GI Abdominal Examination Flashcards
Briefly outline the steps of this examination
- Wash hands
- Introduce self, identify patient
- Explain procedure, consent
- Any questions, pain or discomfort
- End of bed assessment
- Hand examination
- Liver flap & tremor
- Radial pulse
- Face examination - eyes & mouth
- lymph node examination
- Abdominal inspection
- Palpation of 9 quadrants
- Organmegaly palpation - liver, spleen & kidneys
- Palpate for AAA
- Percussion - liver, spleen & for ascites
- Bowel sound auscultation
- Leg examination
- Mention groin hernia examination & PR examination
- Summarise findings
- Thank patient, discuss findings, wash hands
What are the three important things to consider when measuring a pulse?
- Rate, character, rhythm
- E.g. 60bpm, strong regular pulse
What are you looking for in the abdominal inspection?
- Distension, scars, symmetry, masses, stoma, drain
- Striae, bruising, spider naevi, capture medusae
What are you looking for on palpation of 9 quadrants
Check for masses, guarding and patient facial expressions
What are you looking for in the hand examination?
- Palm - palmar erythema, dupytryens contracture
- Dorsal surface - koilonychia
- Index finger diamond window - finger clubbing
What are you looking for in the eye examination?
- Observe, pull lower eye lid down, pull upper eye lid up
- conjunctival pallor, scleral jaundice, corneal arcus, xanthelasma, Kayser-Fleisher (KF) rings
Describe how to palpate the liver
- Start in RIF, asking patient to take deep breaths in and out
- Use the edge of index finger to ‘scoop’ upwards on inspiration to feel for liver edge
- Move the hand up 2cm with each breath during expiration
- Palpate over any detected hepatomegaly
Describe how to palpate the spleen
- Place right hand in RIF
- Use the edge of index finger to ‘scoop’ upwards on inspiration to feel for spleen
- Move the hand 2cm each time, working from RIF to LUQ
- If spleen cannot be felt, this can be repeated with patient rolled on to their right
Where should you percuss for the liver and spleen
Liver
- percuss up from RIF to the right lower costal margin (mid-clavicular line), and percuss down from the fifth intercostal space (mid-clavicular line) to upper border of liver
Spleen
- percuss from RIF to LUQ
Describe how to assess/ percuss for ascites
- Inspect for distension
- Percuss from midline to flank, listening for dullness
- If dullness detected, roll patient towards yourself, wait ten seconds, then re-percuss, to establish if dullness shifts
Name some GI risk factors for dupuytren’s contracture
Alcoholism, liver disease, hyperlipidaemia, diabetes
Name some GI causes of palmar erythema
Liver cirrhosis, hereditary liver disease
Name some GI causes of finger clubbing
Celiac disease, Crohn’s disease, cirrhosis
What causes a liver flap?
Hepatic encephalopathy, uraemia
What is the most common cause of ascites
Cirrhosis
