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Physical examination 2B > GI Examination > Flashcards

GI Examination Flashcards

1
Q

What are the introductory steps to a GI examination?

A
  • Wash hands.
  • Put on PPE.
  • Introduce yourself to the patient.
  • Confirm patient’s name and DOB.
  • Explain the examination (especially what parts of the body will need exposing).
  • Obtain consent from the patient.
  • Offer presence of a chaperone.
  • Adjust bed head to 45.
  • Ask if the patient has any pain anywhere.
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2
Q

What comes after introduction in a GI examination?

A

General inspection:
- Inspect the area around the bed for relevant objects/equipment.
- Inspect the patient from the end of the bed.

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3
Q

What signs of GI disease can be picked up from examining the patient at the end of the bed?

A
  • Colour (Jaundice? Pallor?)
  • Perspiration (Fever?)
  • Build? (Muscle wasting/obesity?)
  • Discomfort?
  • Breathing? (Resp. rate? Depth of breath? Resp. effort?)
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4
Q

What comes after general inspection in a GI examination?

A

Inspection of the hands

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5
Q

What can be picked up from inspection of the hands?

A

Colour? (pallor, erythema)
Clubbing?
Leukonychia/leukonychia totalis?
Koilonychia? (nail spooning)
Spider naevi?
Dupuytren’s contracture?

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6
Q

What comes after general inspection of the hands?

A

Palpation of the hands

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7
Q

What does palpation of the hands entail?

A

Assess temperature of both hands simultaneously using the backs of your own hands.

Feel for symmetrical warmth.

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8
Q

What comes after palpation of the hands?

A

Flapping tremor test.

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9
Q

How is the flapping tremor test carried out?

A

Patient holds hands out in front with wrists and elbows extended.

Observe for “flapping tremor” approx 10 seconds.

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10
Q

What comes after the flapping tremor test?

A

Inspection of the forearms.

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11
Q

What can be picked up from inspection of the forearms?

A
  • Pruritus.
  • Muscle wasting.
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12
Q

What comes after inspection of the forearms?

A

Assessment of the pulse.

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13
Q

How is the pulse assessed?

A

Assess the radial pulse for 10-15 seconds. Assess rate, rhythm and character.

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14
Q

What comes after assessment of the pulse?

A

Inspection of the face.

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15
Q

What can inspection of the face pick up on?

A

Eyes:
- Kaiser-Fleischer rings (Wilsons)
- Corneal arcus (High BP, high cholesterol etc.)
- Xanthelasma (High cholesterol)
- Conjunctival pallor
- Conjunctival jaundice

Mouth:
- Dental hygiene.
- Plaque (potentially frequent vomiting)
- Pallor
- Dry mouth
- Angular stomatitis
- Glossitis
- Ulceration

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16
Q

What comes after inspection of the face?

A

Palpation of the lymph nodes.

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17
Q

Which node is specifically important when palpating the lymph nodes?

A
  • Left supracalvicular node.
  • Swelling in this node is a sign of intra-abdominal malignancy (Trosier’s sign)
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18
Q

What comes after palpation of the lymph nodes?

A

Inspection of the chest wall.

19
Q

What can be picked up on from chest examination?

A
  • Male gynaecomastia. (Liver failure?)
  • Spider naevi (Liver disease - will usually be more than 3, itchy and/or burning).
20
Q

What comes after examination of the chest?

A

Back examination.
Ask the patient to sit forwards if they are able.

21
Q

What can be picked up from examination of the back?

A
  • Surgical scars.
  • Swellings.
  • Spider naevi.
22
Q

What comes after inspection of the back?

A

Inspection of the abdomen.

23
Q

What can be picked up on from abdominal inspection?

A
  • Surgical scars.
  • Lesions.
  • Loose skin/ striations.
  • Distension (5 F’s: Fat, foetus, flatus, faeces, fluid; is it symmetrical distension?).
  • Breathing (should be diaphragmatic).
  • Visible masses/swellings.
  • Visible peristalsis (blockage?)
  • Visible aortic pulsation (Usually benign in skinny people, can be triple A).
  • Dilated veins (suggestive of portal HTN or LHF).
24
Q

What comes after abdominal inspection?

A

General abdominal palpation.

25
How is general abdominal palpation carried out? What can be picked up on?
- Palpate each of the nine sections of the abdomen lightly to assess for tenderness/firmness. - Palpate each section of the abdomen more deeply to assess for any underlying masses. - Look at the patients face whilst doing this to assess for any discomfort/tenderness. NOTE: Ask the patient beforehand if there is any tenderness anywhere - if there is, palpate this part last.
26
What comes after general abdominal palpation?
Specific palpations of the abdomen.
27
What are the different specific things that can be palpated in the abdomen?
- Succussion splash. - Liver palpation (+murphys sign?) - Spleen palpation. - Kidney balloting. - Bladder palpation (Not performed in OSCE but mention). - Aorta palpation.
28
How/when is a succussion splash performed?
If patient has suspected ascites. Shake the stomach rapidly from side to side and listen for a sloshing sound, indicative of fluid.
29
How is the liver palpated? How is Murphy's sign elicited.
- Get patient to breathe deeply in and out. - Starting at the RIF, as they breathe in press firmly with the border of your hand into the abdomen to try and palpate a liver. - When they breathe out, reposition the hand more superiorly. - Keep repeating the process until a liver border is palpated or until the costal margin is reached. - Murphy's sign +ve: Palpate deeply in the RUQ and get the patient to breathe deeply. A sudden stop of breathing due to pain is Murphy's +ve, indicative of cholecystitis.
30
How is the spleen palpated?
- Get patient to breathe deeply in and out. - Same process as with the liver, except from RIF up to LUQ. - In a normal patient, the spleen should not be palpable.
31
How are the kidneys balloted?
- Place one hand anteriorly and palpate deeply in the RUQ/LUQ of the abdomen. - Place one hand posteriorly behind the kidney. - Use the posterior hand to "flick" the kidney upwards. - Normally, kidneys are not palpable. They might be felt in skinnier patients or those with swollen kidneys.
32
How is the bladder palpated?
- Warn the patient they may feel the urge to urinate. - Palpate suprapubically. - In a normal patient bladder should not be palpable.
33
How is the aorta palpated?
- Palpate with both hands symmetrically just superiorly either side of the umbilicus. - Normally, the hands should move up and down with aortic pulsations. - If the hands move in and out, suggestive of triple A. NOTE: Aorta may not be palpable in larger patients.
34
What comes after specific abdominal palpation?
Percussion of the abdominal organs.
35
How are the different abdominal organs percussed?
Percuss for the liver: - From the lungs down - listen for resonant to dull change for upper border. - From the RIF up - listen for resonant to dull change for lower border. Percuss for the spleen: - From RIF towards the LUQ. - Normally, spleen cannot be percussed. Percuss for the bladder: - Percuss from umbilical cord towards the pubic symphysis. - Resonant to dull change suggests the upper border of the bladder has been met.
36
What comes after percussion of the abdominal organs?
Shifting dullness percussion.
37
How is shifting dullness percussion carried out?
- Percuss from the umbilical of the patient towards the left flank, listening for change from resonant to dull. - If dull note heard, roll patient towards you (onto their right hand side) whilst keeping percussing hand in place. - Wait 10 seconds for the fluid to redistribute, then percuss again in the same place. Listen for a resonant sound. - Percuss back in towards the umbilicus, listening for a now dull sound. - If a dull sound is then heard more medially, this is +ve for shifting dullness and indicative of ascites.
38
What comes after shifting dullness percussion?
Auscultation of the abdomen.
39
How is the abdomen auscultated?
- Listen for bowel sounds in at least two places on the abdomen. - Listen to the aorta either side, approx. 1-2cm above the umbilicus. - On the same level as listening to the aorta, but in the mid-clavicular line, listen to the renal arteries.
40
What comes auscultation of the abdomen?
Concluding the examination with the patient.
41
How is the examination concluded with the patient?
- Thank the patient for their time. - Ask them to redress (ask if they need any help?)
42
What comes after concluding the examination with the patient?
Concluding the examination with the examiner.
43
How should the examination be concluded with the examiner?
- Wash hands. - Report key findings back. - List ISHRUG for further investigations.
44
What is ISHRUG?
I - Inguinal lymph node palpation. S - Stool sample (both visual and micro). H - Hernial orifices palpation (inguinal and femoral). R - Rectal examination. U - Urinalysis. G - Genital examination.

Physical examination 2B (13 decks)

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