is worse when releasing pressure - peritonitis
Guarding
involuntary tension in the abdo muscles
Assessing masses
Location
Size
Shape
Consistency- smooth, soft, hard, irregular
Mobility- attached to superficial/underlying tissues
Pulsatility
+ve Murphy’s sign =
cholecystitis
Spleen is palpable when..
it is at least 3 times the normal size
Steps for palpation
Light palpation Deep palpation Liver Spleen Ballot the kidneys
Palpation of the organs the patient must…
take deep breathes in and out, and you palpate when they breathe in
Steps for percussion
Liver, spleen, shifting dullness
Key for shifting dullness
If fluid is present, the area that was previously dull (when supine) will now be resonant (when lying on side)
Auscultation
Bowel sounds
Tinkling bowel sounds
bowel obstruction
Absent bowel sounds
ileus/peritonitis
Suggest further assessments
Check for hernias
PR exam
External genitalia - if appropriate