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MD3002 > GI and GU clinical examination > Flashcards

GI and GU clinical examination Flashcards

1
Q

what would a general examination involve

A

do they look well
in pain?
height, weight, BMI, stretch marks
liver disease

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2
Q

what are the GI causes of finger clubbing

A

– Cirrhosis
– Ulcerative Colitis
– Crohn’s disease
– Coeliac disease

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3
Q

what is asterixis

A

coarse flapping tremour

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4
Q

what would you look for in the hands

A

leuconychia and koilonychias

palmar erythema

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5
Q

what else could you look for on the skin

A 
spider naevus 
purpurae
jaundice 
conjuctivae 
xanthelasma 
striae 
scratch marks/ redness
marks from IV injections
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6
Q

what would you look for on the chest

A

gynaecomastia
spider naevi
axillae for body hair
striae

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7
Q

how do you examine the mouth

A

tongue depressor and light

mouth, breath, lips, tongue, teeth, gums

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8
Q

what stigmata might you find in the mouth

A

stomatitis, glossitis, candidiasis, ulcers, pigementation, telangiectasia, dentition, gingivitis, odour

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9
Q

what is telangiectasia

A

small dilated blood vessels near the surface of the skin, usually on the lips

may be Cushing’s disease or congenital or Puetz jager

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10
Q

what causes leukonychia

A

low levels of albumin - could be kidney or liver problem

they are white marks on the nails
may also be nail injury

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11
Q

what could cause palmar erythema

A

excess oestrogen in men or women

may be due to pregnancy or liver damage

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12
Q

what is dupytren’s contracture associated with

A

poor liver function test

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13
Q

what is spider naeve a sign of

A

liver damage
around the distribustion of SVC
more than 5 is significant
blanches when touched

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14
Q

what is purpurae a sign of

A

liver damage with coagulative factors
or side effect of drugs
does not blanch

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15
Q

how should jaundice be examined

A

under natural light

ask about itchiness and pain

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16
Q

what could cause xanthelasma

A

liver damage

lipid disorder

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17
Q

what is fetor hepaticus

A

dead mouse smell with failing liver

18
Q

what does glossitis look like

A

beefy red tongue

19
Q

what are the GI causes of oedema

A 
renal failure 
impaired sodium excretion 
reduced intravascular oncotic pressure 
liver cirrhosis 
also pregnancy
20
Q

what position do you examine the abdomen in

A

lying with head on one pillow

21
Q

what are the five Fs of distension

A

Fat, Fluid, Faeces, Flatus, Foetus

22
Q

how do you palpate the abdomen

A 
warm hands 
kneel beside the bed 
ask pt to point to areas of pain 
palpate all 9 areas 
watch pts face
23
Q

what should you palpate for

A

tenderness, masses, organomegaly, abdominal aorta

24
Q

how do you describe hepatomegaly

A

smooth, nodular, generalised or focal enlargement

25
Q

what are causes of hepatomegaly

A 
hepatitis 
alcoholic liver disease 
right heart failure
fatty infiltration 
biliary tract obstruction 
malignancy 
haematological disorders
26
Q

how do you palpate for hepatomegaly

A 
liver moves with respiraton 
begin in R iliac fossa
ask pt to breathe in and out deeply 
palpate upwards to R costal margin
feel for liver edge
27
Q

what are the causes of splenomegaly

A

– Haematological - Haemolytic anaemias / Leukaemias /
Polycythaemia rubra vera / Lymphoma /
myeloproliferative diseases / myelofibrosis
– Infective (e.g. infectious mononucleosis, infective
endocarditis, TB, malaria)
– Portal hypertension
– Rheumatological disorders – rheumatoid arthritis (Felty’s
syndrome) / SLE
– Rare causes – sarcoidosis / amyloidosis / glycogen storage
diseases

28
Q

how do you palpate for splenomegaly

A 
• Spleen moves with
respiration
• Ask the patient to breathe
in and out deeply
• Palpate upwards to left
hypochondrium
• Feel for edge of an
enlarged spleen
• Characteristic notch may
be palpable

you should not be able to feel a normal spleen

29
Q

what are the causes of renal enlargement

A

hydronephrosis
PCKD
Renal cell carcinoma
cysts

use to hands in front and behind
sit forwards and palpate from behind

30
Q

what organs should you percuss

A

liver and spleen

percuss up to right costal margin for lower border of the liver

percuss downwards from just above right nipple for upper border

percuss towards left hypochondrium for lower border of the spleen

31
Q

what are the causes of ascites

A 
– Hepatic cirrhosis
– Intra-abdominal malignancy
– Nephrotic syndrome
– Cardiac failure
– Pancreatitis
– Constrictive pericarditis etc
32
Q

what does fluid sound like

A

dull

33
Q

what is shifting dullnes

A

ask patient to move postion, fluid will move changing areas of dullness

34
Q

what should be auscultated

A

listen to bowel sounds for 2 mins
listen for silence

ausculate for aortic bruits

auscultate renal arteries

metallic sounds could be bowel obstruction

35
Q

where may upper GI tract tumours metastasise to

A

left posterior cervical triangle (Virchow’s node)

36
Q

what are the indications for a rectal exam

A

rectal bleeding
prostatic symptoms
change in bowel habit
spinal cord injury

37
Q

what pathology might b found in a DRE

A 
• Haemorrhoids
• Rectal prolapse
• Anal fissure
• Skin tags
• Anal carcinoma
• Anal fistula
• Prostatic enlargement
– Benign prostatic hyperplasia
– Prostatic carcinoma
– Prostatitis (tender prostate)
38
Q

what are indications for female pelvic examination

A

pelvic pain
abnormal bleeding
abnormal vaginal discharge
prolapse

39
Q

what female pelvic pathology might you find on examination

A

• Ovarian pathology
– E.g. Ovarian cyst, malignancy
• Uterine pathology
– E.g. Uterine prolapse, fibroids, cervical carcinoma,
carcinoma of body of uterus
• Vaginal pathology
– E.g. vaginitis , prolapse
• Pelvic infection (Pelvic inflammatory disease)
• Ectopic pregnancy - do a pregnancy test
• Always consider a pelvic ultrasound scan

40
Q

what testicular pathology might be found on examination

A 
– Infection (epididymitis,
orchitis, epididmyoorchitis)
– Testicular torsion
– Epididymal cysts
– Testicular tumours
– Indirect inguinal hernia
• Always consider USS
41
Q

what is orchitis

A

inflammation of the testicle

MD3002 (56 decks)

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