OSCE systems: Gastrointestinal, cardiovascular and Endocrine Flashcards
Gastrointestinal examination. What do you want to know about abdominal pain?
location (epigastric, lower right quadrant, upper left quadrant, etc)
Gastrointestinal examination. What would vomiting or nausea indicate?
bowel obstruction. bacterial or viral infection. food poisoning. food intolerances
Gastrointestinal examination. What would difficulty swallowing indicate?
obstruction. neurological disease
Gastrointestinal examination. What would a change in stool indicate?
blood. Family history of bowel cancer. inflammatory bowel disease. irritable bowel syndrome
Gastrointestinal examination. What could telangiectases (spider veins) or spider angiomas in the cutaneous area indicate?
> 3 liver disease or increased estrogen effect of the pill or pregnancy
Gastrointestinal examination. What would examination of the sclera of the eyes show?
yellowing of sclera - jaundice
Gastrointestinal examination. What would examination of the corners of the lips show?
Stomatitis- systematic disease, infection, nutritional deficiencies, chemical or allergic irritation
Gastrointestinal examination. If an examination of the tongue showed what appears to be a bright pink surface what would that indicate?
Colour (yellow, cream, red, white)
▪ Texture (rough, smooth)
▪ Inferior surface
▪ Geographic tongue * A bright pink color on the tongue is most often due to a deficiency in iron, folic acid, or vitamin B-12. An allergic reaction to gluten can also cause this.
Gastrointestinal examination: What is the buccal mucosa? Why would you inspect it?
The buccal mucosa extends from the inside of your lips and cheeks to just behind your last teeth. It’s a soft, wet mucous membrane that’s made up of several layers of tissue. Its main function is to support your mouth when you’re eating and chewing. Inspection would show ulcers, bleeding, infection.
Gastrointestinal examination: What is Bruxism? Why would you inspect the teeth?
Staining, general hygiene, cavities, Bruxism. Teeth grinding (bruxism) is involuntary clenching, grinding, and gnashing of the teeth that usually happens during sleep. Causes can include stress, concentration, and use of illegal drugs.
Gastrointestinal examination: What is Terry Nails? What is koilonychia? What is clubbing?
Terry’s nails is a type of nail discoloration. The nailbeds look “washed out,” except for a thin reddish-brown strip near the tip. Often, Terry’s nails is a symptom of a chronic condition, such as liver failure or diabetes.
Koilonychia is a deformity of the nails where the central portion of the nail is depressed and the lateral aspects of the nail are elevated. This symptom can be a sign of an underlying disease process or a congenital process.
Nail clubbing is when your nails appear wider, spongelike or swollen, like an upside-down spoon. Clubbed nails are often a sign of a health condition that needs treatment, such as lung cancer.
Gastrointestinal examination: What is Erythema nodosum? What is palmer erythema?
Erythema nodosum is characterized by tender, red bumps, usually found symmetrically on the shins. Up to 55 percent of cases have no clear identifiable cause. Sometimes, erythema nodosum is not a separate disease. Rather, it is a sign of some other infection, disease, or of sensitivity to a drug. However, it is the most common skin sign of IBD. Can be caused by Chron’s disease Ulcerative Colitis- it is a form of panniculitis.
Gastrointestinal examination: What is palmer erythema?
palmer erythema is a Redness of palms (often heel of the hand) from dilated blood vessels. could be increased cardiac output/hyperdynamic circulation
Capillary dilation in the palms due to local factors
localized inflammation
High circulation estrogen levels- pregnancy, liver cirrhosis; rheumatoid arthritis
could be caused by liver disease or smoking
Gastrointestinal examination: What is Striae? Why would you inspect the abdomen?
contour
scars
swellings (fat, flatus, fluid, faeces, fibroids, foetus, fatal tumour
striae - pink purple may be due to Cushings Syndrome
Striae are a form of dermal scarring associated with stretching of the dermis. They often result from a rapid change in weight (gain and loss) or are associated with endogenous or exogenous corticosteroids.
Gastrointestinal examination: Auscultate abdomen. What are you listening for?
Bowel sounds (listen in all 4 quadrants for 2+ minutes)
o Frequency ▪ Normal
* 5-30 per minute
* Normally intermittent, low-pitched sounds
▪ Hypoactive
* Bowel obstruction
* Constipation
* Ischaemic bowel disease
▪ Hyperactive
* Bowel obstruction
* Infectious enteritis
* Malabsorption
* Gastrointestinal bleeding
o Character
▪ Gurgles, clicks, soft, strong
Gastrointestinal examination: Palpate the abdomen. What are you feeling for?
Observe for
o Masses
o Tenderness
o Guarding
o Rigidity
o Rebound tenderness
Gastrointestinal examination: What is an Abdominal Aortic Aneurysm - how would you detect it?
A periumbilical or upper abdominal mass with expansile pulsations 3cm or more wide suggests AAA.
Press firmly deep in the upper abdomen slightly to the left of the midline – identify aortic pulsations.
o In patients > 50yo press deeply on either side of the aorta.
Normal: not more than 3cm – allow for the thickness of the abdominal wall.
The ability to feel varies greatly with the thickness of the abdominal wall and the AP diameter of the abdomen
Gastrointestinal examination: Palpate the caecum, ileocaecal and sigmoid regions. What are you feeling for?
If there is currently pain in a specific location begin palpation away from the site of pain (such as the opposite side of the abdomen) and begin with gentle pressure.
o The ileocaecal valve may be palpable as a localised area of tightness in the vicinity of McBurney’s point (approximately 1/3 the distance of the way from ASIS to umbilicus).
o Feel for masses, increased peristaltic waves of intestinal obstruction (along with increased bowel sounds on auscultation), pulsing of the abdominal aorta.
Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a high-pitched, dull-quality sound indicate?
normal bone or muscle
abnormal collapsed lung, dense mass
Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a medium-pitched, thud like -quality sound indicate?
normal liver and organs
abnormal pleural effusion, ascites
Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a low-pitched, hollow-quality sound indicate?
normal lung
Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a very low-pitched, booming-quality sound indicate?
emphysema
Gastrointestinal examination: When assessing the sounds of percussion of the abdomen, what does a high-pitched, drum-like -quality sound indicate?
normal gastric bubble
abnormal air-distended abdomen
Gastrointestinal examination: Why do we palpate the liver?
hepatomegaly (enlarged liver) or tenderness
Gastrointestinal examination: What is McBurneys’s Point?
McBurney’s point refers to the point on the lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis. Acute appendicitis is characterized by the inflammation, infection, or swelling of the appendix.
Gastrointestinal examination: What is Murphy’s Sign?
Murphy’s sign is elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive
Gastrointestinal examination: What is Rebound Tenderness?
Press steadily into the abdomen and then suddenly release.
Pain is a positive result
o Suggests peritoneal irritation (such as if appendicitis has progressed to cause peritonitis)
Gastrointestinal examination: What is the Psoas Sign?
Place a hand above the right knee, and ask the patient to flex the hip against the resistance from your hand.
Pain with engagement of hip flexion is a positive result
indicating potential appendicitis due to pressure from the underlying psoas