GI Systems Examination - Principles

Question 1

When examining a patient for an abdominal examination, are patients lay flat or at 45 degrees?

Answer 1

• for the abdominal examination patient is flat

Question 2

When examining a patient for an abdominal examination and you want to examine the hands and the face, would the patient be lying flat or at 45 degrees?

Answer 2

• 45 degrees

Question 3

When examing a patient in an abominal examination, where would we need uncovering and access to on the front of the body?

Answer 3

• xiphisternum to pubic synthesis

Question 4

During an abdominal examination we need to examine the hands. Palmar erythema is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 4

• palms of hands become red
• sign of liver disease

Question 5

During an abdominal examination we need to examine the hands. Dupuytren’s contractures is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 5

• contracture of the hands cuasing a deformity
• can be caused by ecessive alcohol

Question 6

During an abdominal examination we need to examine the hands. Asterixis is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 6

• hand tremour or flap
• liver disease causing encephalopathy

Question 7

During an abdominal examination we need to examine the hands. Clubbing is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 7

• excess fluid in fingers
• IBD and liver disease

Question 8

During an abdominal examination we need to examine the hands. Koilonychia is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 8

• curved nails (also called spooned nails)
• iron deficiency

Question 9

During an abdominal examination we need to examine the hands. Leukonychia is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 9

• white discolouration appearing on nails
• malabsorption and cirrhosis

Question 10

During an abdominal examination we need to examine the eyes. Pallor is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 10

• pale colour on conjunctiva
• anaemia

Question 11

During an abdominal examination we need to examine the eyes. Icterus (commonly known as jaundice) is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 11

• yellowing of the eye

Question 12

During an abdominal examination we need to examine the face. Flushing (commonly known as jaundice) is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 12

• change in colour of face
• change from pale to pink to purple in extreme case

Question 13

During an abdominal examination we need to examine the face. Angular stomatitis is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 13

• swollen, red patches in the corners on the outside of the lips
• iron/vitamine B deficiency

Question 14

During an abdominal examination we need to examine the face. Glossitis is something that we may see. What is this and what is a common cause of this in the GIT?

Answer 14

• inflammation of the tongue
• iron deficiency

Question 15

During an abdominal examination we need to examine the face. Mouth ulcers are something that we may see. What is this and what is a common cause of this in the GIT?

Answer 15

• painful lessions in or outside the mouth
• IBD

Question 16

Once we have done visual observations and inspected the eyes and face, what should we examine next?

Answer 16

• the chest
• looking for gynaecomastia and spider naevi (excessive oestrogen caused by chronic liver disease)
• tattoos and needle marks (viral hepatitis)

Question 17

Following examination of the chest, where do we move to next, and what are some visual ques that may be helpful?

Answer 17

• abdomen examination
• scars
• stomas
• obvious masses
• distension (bowel obstruction or ascites)
• hernias

Question 18

What is a stoma?

Answer 18

• opening in the abdomen
• generally connected to GIT or urinary tract

Question 19

What are the 2 types of stoma?

Answer 19

1 - ileostomy (can be on either side of abdomen)

2 - colostomy (right side only)

Question 20

When examining the abdomen for distension, what does the 5 Fs refer to?

Answer 20

1 - Fat

2 - Fluid

3 - Flatus

4 - Faeces

5 - Fetus

Question 21

Following all of the inspections described up to this point, we move on to palpation. What is the first thing we will plapate?

Answer 21

• parotids salivary glands (excessive alcohol)
• lymphadenopathy – Cervical, Axillary, Virchow’s,
• Virchow’s node = near JVP sign of gastric cancer
• Inguinal nodes in groin

Question 22

Following palpatation of the lymph nodes, where do we move to next as part of our palation?

Answer 22

• abdomen

Question 23

Following palpatation of the lymph nodes, we move to the abdomen next as part of our palation. What part of the hand should we use and what are the areas we should invesgitate first?

Answer 23

• use palm of our hands
• palpate each of the 9 segments
• if patient has pain, start furthest away

Question 24

What is abdominal guarding that patients can experience during an abdominal examination?

Answer 24

• tension in the abdomen to protect it
• can be voluntary or involuntary

Question 25

What is abdominal rigidity that patients can experience during an abdominal examination?

Answer 25

- rigidity in abdomen, generally due to pain

Question 26

What is rebound tenderness that patients can experience during an abdominal examination?

Answer 26

- patients feel pain once the pressure has been removed - called Blumberg’s sign

Question 27

When investigating the abdoment for a mass we need to describe a lot of its features. SPACESPIT can be used as a mnemonic to remember this, what does it stand for?

Answer 27

- Size - Position - Attachments - Consistency - Edge - Surface - Pulsation - Inflammation (Redness, Tenderness, Warmth) - Transillumination

Question 28

Following examination of all 9 areas of the abdomen in a abdominal examination, where would we palpate next?

Answer 28

- kidneys - in healthy patients these are not palpable

Question 29

Following examination of all 9 areas of the abdomen in a abdominal examination, where we then palpate the kidneys. How do we do this?

Answer 29

- use one hand on patients back over kidney - second hand on front of abdoment - patient takes a deep breathe in - you ballot (tap) the kidney from the back

Question 30

Following palpation of the kidneys we use percussion to investigate the abdomen. Which organs of the GIT should sound resonant (filled with air)?

Answer 30

- bowels

Question 31

Following palpation of the kidneys we use percussion to investigate the abdomen. Which organs of the GIT should sound dull (filled with fluid or solid)?

Answer 31

- liver - spleen - kidneys - bladder - masses - fluid

Question 32

If we want to percuss or palpate the liver, what are the 2 places we start from?

Answer 32

- 5th intercostal space and move down to right hypochrondrium - right iliac region and work up to right hypochrondrium

Question 33

If we want to percuss or palpate the spleen, where should we start from?

Answer 33

- right iliac region - move diagonally up to left hypochrondrium region

Question 34

If we palpate for the liver, how many fingers that we can feel is classed as abnormal?

Answer 34

- \>2 fingers below the costal margin

Question 35

What are ascites?

Answer 35

- abnormal build-up of fluid in the abdomen

Question 36

When percussing for ascites (fluid in the abdomen) why do we need to ask the patient to roll onto their left side for 1 minute once we have investigates the abdomen?

Answer 36

- ascites can sink to back of abdomen and percussion sounds resonant - once on their side the same area may now sound dull as the ascites moves with gravity

Question 37

Once we have completed our inspection, palpation and percussion, we move onto what?

Answer 37

- auscultation

Question 38

When we are auscultating the abdomen hopw often should we hear sounds, and if sounds are not present, what does this suggest?

Answer 38

- should be every 5-10 seconds - absent or tinkling (high pitched) suggests obstruction

Question 39

What is a bruit that may be heard during auscultation?

Answer 39

- a vascular murmur caused by turbulent blood flow

Question 40

What is a hepatic bruit that may be heard during auscultation?

Answer 40

- abnormally turbulent blood flow around the liver

Question 41

What is a renal bruit that may be heard during auscultation?

Answer 41

- abnormally turbulent blood flow around the kidneys - sign or renal artery stenosis

Question 42

Once we have finished auscultation of the abdomen, what would be the final area we would examine?

Answer 42

- the legs

Question 43

Once we have finished auscultation of the abdomen, we would then examine the legs. We may see pyoderma gangrenosum, what is this and what may cause this?

Answer 43

- inflammatory skin disease - painful pustules or nodules become ulcers that grow - common in crohns disease

Question 44

Once we have examined the legs, where are the next 2 areas we would examine?

Answer 44

1 - genitals 2 - rectal examination

Question 45

When we examine the abdomen we can place our stephascope of the epigastric region to listen to succussion splash. What is succussion splash?

Answer 45

- stephascope placed on epigastric region - patient is rocked from side to side - if splashing is present more than 4 hours after their last meal then an obstruction may be present

Question 46

Once all examinations are complete, what sample can be collected to be investigated and what investigations would be suitable?

Answer 46

- urine - microbiology, cytology and biochemistry

Question 47

When would a digital rectal examination be required?

Answer 47

- patients with bright red rectal bleeding - change in bowel habits - anal incontinence - suspected prostatic pathology

Question 48

When performing a digital rectal examination what is the first thing we examine?

Answer 48

- prostate - should be first thing we encounter upon entering the rectum

Question 49

Following examination of the prostate during a digital rectal examination what do we do next?

Answer 49

- turn our finger clockwise from 6 to 12pm - return to 6pm and then work anti-clockwise 6 to 12pm

Question 50

When performing a digital rectal examination what 5 things do we need?

Answer 50

- non-sterile gloves - lubricant - apron - paper towels - chaperone

Question 51

During a digital rectal examination, if the patient is lying down on their side, where is 6pm located?

Answer 51

- straight down towards the bed

Question 52

During a digital rectal examination, prior to placing out finger inside the patients rectum, what are we looking for around the anus?

Answer 52

- skin excoriation (picking/scratching skin around anus) - abscess (collection of pus) - haemorrhoids (enlarged blood vessels)

Question 53

During a digital rectal examination, whilst the finger is inside the patients rectum, what should you ask the patient to do?

Answer 53

- squeez your finger - poor squeeze indicated anal incontinence

Question 54

Once you have completed the rectal examination, prior to disposing of the gloves, what should you do with the finger you have just used?

Answer 54

- examine stool for blood

Question 55

How do we assess BMI?

Answer 55

- weight (kg) / height (m)² - weight = 81kg and height = 1.86m - 81/1.86² = 23.41 kg/m²

Question 56

In term of BMI what are classifications of: - Underweight - Healthy Weight - Overweight - Obese

Answer 56

- \<18.5 = Underweight - between 18.5 - 24.9 = Healthy Weight - between 25 - 29.9 = Overweight - \>30 = Obese

Question 57

What is the Malnutrition Universal Screening Tool Score (MUST Score)?

Answer 57

- 5 step scoring system - all patients admitted to hospital - identifies those at risk of obesity or malnutrition