GI PE IM PLAT Flashcards
Skin
Note for
Presence of scars, striae, rashes, ecchymoses
Dilated veins
Umbilicus
Observe contour
Location
Abdominal contour
Round
Flat
Scaphoid
Protuberant
Local bulges
Asymmetry
Violaceous striae is associated
Cushing’s syndrome
Umbilical bulge is seen in
Ventral hernia
Dilated veins is seen in
Portal hypertension and inferior vena caval obstruction
Bulging flanks is associated with
Ascites
Normal auscultation findings on the abdomen
Clicks and gurgles 5-34 per min
High-pitched rumbling sounds of hyperperistalsis that correspond with crampy abdominal pain
Borborygmi
For auscultation check fr
Borborygmi
Bruits
Friction rubs
Percussion
Percuss the abdomen lightly in all 4 quadrants
Assess distribution in the abdomen, characteristics of palpable masses ( fluid-filled, solid) and size of liver and spleen
Prominent peristaltic waves may be seen in
Intestinal obstruction
Thin individuals
Liver percussion
Lower border of liver dullness - start at level of umbilicus, right midclavicular line, percuss cranially until dullness is noted
Upper border of liver dullness- nipple line, right midclavicular line, percuss from lung resonance down to liver dullness
Normal liver span
Right midclavicular line 6-12 cm
Midsternal line 4-8 cm
How does the spleen expand
It expands anteriorly, downward and medially and replaces the general tympanitic tone with dullness
How to percuss the spleen
Percuss the left lower anterior chest wall
From border of cardiac dullness at the 6th rib -> anterior axillary line -> down to the costal margin
Tympany is prominent -> splenomegaly unlikel
Obliterated Traube’s space signifies
Splenomegaly
Or presence of fluids /solids in the stomach or colon
Splenic percussion sign
Change in percussion note from tympany to dullness on inspiration
Predominant percussion tone
Due to gass in the abdomen
Tympany
Signifies presence of underlying mass/organ, fluid or feces
Dullness
Used to elicit tenderness, muscular resistance and presence of superficial organs and masses
Light palpation
How to differentiate voluntary guarding from involuntary muscular spasms by
Asking patient to relax
ask patient to mouth-breathe with jaw dropped open
How to position hands when palpating for liver dullness
Left hand -> behind he patient at the level of right 11 and 12th ribs
Right hand-> right abdomen lateral to the rectus muscle with finger tips below the lower border of liver dullness
ask patient to breathe deeply, then try to feel the liver edge as it comes in contact: note consistency, presence of contour irregularity, and any tenderness
Splenic palpation
At the patient’s right side, reach over and around the patient using the left hand to support and press forward the left
right hand -> press below the left costal margin and press in toward the spleen contour and presence of any tenderness
Ask patient to take a deep breath, feel the splenic edge, note contour and presence of any tenderness
Measure the distance between the spleen’s lowest point and left costal margin
Repeat procedure but with patient assuming a right decubitus position
Why right decubitus position in spleen palpation
Places the spleen forward and to the right and makes it more accessible to palpation
Shifting dullness is seen in
Ascites
Dullness shifting to more dependent side
Shifting dullness
Palpable impulse on the side opposite the pressure (with hands pressed firmly on the midline of the abdomen)
Fluid wave
Pain in the RLQ during left sided pressure
Also associated with referred rebound tenderness - RLQ pain on withdrawal of pressure on left side
Rovsing’s sign
Abdominal pain on hip flexion and or extension
Psoas sin
Right hypogastric pain on internal rotation of the right hip
Obturator sign
Extreme pain on light touch over the area bound by the umbilicus, pubic tubercle and anterior superior iliac spine
Cutaneous hyperesthesia
Sharp increase in RUQ tenderness with a sudden stop in inspiratory effort while pressure is applied under the costal margin lateral oto the border of the rectus muscle
Murphy’s sign
Proper positioning for DRE
Ask patient to lie on his/her left side,flexing his/here knees, wit buttocks close to the edge of the examination table
DRE STEPS
Proper position of patient 1. With gloved hands, spread buttocks apart and inspect immediate area for A. Skin lesions B. Ulcers C. Masses D. Inflammation
Sphincter tightness may be noted in
Anxiety
Inflammation
Scarring
Sphincter laxity may be noted in
Some neurologic diseases
Induration may be noted due to
Inflammation, scarring or malignancy
Local hardening of soft tissue, firm, but not as hard as bone
Induration
Soft, pliable tags of redundant skin at anal margin
Usually seen in most individuals
Skin tags
Also known as semilunar space
Traube’s space
Is an anatomic space
Crescent shaped space
Encompassed by the lower edge of the left lung, anterior border of the spleen. And left costal margin and inferior margin of the left lobe of the liver
Traube’s space
Surface markings of traube’s space
Left sixth rib - superiorly
Left mid axillary line - laterally
Left costal margin inferiorly
Obliteration of Traube’s space may indicate
Dullness instead of tympany
Splenomegaly
(Sensitivity of 62% and specificity of 72%)
Higher specificity if patient has not eaten in the last 2 hours
Normal finding after a meal
Left pleural effusion
