gi exam Flashcards
introduction?
intro myself name and stage( clean hands)
confirm name and DoB
‘ I am going to perform an abdo exam ths will involve looking at your hands, face, chest and abdomen followed by a feel of your tummy? is that ok?
offer a chaperone.
next step?
look if patient seems well- pale, in pain
look around bed for cues and aids - catheher, walkng aids, medications
next step what are you looking for?
hands and nails: tendon xanthomas clubbing palmar erythema oncholychia leukoclychia duptens contracture
what can tendon xanthomas indicate?
hyperlipidemia
what can tend palmar erythema indicate?
CLD hyperthyroidism RA pregnancy
what can clubbing indicate?
lymphoma
cirrhosis
ibd
coeliac diease
duputrens contracture
phenytoin
lvier disease
diabetes
koilonychia and leuconychna
iron def anaema
hypoalbuminia
next step?
check for hep tremor -liver disease
pulse - characteristic, regular/iregg/ bpm
next step and what are you looking for?
arms
ivd marks and bruising
exorciation -itching
next step?
axilla
- feel for lymph nodes
look for acatan nigrans - malignancy
then what?
face- puffing - alcoholism moon face, acne
eyes - conjunctiva, kayser fleicher ring (Wilson disease), corneal arcus ad xanthelasma - hyperlipidemia and jaundice
mouth - glottitis IBD
ulcers- coeliac disease, IBD
pear breath- lier disease, failure diabetes
then?
feel thyroid lymph nodes and supraclavicular - gastric maliganacy
then?
ask to exposure patient stomach down to top of bladder
ask if any pain and to lie down
INPSECT for scars- gynaemastica, bloating
caputa medusa
then?
GET ON ONE KNEE GO AWAY FROM PAIN
light palpitations to deeper
feeling for guarding, tenderness, masses
then
palpate for liver edge from RIF, inspiration feel in for edge then lightly percuss
do the same with the spleen
then
ballot kidneys
feel AAA below umbilicus area
then
shifting dullness - percuss towards left flank, roll patient towards you and re-percuss
then
listen to bowel sounds
then renal bruits (super and lateral to umbilicus) and liver if poss
then
check legs for pyoderma gangrenosum -UC
odema -clf
and erythema nodsum - ibd
then
cover patient
thank pt
ask if any questions
what can I offer examiner?
investigations I would do- resp rate, O2, temp, Stool sample Hernia orfices Rectal exam Urine dipstick Genital exam
what is Cullen sign of and where
bruising around umbilicus -sign in ruptured ectopic pregnancy, bleeding, pancreatitis
what is grey turner of and where
bruising on on flank - panreatitis
three signs that constitute clubbing
(increased nail curvature,
loss of the hyponychial angle
fluctuance of the nail bed)
how long hep flap?
30 seconds
how long listen to stomach sounds?
2 minutes
what does shifting dullness and fluid thrill test?
ascites
