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ZA - FoCM > GI Examination > Flashcards

GI Examination Flashcards

1
Q

What are the steps that should be done in the introduction section of the GI exam?

A
  1. Wash hands
  2. Introduce your name and status
  3. Check patient ID, wristband and charts to see if they are all the same
  4. Explanation AND Consent
  5. Check for pain
  6. Position at a 45 degree angle
  7. Ask patient to remove the nessasary clothing
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2
Q

What is the first step after introduction is done?

A

End of bed examination

Patient

  • AVPU
  • Is patient sweating, comfortable or distressed?
  • Cachexia - weakness and wasting

Enviroment - Vomit bowl, lines or drains or NG tubes

Charts - look for trends

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3
Q

What is the next step after end of bed examination?

A

Inspection of the hands

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4
Q

What is looked specifically for in the nails relating to GI?

A
  1. Clubbing
  2. Leukonychia
  3. Koilonychia
  4. Tar staining
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5
Q

What is looked for in the palms in a GI exam?

A

Palmer erythema

Pale palmer creases

Muscle wasting

Duputryn’s contracture

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6
Q

How do you check for duputreyn’s contracture?

A

Run finders along the lenght of the hand (on the side of the pinky finger)

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7
Q

What shoudl be done after examination of the hands?

A
  1. Flapping tremour
  2. Fine tremour
  3. Pulse, resp rate and BP (state that you would check these)
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8
Q

What is done after checking for tremors?

A

Inspection of the arms

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9
Q

What would you look for on inspection of the arms?

A
  1. Brusing
  2. Scratches due to pruritis
  3. Muscle wating
  4. Track marks
  5. Pinch for skin turgour - dehydration
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10
Q

What is done after arms? What do you look for?

A

Examination of the head

  • Face for parotid swelling
  • Eyes for jaundice (sclera) and anemia (conjunctiva)
  • Mouth for angular stomatitis, oral candidiasis and mouth ulcers
  • Smell breath for foetor hepaticus

State you would do a full examination of the mouth if there was time

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11
Q

What is done after the head?

A

Neck

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12
Q

What is done on the neck?

A

Make SURE to start off with and check virchow’s node in the left supraclavicular region - gastric malignancy

Do rest of lymph nodes - anterior cervical chain, submandibular and submental, pre and post auricular, occipital and posteriro chain

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13
Q

What should be examined in the necklace/chest region?

A
  • Spider naevi spots
  • Gynaecomastia
  • Loss of body hair in males
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14
Q

Summarize so far the regions checked…

A

End of bed inspection

Hands

Arms

Head - eyes, face, mouth

Neck - lymph nodes

Necklace area/chest

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15
Q

What would be checked after the necklace area/chest?

A

Legs for peripheral oedema, loss of body har and erythaema nodosum (IBD)

This can also be checked at the end!

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16
Q

What position must the patient be in for you to examine the abdomen?

A

Supine - so adjust the bed

17
Q

What IPPA stand for and what does this mean?

A

Inspection

Palpation

Percussion

Auscaltation

The order of things you do to the abdomen

18
Q

What do you look for in I - inspection of the abdomen?

A
  • Scars
  • Masses
  • Pulsation
  • Cullen’s sign – bruising surrounding umbilicus
  • Grey-Turner’s sign – bruising in the flanks
  • Abdominal distension – fluid (ascites) / fat (obesity)
  • Striae/Stretch marks
  • Stoma bags
19
Q

What should be done BEFORE you palpate?

A

Ask about pain again

20
Q

What palpations are done?

A

Light palpation of all 9 regions

Deep palpation of all 9 regions

Liver palpation

Splenic palpation

Kidney palpation

21
Q

How should light and deep palpations be done?

A

Sitting down

Flat hand

Light should be done looking at patient to assess for tenderness/pain/rigitidy

Deep for masses, areas of further tenderness

22
Q

How is liver and splenic palpations done?

A

Edge of hand

Asking patient to breath in and out - on inspiration push in

23
Q

How do you palpate kidneys?

A

Both hands, one under side and one above, ask patient to take a deep breath in and then out, push hands together as they breath out

Keep hands in this position and ask patient to breath in

24
Q

How do you percuss the liver??

A

Begin percussing from right iliac fossa towards right costal margin

Should be resonant but become dull when edge of liver is reached

25
Q

If you percuss and enlraged liver, what should you do to check if the liver is enlarged or being pushed down by hyperinflated lungs?

A

Percuss above the liver - starting in the 2nd costal space and should hear the resonant to dull change in the 5th or 6th intercostal space

26
Q

How do we percuss the spleen?

A

Right iliac fossa to the left costal margin

Resonant to dull in enlarged spleen

27
Q

What is done after percussion of the spleen?

A

Detection of free fluid in abdomen

Start percussing in the midline and percuss out away from you til the note turns form resonant to dull

Keep hand in the dull area and ask patinet to roll towards you - wait 10 secs then percuss again

If the dullness changes to resonant - the fluid has shifted

28
Q

What is done after shifting dullness?

A

Fluid thrill

Ask patient to place hand in midline and flick the side of abdomen while placing your hand on the other side

A thrill will be detected by the hand that has not flicked

29
Q

What is done in auscultation?

A

Listen over:

Bowel sounds in left lower quadrant for at least 30 seconds, if heard no need to move to another area

Abdominal aorta for bruits

Renal arteries stenosis - both sides of the midline just superiolateral to the belly button

Liver bruits and hepatic rubs - for rubs ask patient to breath in and out

Splenic bruits and rubs - rubs ask patient to breath in and out

30
Q

When can you state bowel sounds are absent?

A

If none noted after 2 mins

31
Q

What would you state to the examiner after you have finished the examination?

A

“To complete the examination I would perfom an examination of the groin for lymphadenopathy, ecamine hernial orafices, do a digital rectal exam and a male genitalia exam”

32
Q

What would you say to the patinet upon completing?

A

Thank them

Tell them they can get comfortable and redressed

Clean hands

ZA - FoCM (39 decks)

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