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Yr 3 examinations > GI examination > Flashcards

GI examination Flashcards

1
Q

what do you look for in general inspection of abdo exam

A

vomiting bowls

IV

medication

consciousness level

distress

demeaner

pallor, jaundice, pigmentation (addisons)

loose skin folds

syndromes - cushings

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2
Q

examination of hands

A

clubbing

koilonychia

leukonychia

loss of lunula

dupuytren’s contracture

palmar erythema

fingertip capillary glucose monitoring marks

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3
Q

causes of clubbing

A

liver cirrhosis

IBD (crohn’s, UC)

malabsorption syndromes - coeliac

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4
Q

summarise koilonychia

A

spoon shaped nails

associated with IDA

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5
Q

summarise leukonychia

A

white nails

hypoalbuminaemia - perhaps from liver cirrhosis, protein losing entropathy (coeliac), heavy and prolongued proteinuria (nephrotic syndrome), protein calorie malnutrition (kwashiorkor)

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6
Q

describe the loss of lunula

A

loss of half moon at bottom of nail

signify chronic liver disease

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7
Q

dupuytren’s contracture

A

may be idiopathic

genetic

alcoholic liver disease

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8
Q

palmar erythema

A

oestrogenic effect

liver disease = reduced break down sex steroids = increased oestrogen = vasodilation

the increased oestrogen cause hyperdynamic circulation

happens in pregnancy

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9
Q

fingertip capillary glucose monitoring marks

A

dm

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10
Q

what is looked for in arm part of examination

A

asterixis (liver flap)

radial pulse - tachycardic

bruising - clotting abnormality secondary to liver disease

excoriations - pruritus, secondary to hyperbilirubinaemia (jaundice)

tattoos/needle track marks - risk of hep

offer to measure BP

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11
Q

summarise asterixis

A

extend wrists out for 15secs

nitrogen containing wast products eg ammonia go to liver for metabolism and excretion

ammonia in systemic circ crosses BBB - absorbed and metabolised by astrocytes = increase in glutamates and glutamine = increase in osmotic pressure and swelling (cytoxic brain oedema) = tremor

liver flap can be from chronic liver disease or CO2 retention

caused by hepatic encephalopathy

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12
Q

what is examined in the face part

A

conjunctival pallor - to see anaemia

scleral icterus

xanthelasma

kayser-fleischer rings

bilateral parotid swelling

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13
Q

how do you investigate conjunctival pallor

A

ask pt to look up and you pull eye down

shows anaemia eg from bleeding/malabsorption

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14
Q

summarise scleral icterus

A

pt look up, you retract lower lid

diffuse yellow sclera = jaundice (hyperbilirubinaemia)

sign of liver disease

(NB dont confuse with - small yellow spots of conjunctival degeneration = pinguecula seen at peripheral of sclera - benign, correlated to UV exposure - may be inflamed with pingueculitis

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15
Q

summarise periorbital xanthelasma

A

sign of primary billary cirrhosis

yellow deposits of cholesterol

hyperlipidaemia in cholestasis

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16
Q

summarise keyser-fleischer rings

A

seen with slit lamp

deposits of copper in wilson’s disease

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17
Q

summarise bilateral parotid swelling

A

due to sialoadenosis (non-inflammatory, non-neoplastic, enlargement, usually associated with systemic disease)

feature of chronic alcohol abuse, malnutrition and bulimia associated with recurrent vomiting

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18
Q

what is seen in the mouth examination

A

oral candidiasis - from chronic steroids

aphthous ulcers - crohn’s coeliac (IBD)

glossitis

angular stomatis = B12/folate/iron deficiency

osler-weber rendu = hereditory haemorrhagic telangiectasia (high risk of GI bleeding)

breath - alcohol, pear drops (DKA), foetor hepaticus (liver failure), faceculent in obstruction

19
Q

summarise glossitis

A

sign of anaemia

beefy red tongue = B12/folate deficiency (also steroid inhalers, antibiotics, candidiasis

pale, smooth tongue (atrophic glossitis) = IDA

20
Q

what is seen on neck examination

A

lymph nodes

gastric and pancreatic cancer cause enlargement of virchow’s node (L supraclavicular lymph node) = troisier’s sign

more generalised lymphadenopathy with hepatomegaly - lymphoma

while sat forward check back for excoriations and spider naevi

21
Q

what is looked for on the chest

A

gynaecomastia

spider naevi

loss of axillary hair

all due to increased oestrogen levels in liver disease/pregnancy

22
Q

summarise gynaecomastia

A

chronic liver disease = excess oestrogens = breast tissue in males, loss of chest hair and testicular atrophy

23
Q

summarise spider naevi

A

oestrogenic effect

isolated telangiectases (dilated capillaries)

characteristically fill from a central feeding vessel

dound in distribution of SVC on upper trunk, arms and face

24
Q

are spider naevi pathological

A

women may have up to five in normal health and more in preg (as well as palmer erythra)

but >5 is pathological - liver disease

25
Q

what do you look for on back

A

skin lesions - immunosuppression

spider naevi

26
Q

what do you look for on abdo inspection

A

scars

stomas

skin

BV

distension

incisional hernias - ask pt to cough

movement with respiration - absent in peritonitis

obvious pulsations

distended portal-systemic anastomosis

27
Q

summarise scars

A

suggest surgical history eg laproscopy, pfannensteil in c-section

feel for incisional herniae - ask pt to raise head off bed and cough

28
Q

summarise stomas

A

ileostomy in R iliac fossa and is formed as a spout - protect skin from alkaline nature of ileum’s contents

loop colostomy may be created to temporarily defunction the distal bowel - usually in transverse colon and has afferent and efferent limbs

colostomy usually flush and in L iliac fossa (contents not as harmful to skin)

comment on position bag, contents, spout and local irritation

29
Q

describe skin on abdo inspection

A

seborrheic warts and haemangiomas (campbell de Morgan spots) are normal

note any striae, bruising or scratch marks

(striae from pregnancy/cushings)

30
Q

describe bv on abdo inspection

A

caput medusae - portal hypertension, recanalisation of the umbilical veins along the falciform ligament produce distended (varicose) veins draining from teh umbilicus - distended portal-systemic anastomosis

obstruction of venae carva can cause distened tortuous veins

pancreatities can cause accumulation of blood

pulsatile AAA

spider naevi

31
Q

decribe effect of pancreatitis on abdomen

A

grey-turner’s sign = flank bruising

cullen’s sign = periumbilical bruising

because of release of pancreatic enzymes

32
Q

summarise distension of abdomen

A

fat

fluid

flatus

faeces

foetus

fulminant tumour

(stand from end of bed and note any asymettry/uniformity)

33
Q

summarise abdomen screening tests

A

deep breath - if peritonism very painful

cough with head to the side and hands in the inguinal region - feeling for hernias

lift head of the pillow - look for diverication or paraumbilical/incisional hernias

34
Q

summarise palpation

A

ask pain - start away from it

get to patient’s level and watch their face (get on 1 knee)

begin light then deep in all 9 areas

feel for tenderness, pain and masses

if masses do a lump examination

see if guarding - voluntary Iie distractable or involuntary - peritonitis

look for rebound tenderness (peritonitis)

35
Q

what do you look for on deep palpation

A

(upper hand exerts pressure, lower hand feels)

masses

deep tenderness

if relevant Rovsing’s sign (appendicitis) and Murphy’s sign (cholecystitis)

36
Q

how do you check for organomegaly of liver

A

start in R iliac fossa go up to hypochondrium

press in on exhale and let them inhale to bring liver to hand

if feel liver = liver enlargement/hyperinflation of lungs

hepatomegaly = metastasis/HCC, cirrhosis, hepatitis, RVF, leukaemia/lymphoma

37
Q

how do you check for spleen enlargement

A

start in R iliac fossa and move to L hypochondrium (can augment with hand behind ribs on that side)

felt better if pt rolls onto R side with bent legs

press on exhale and feel on inhale

splenomegaly = lymphoma/leukaemia, myelofibrosis, malaria, portal hypertension, haemolysis

(spleen moves down on inspiration)

38
Q

how do you palpate the kidneys

A

ballot each flank

ask pt to expire and press up into renal angle with posterior hand and press down with anterior hand - as pt breathes may feel it between hands

ballot by flexing the metacarpophalangeal joints of posterior hand - do flick, flick stop and repeat as necessary

39
Q

how do you palpate AAA

A

2 hands into abdo above umbilicus - start laterally and move in

see if expansile = AAA

pulsitile mass can be normal

40
Q

percussion for organomegally

A

percuss bottom up and top down for liver - in case false hepatomegaly if diaphragm is pushed down by eg hyperinflation in COPD

for spleen percuss up to spleen from R iliac fossa (dull percussion note of spleen only heard when enlarged) - percuss up to Traube’s space which is just above the L costal margin in mid-clavicular line

suprapubic percussion for bladder

shifting dullness - if distended with ascites percuss laterally from midline and find point of dullness - will be more medial than expect (suggests fluid in abdo cavity). Keep finger in this position and get pt to roll onto side. after 10s percuss same spot - if resonant, the shifting dullness = +ve = free fluid in abdo

fluid thrill for ascites - pt hand hard in abdo midline, tap one side and feel other side for the tap = ascites

percussion tenderness = peritonitis

tympanic = flatus

41
Q

describe auscultation in abdo

A

ausculate in R lower quadrant at ileocaecal valve until heard

bowel sounds - normal in 2 places

tinkling = obstruction

absent = ileus ie bowels arent working (need to listen for 3mins to make diagnosis) or peritonitis

bruits - renal arteries and aorta (turbulent blood flow due to stenosis/aneurism) - 1cm superior and lateral to the umbilicus bilaterally

42
Q

describe leg examination

A

examine for peripheral oedema, bruising, erythema nodosum (IBD, vasculitis, drugs, oral contraceptive pill, sarcoid, TB

43
Q

to complete the exam

A

thank pt and cover them

'’to complete my exam I would examine the external herneal oridices, the external genitaloia and do a DRE’’

Yr 3 examinations (10 decks)

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