GI examination Flashcards
What are you looking for in your end of bed assessment?
Visible dyspnoea, signs of pain/ discomfort and conscious level
Oedema: liver cirrhosis
Pallor: anaemia or conversely
hyperpigmentation : haemachromatosis
Jaundice : High bilirubin levels, acute hepatitis, liver cirrhosis, pancreatic cancer
What items of note are you looking for around the bedside?
Stoma bag - colostomy on left, ililstomy on right
Surgical drains
Feeding tubes
Mobility aids
What are you looking for in inspection of the hands?
Palms- pallor, palmar erythema (liver disease, pregnancy), palmar creases (pale in anaemia) , spider naevi (liver disease)
Palpate for thickening of the palmar fascia- duputryen’s contracture ( type 2 diabetes, alcohol and smoking aggravate)
Check nails
* Koilonychia: spoon-shaped nails, iron deficiency anaemia (e.g. malabsorption in Crohn’s disease).
* Leukonychia: whitening of the nail bed, hypoalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy).
* Clubbing
Check cap refill on fingernails
as well- hold for 5, expect to return within 2 seconds
Hepatic flap
Take radial pulse (rate and rhythm)
What are you looking for on inspection of the face?
Eyes
Conjunctival pallor
Yellowing of the sclera
Corneal Arcus
Xanthelasma
Mouth
Angular stomatitis ( iron deficiency)
Glossitis ( B12 and folate def)
Mouth ulcers
Denition
Ask pt to stick out tongue :
Tongue disorders, signs of dehydration
Oral candidiasis ( immunosuppression)
What lymph node do you focus on?
Virchow’s node- left supraclavicular- for GI mets
What do you look for on abdominal inspection?
Scars
Asymmetry
Abdominal distension/ striae
Venous distension- Caput Medusa
Visible pulsation/ peristalsis
Discolouration:
Cullens sign- bruising around umbilicus - haemorrhagic pancreatitis
Grey-turners sign- flank bruising (retroperitoneal haemorrhage)
What do you do on physical examination of the abdomen?
Ensure sitting down at level of abdomen and check patients face for signs of discomfort as you proceed with the examination
Palpate in 9 areas, superficial then light
Rebound tenderness
Liver - right iliac fossa up
Spleen - right iliac fossa up diagonally
Kidneys- one hand under back , bounce kidney towards other hand
Palpate aorta
Percuss liver and spleen
Auscultation for bowel sounds in right iliac fossa (Tinkling = obstruction)
Auscultation for aorta and liver bruits
How would you finish off the exam?
Would finish by examining hernial orifices, external genitalia and do a DRE
Potentially temp and urinalysis
