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

GI Systems Examination - Principles Flashcards by David Houghton

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

for the abdominal examination patient is flat

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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?

45 degrees

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

xiphisternum to pubic synthesis

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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?

palms of hands become red
sign of liver disease

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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?

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

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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?

hand tremour or flap
liver disease causing encephalopathy

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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?

excess fluid in fingers
IBD and liver disease

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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?

curved nails (also called spooned nails)
iron deficiency

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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?

white discolouration appearing on nails
malabsorption and cirrhosis

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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?

pale colour on conjunctiva
anaemia

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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?

yellowing of the eye

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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?

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

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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?

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

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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?

inflammation of the tongue
iron deficiency

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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?

painful lessions in or outside the mouth
IBD

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

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

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

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

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What is a stoma?

opening in the abdomen
generally connected to GIT or urinary tract

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What are the 2 types of stoma?

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

2 - colostomy (right side only)

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

1 - Fat

2 - Fluid

3 - Flatus

4 - Faeces

5 - Fetus

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

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

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

abdomen

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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?

Study These Flashcards

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

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

Study These Flashcards

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

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

- rigidity in abdomen, generally due to pain

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

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

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?

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

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

- kidneys - in healthy patients these are not palpable

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

- 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

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

- bowels

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)?

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

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

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

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

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

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

- \>2 fingers below the costal margin

What are ascites?

- abnormal build-up of fluid in the abdomen

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?

- 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

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

- auscultation

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

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

What is a bruit that may be heard during auscultation?

- a vascular murmur caused by turbulent blood flow

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

- abnormally turbulent blood flow around the liver

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

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

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

- the legs

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?

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

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

1 - genitals 2 - rectal examination

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

- 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

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

- urine - microbiology, cytology and biochemistry

When would a digital rectal examination be required?

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

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

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

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

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

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

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

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

- straight down towards the bed

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

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

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

- squeez your finger - poor squeeze indicated anal incontinence

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

- examine stool for blood

How do we assess BMI?

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

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

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

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

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

GI Systems Examination - Principles Flashcards

(57 cards)