gu & gi exam

Question 1

observation

Answer 1

Ask patient about: bowel and bladder movements, do they go to the toilet during the night (could be a prostate problem), any pain/ discomfort/ sensitivity–> what cause is depends on abdominal contents, time of the month?
Look at patients: posture, position, do they look comfortable
Observe: cachetic (Cancer, AIDS, COPD, MS, Heart Failure, TB, some poisoning or hormonal deficiency), pallor (many causes of being pale), jaundiced (Liver Cancer, Hepatitis, Leptospirosis, Obstruction Biliary tract (gallstones, pancreatic cancer), congenital)

Question 2

cachexia

Answer 2

(wasting syndrome) = characterized as loss of weight, muscle atrophy, fatigue, weakness and loss of appetite. Even if patient is having correct calories and nutrients they are still losing weight. Seen in patients with cancer, aids, chronic obstructive pulmonary disease, multiple sclerosis, congestive heart failure, tuberculosis, familial amyloid polyneuropathy, mercury poisoning and hormonal deficiency. It’s a positive risk factor- chance of death from underlying condition is increased dramatically

Question 3

hands and face

Answer 3

What is happening in the gut often translates in the skin
Look for:
-clubbing (cirrhosis, ulcerative colitis, crohn’s coeliac)
-leukonychia (liver disease)
-Koilonychias (Anemia) Cirrhosi
-Nephrotic Syndrome
-Iron Deficiency
-Palmar erythema–> primary- idiopathic, pregnancy, hereditary. Secondary- (RA, Chronic Liver Disease, Contraceptive Pill, SLE, DM, ) Increased liver disease abnormal oestradiol levels – increased cardiac output
-Dupuytren’s Contracture–> Connective tissue (fascia) of palm thickens –forming nodules (can be tender initially). Nodules increase in size and form cords which shorten causing a contracture. Cause unknown – genetic? – Common – later life over 50. Smoking. (Reported to be three times more common in smokers.)
-Eyes- jaundiced, connectival pallor, keiser Fleischer rings (sign of wilson’s disease involving abnormal copper handling)

Question 4

abdominal aorta auscultation

Answer 4

-Palpate linear semilunaris- push in and feel for a pulse (left of navel)–> feel other side and check to see if there’s an enlargement
-Auscultate for boewl sounds, bruits aorta and renal artery
-Should hear borborygmi every 10-30 seconds (which are normal bowel sounds)–> a lack of sound= intestinal obstruction, paralytic ileus caused by adhesions, hernias, impact stool, tumours (mechanical), bacteria, chemical, ischemia, kidney and lung disease (non mechanical)
-Auscultate renal arteries, iliac arteries and femoral arteries

Question 5

palpation

Answer 5

-Palpate superficial to deep
-Ensure hand is flat and push with left hand on top, movement comes from knuckles
-Find ASIS and palpate in concentric circles to the umbilicus
-Then go deeper- push down and hold and check for symmetry
Also palpate pubic symphysis-
-Mine or patients ulnar border to create barrier
-Ulnar border should be even- if not then it indicates a sacroiliac dysfunction
If any mase are found they are graded in size, site, shape, surface, edge, consistency, percussion note, bruit/ bowel sounds

Question 6

organ palpation

Answer 6

If liver is enlarged = right side is tender
-push liver up towards my contact
If spleen is enlarged= towards midline
-Start at the midline towards the costal cartilage
-Try and push the spleen into my contact
Balloting kidneys–> shouldn’t be able to feel them, pull up and palpate deeply in, when there’s contact, lean into them with my contact
Percuss organs

Question 7

stomach pain locations

Answer 7

upper right= gallstones, stomach ulcer, pancreatitis
middle right= kidney stones, urine infection, constipation, lumbar hernia
lower right= appendicitis, constipation, pelvic pain, groin pain
upper middle= stomach ulcer, heartburn/ indigestion, pancreatitis, gallstones, epigastric hernia
middle= pancreatitis, early appendicitis, stomach ulcer, inflammatory bowel, umbilical hernia
lower middle= urine infection, appendicitis, diverticular disease, inflammatory bowel, pelvic pain
upper left= stomach ulcer, biliary colic, pancreatitis
middle left= kidney stones, diverticular disease, constipation, ibs
lower left= diverticular disease, pelvic pain, groind pain