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GASTROINTESTINAL Flashcards

(48 cards)

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1
Q

GI - WHAT MAKES UP A GI/GU EXAM?

A
  • General signs & closer look at hands
  • Abdominal inspection
  • Palpate the aorta
  • Abdominal auscultation
  • Abdominal palpation
  • Palpate the liver
  • Palpate the spleen
  • Ballot the kidneys
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2
Q

GI - GENERAL SIGNS - OBVIOUS SCARS

A
  • Obvious scars: may provide clues regarding previous abdominal surgery.
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3
Q

GI - GENERAL SIGNS - ABDOMINAL DISTENTION

A
  • Abdominal distention: may suggest the presence of ascites or underlying bowel obstruction and/or organomegaly.
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4
Q

GI - GENERAL SIGNS - PALLOR

A
  • Pallor: a pale colour of the skin that can suggest underlying anaemia (e.g. gastrointestinal bleeding or malnutrition). It should be noted that healthy individuals may have a pale complexion that mimics pallor.
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5
Q

GI - GENERAL SIGNS - JAUNDICE

A
  • Jaundice: a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels (e.g. acute hepatitis, liver cirrhosis, cholangitis, pancreatic cancer).
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6
Q

GI - GENERAL SIGNS - HYPERPIGMENTATION

A
  • Hyperpigmentation: a bronzing of the skin associated with haemochromatosis.
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7
Q

GI - GENERAL SIGNS - OEDEMA

A
  • Oedema: typically presents as swelling of the limbs (e.g. pedal oedema) or abdomen (i.e. ascites) and is often associated with liver cirrhosis
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8
Q

GI - GENERAL SIGNS - STOMA BAG

A
  • Stoma bag(s): note the location of the stoma bag(s) as this can provide clues as to the type of stoma (e.g. colostomies are typically located in the left iliac fossa, whereas ileostomies are usually located in the right iliac fossa).
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9
Q

GI - GENERAL SIGNS - STRETCH MARKS

A
  • Stretch marks: caused by tearing during the rapid growth or overstretching of skin (e.g. ascites, intrabdominal malignancy, Cushing’s syndrome, obesity, pregnancy).
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10
Q

GI - GENERAL SIGNS - HERNIAS

A
  • Hernias: ask the patient to cough and observe for any protrusions through the abdominal wall (e.g. umbilical hernia, incisional hernia).
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11
Q

GI - GENERAL SIGNS - HANDS - PALLOR

A
  • Pallor: may suggest underlying anaemia (e.g. malignancy, gastrointestinal bleeding, malnutrition).
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12
Q

GI - GENERAL SIGNS - HANDS - PALMAR ERYTHEMA

A
  • Palmar erythema: a redness involving the heel of the palm that can be associated with chronic liver disease (it can also be a normal finding in pregnancy).
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13
Q

GI - GENERAL SIGNS - HANDS - KOILONYCHIA

A
  • Koilonychia: spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease).
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14
Q

GI - GENERAL SIGNS - HANDS - LEUKONYCHIA

A
  • Leukonychia: whitening of the nail bed, associated with hypalbuminaemia (e.g. end-stage liver disease, protein-losing enteropathy).
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15
Q

GI - GENERAL SIGNS - HANDS - FINGER CLUBBING

A
  • Finger clubbing: inflammatory bowel disease, coeliac disease, liver cirrhosis and lymphoma of the gastrointestinal tract.
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16
Q

GI - GENERAL SIGNS - HANDS - TEMPERATURE

A
  • Temperature: Cool hands may suggest poor peripheral perfusion.
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17
Q

GI - WHAT ARE THE 6 F’S FOR?

A
  • Abdominal distension: can be caused by a wide range of pathology including the six f’s
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18
Q

GI - 6 F’S

A
  • Fat
  • Fluid
  • Flatus
  • Faeces
  • Fetus
  • Fulminant mass
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19
Q

GI - PALPATE THE AORTA

A
  • Using both hands perform deep palpation just superior to the umbilicus in the midline.
  • Note the movement of your fingers:
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20
Q

GI - NORMAL AND ABNORMAL SIGNS WHEN PALPATING THE AORTA

Study These Flashcards
A
  • In healthy individuals, your hands should begin to move superiorly with each pulsation of the aorta.
  • If your hands move outwards, it suggests the presence of an expansile mass (e.g. abdominal aortic aneurysm).
21
Q

GI - 9 AREAS OF THE ABDOMEN - LEFT HYPOCHONDRIAC REGION

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A
  • Left hypochondriac region
    • Area 3 as ur looking down on Pt (Below the costal cartilages)
    • The stomach
    • The top of the left lobe of the liver
    • The left kidney
    • The spleen
    • The tail of the pancreas
    • Parts of the small intestine
    • The transverse colon
    • The descending colon
22
Q

GI - 9 AREAS OF THE ABDOMEN - RIGHT HYPOCHONDRIAC REGION

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A
  • Right hypochondriac region
    • Area 1
    • The liver
    • The gallbladder
    • The small intestine
    • Small intestine
    • The right kidney
23
Q

GI - 9 AREAS OF THE ABDOMEN - EPIGASTRIC REGION

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A
  • Epigastric region
    • Area 2 (above the stomach)
    • The stomach
    • The liver
    • The spleen
    • The pancreas
    • Adrenal glands
    • GORD
    • HEART ATTACK
    • PEPTIC ULCER
24
Q

GI - 9 AREAS OF THE ABDOMEN - LEFT LUMBAR REGION

Study These Flashcards
A
  • Left lumbar region
    • Area 6
    • A part of the descending colon
    • The tip of the left kidney
25
GI - 9 AREAS OF THE ABDOMEN - RIGHT LUMBAR REGION
- **Right lumbar region** - Area 4 - The tip of the liver - The gallbladder - The ascending colon
26
GI - 9 AREAS OF THE ABDOMEN - UMBILICAL REGION
- **Umbilical region** - Area 5 - The small intestine - Umbilical hernia
27
GI - 9 AREAS OF THE ABDOMEN - LEFT INGUINAL REGION
- **Left inguinal region** - Area 9 - The descending colon - Sigmoid colon - The left ovary and the left fallopian tube in females. - Divavticultis
28
GI - 9 AREAS OF THE ABDOMEN - RIGHT INGUINAL REGION
- **Right inguinal region** - Area 7 - The appendix - The cecum - The right ovary and right fallopian tube in females.
29
GI - 9 AREAS OF THE ABDOMEN - HYPOGASTRIC REGION
- **Hypogastric region** - Area 8 (Below stomach) - The sigmoid colon - The urinary bladder - The uterus, the right and left ovaries and the fallopian tubes can be found in females
30
GI - ABDOMINAL AUSCULTATION - NORMAL BOWEL SOUNDS
- **Normal bowel sounds:** typically described as gurgling (listen to an example in our video demonstration)
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GI - ABDOMINAL AUSCULTATION - TINKLING BOWEL SOUNDS
- **Tinkling bowel sounds:** typically associated with bowel obstruction.
32
GI - ABDOMINAL AUSCULTATION - ABSENT BOWEL SOUNDS
- **Absent bowel sounds:** suggests ileus which is a disruption of the normal propulsive ability of the intestine due to a malfunction of peristalsis. Causes of ileus include electrolyte abnormalities and recent abdominal surgery. To be able to confidently state that a patient has ‘absent bowel sounds’ you need to auscultate for at least 3 minutes (this is unlikely to be the case in an OSCE given the time restraints).
33
GI - AUSCULTATION OVER THE AORTA
- To identify vascular bruits suggestive of turbulent blood flow: - **Aortic bruits**: auscultate 1-2 cm superior to the umbilicus, a bruit here may be associated with an abdominal aortic aneurysm.
34
GI - AUSCULTATION OVER THE RENAL ARTERIES
- To identify vascular bruits suggestive of turbulent blood flow: - **Renal bruits**: auscultate 1-2 cm superior to the umbilicus and slightly lateral to the midline on each side. A bruit in this location may be associated with renal artery stenosis.
35
GI - ABDOMINAL PALPATION
- Pt flat, knees up, Lightly palpate each of the nine abdominal regions, assessing for clinical signs suggestive of gastrointestinal pathology. - Looking for any tenderness, voluntary/inventory guarding, rovisngs sign and masses. - Then repeat but now with more pressure to find deeper masses.
36
GI - ABDOMINAL PALPATION - REBOUND TENDERNESS
- **Rebound tenderness:** said to be present when the abdominal wall, having been compressed slowly, is released rapidly and results in sudden sharp abdominal pain. This is a non-specific, unreliable clinical sign that can, in some cases, be associated with peritonitis (e.g. appendicitis).
37
GI - ABDOMINAL PALPATION - VOLUNTARY GUARDING
- **Voluntary guarding:** contraction of the abdominal muscles in response to pain
38
GI - ABDOMINAL PALPATION - INVOLUNTARY GUARDING/RIGIDITY
- **Involuntary guarding/rigidity:** involuntary tension in the abdominal muscles that occurs on palpation associated with peritonitis (e.g. appendicitis, diverticulitis).
39
GI - ABDOMINAL PALPATION - ROVSING'S SIGN
- **Rovsing’s sign:** palpation of the left iliac fossa causes pain to be experienced in the right iliac fossa. This sign was historically said to be indicative of appendicitis, but it is not reliable and at best indicates peritoneal inflammation of any cause affecting the left and/or right iliac fossa.
40
GI - ABDOMINAL PALPATION - MASSES
- **Masses**: large or superficial masses (e.g. hernias) may be noted on light palpation.
41
GI - CHARACTERISTICS OF MASSES
- **Location**: note which of the nine abdominal regions the mass located within. - **Size and shape:** assess the approximate size and shape of the mass. - **Consistency**: assess the consistency of the mass (e.g. smooth, soft, hard, irregular). - **Mobility**: assess if the mass appears to be attached to superficial or underlying structures. - **Pulsatility**: note if the mass feels pulsatile, suggestive of vascular aetiology (e.g. abdominal aortic aneurysm).
42
GI - PALPATE THE LIVER
- Begin palpation in the right iliac fossa, starting at the edge of the superior iliac spine, using the flat edge of your hand (the radial side of your right index finger). - Ask the patient to take a deep breath and as they begin to do this palpate the abdomen. Feel for a step as the liver edge passes below your hand during inspiration (a palpable liver edge this low in the abdomen suggests gross hepatomegaly). - Repeat this process of palpation moving 1-2 cm superiorly from the right iliac fossa each time towards the right costal margin. - As you get close to the costal margin (typically 1-2 cm below it) the liver edge may become palpable in healthy individuals.
43
GI - PALPATE THE LIVER - IF YOU CAN IDENTIFY THE LIVER EDGE, ASSESS THESE CHARACTERISTICS
- **Degree of extension below the costal margin:** if greater than 2 cm this suggests hepatomegaly. - **Consistency of the liver edge:** a nodular consistency is suggestive of cirrhosis. - **Tenderness**: hepatic tenderness may suggest hepatitis or cholecystitis (as you may be palpating the gallbladder) - **Pulsatility**: pulsatile hepatomegaly is associated with tricuspid regurgitation. Could be caused by Hepatitis, leukaemia, myeloma
44
GI - PALPATE THE SLEEN
- Begin palpation in the left iliac fossa, starting at the edge of the superior iliac spine, using the flat edge of your hand (the radial side of your right index finger). - Ask the patient to take a deep breath and as they begin to do this palpate the abdomen with your fingers aligned with the left costal margin. Feel for a step as the splenic edge passes below your hand during inspiration (the splenic notch may be noted). - Repeat this process of palpation moving 1-2 cm superiorly from the right iliac fossa each time towards the left costal margin.
45
GI - SHOULD YOU BE ABLE TO PALPATE THE SLEEN ON A HEALTHY PERSON?
NO
46
GI - WHAT COULD A PALPABLE SPLEEN MEAN?
- A palpable spleen at the edge of the left costal margin would suggest splenomegaly (for the spleen to be palpable at this location it would need to be approximately three times its normal size). - Causes of splenomegaly: - Portal hypertension secondary to liver cirrhosis - Haemolytic anaemia - Congestive heart failure
47
GI - BALLOT THE KIDNEYS
- Place your left hand behind the patient’s back, below the ribs and underneath the right flank. - Then place your right hand on the anterior abdominal wall just below the right costal margin in the right flank. - Push your fingers together, pressing upwards with your left hand and downwards with your right hand. - Ask the patient to take a deep breath and as they do this feel for the lower pole of the kidney moving down between your fingers. This bimanual method of kidney palpation is known as balloting. - Repeat this process on the opposite side to ballot the left kidney.
48
GI - CAUSES OF ENLARGED KIDNEYS
- If a kidney is ballotable, describe its size and consistency. - In healthy individuals, the kidneys are not usually ballotable, however, in patients with a low body mass index, the inferior pole can sometimes be palpated during inspiration. - Bilaterally enlarged, ballotable kidneys can occur in polycystic kidney disease or amyloidosis. - A unilaterally enlarged, ballotable kidney can be caused by a renal tumour.

CLINICAL EXAMINATIONS (7 decks)

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