GI OSCE Flashcards
GI EXAMINATION ORDER
1) INSPECTION
2) PALPATION
3) PERCUSSION
4) AUSCULTATION
GI INSPECTION (peripheral)
NEWS CHART, end of bed examination
*vomit, supplemental nutrition, IV fluids, medications
HANDS:
- pallor
- palmar erythema
- nails = Koilonychia (Fe anemia), Leukonychia (hypoalbum.endstage liver)
- finger clubbing
TREMOR CHECK
ARMS:
- pulse
- skin turgor = hydration
- bruising, excoriation, itching
FACE:
* sclera of eyes = jaundice? pale conjunctive?
LYMPH NODES: virchows nod (site of mets gastric e.g.)
CHEST & NECK
- gynaecomastia
- spider naevi
- bruising
LOWER LIMB
- oedema = low protein state
- hair loss
GI INSPECTION (main)
supine position
- 9 regions of the abdomen
- visible masses
- skin changes
- skin deposits
- ileostomies and hx. of sx
Significance of Koilonychia and Leukonychia
Koilonychia = Fe anemia
Leukonychia = white deposits d/t hypoalbuminemia as a result of endstage liver disease
GI Palpation
supine
press at all 9 areas whilst kneeling
1) LIGHT PALPATION, check for guarding/signs of pain, mass
2) DEEP PALPATION check for structure, caecala squelch, indented faeces, aortic pulsation
* movement from metacarpal pharangeal joints
3) HEPATOMEGALY
press hand in , ask for deep inhalation,
move across abdomen in a fan shape movement to the costal margin
4) SPLENOMEGALY
start at right. iliac fossa, work across abdomen diagonally to the left costal margin
*bimanual palpation, bring ribs up
5) NEPHROMEGALY
reach round renal angle. @ flank, ask for deep breath, PRESS FIRMLY
GI PERCUSSION & AUSCULTATION
HEPATIC BORDERS
percuss up the right side to the liver, listening for progressive dullness
* goto 6th intercostal space approx superior border
SPLENIC BORDERS
percuss diagonally to spleen
+SHIFTING DULLNESS
AUSCULTATE FOR BOWEL SOUNDS
*if present dont need to continue
BRUITS EPIGASTRIUM for AORTIC BRUIT RENAL BRUITS HEPATIC BRUITS SPLENIC BRUIT LIVER & SPLENIC RUB = inflammed capsule
Shifting Dullness & Fluid Thrills
SHIFTING DULLNESS checks for ASCITES
if distension is present, can check for free fluid
1) percuss from umbillicus horizontally along to the left border of abdomen, checking for sudden dullness
* ask patient to roll, maintain spot, wait for shifting of fluid
become more resonant = free fluid
2) FLUID THRILL, ask patient to place hand across midline
* place left hand on right side
* flick left side to detect any resonation of a thrill readinig the left hand
Closing the GI session
- check hernial orifices
* DRE for lower GI track abn
Assessment of bowel sounds
GURGLING = NORMAL
TINKLING = potential obstruction
ABSENT = potential ileus, dysfunction of peristalsis (requires 3min of absent auscultaation)
Extra-abdominal signs
Pale Conjunctive
Xanthelasma = hypercholesterolaemia
Jaundice
SPIDER NAEVI = liver cirrhosis
PITTING OEDEMA = hypoalbuminemia
Abdominal Signs
Stoma bags
Caput medusae
Distension
Hernias
Cullen’s sign: bruising of the tissue surrounding the umbilicus associated with haemorrhagic pancreatitis (a late sign).
Grey-Turner’s sign: bruising in the flanks associated with haemorrhagic pancreatitis (a late sign)
Significance of Dupuytren’s contracture in GI
thickening of the palmar fascia, resulting in the development of cords of palmar fascia which eventually cause contracture deformities of the fingers and thumb. There are a number of factors that have been associated with the development of Dupuytren’s contracture including genetics alongside
- XS alcohol
- age
- male
- DM
