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History and Examination > GIT - UQ Notes > Flashcards

GIT - UQ Notes Flashcards

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1
Q

What is Jaundice?

A

Jaundice (Icterus) is the yellowing of skin, sclera, and mucous membranes due to elevated bilirubin levels.

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2
Q

What is bronzed skin associated with in GIT examination?

A

Bronzed skin is associated with haemochromatosis (iron overload).

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3
Q

What does poor skin turgor indicate?

A

Poor skin turgor may reflect dehydration or poor tissue perfusion.

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4
Q

What does a capillary refill time of more than 2 seconds suggest?

A

It suggests poor tissue perfusion, as seen in dehydration or shock.

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5
Q

What condition is palmar erythema associated with?

A

Palmar erythema is associated with chronic liver disease and may also be idiopathic.

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6
Q

Describe Dupuytren’s Contracture and its GIT relevance.

A

It’s a thickening of the palmar fascia, often affecting the ring finger. Associated with chronic alcoholism but there are many other causes.

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7
Q

Describe Koilonychia.

A

Spoon-shaped nails; may be seen (rarely) in iron deficiency anaemia.

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8
Q

What is Leukonychia and what does it suggest?

A

Whitening of the nail bed; suggests hypoalbuminaemia, especially in patients under 50.

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9
Q

What are Muehrcke’s lines?

A

Paired transverse white lines on nails (non-palpable, don’t move with nail growth); associated with hypoalbuminaemia.

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10
Q

Describe spider naevi, their location and association.

A

Central red arteriole with radiating capillaries that blanch; found on face, neck, chest, and arms. Associated with liver disease due to excess estrogen.

Can also be a normal finding in pregnancy or in women taking the combined oral contraceptive pill. If more than 5 are present it is more likely to be associated with pathology such as liver cirrhosis.

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11
Q

What is Xanthelasma and what is it associated with?

A

Yellow cholesterol plaques on the eyelids; associated with hyperlipidaemia or cholestasis.

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12
Q

What are Kayser-Fleischer Rings and what condition are they associated with?

A

Yellow-green/brown corneal rings near the limbus; associated with Wilson’s disease (copper accumulation).

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13
Q

What are the skin signs of Peutz-Jegher’s Syndrome?

A

Hyperpigmented macules on lips and oral mucosa; associated with GIT bleeding and polyps.

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14
Q

What is Cheilitis?

A

Inflammation of the lips, often red, cracked, and scaly.

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15
Q

What is Glossitis?

A

Inflammation of the tongue, often smooth, red, and swollen; seen in vitamin B12 or iron deficiency.

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16
Q

Describe Acanthosis Nigricans and its associations.

A

Dark, velvety hyperpigmentation on nape and axillae; associated with diabetes mellitus and endocrinopathies.

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17
Q

What is the significance of the left supraclavicular lymph node (Virchow’s node)?

A

It receives lymphatic drainage from the abdominal cavity. Enlargement can be an early sign of metastatic intra-abdominal malignancy, most commonly gastric cancer.

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18
Q

What does lymphadenopathy in Virchow’s node typically suggest?

A

Possible gastric cancer or other abdominal malignancies.

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19
Q

What is the significance of the right supraclavicular lymph node?

A

It drains lymph from the thorax, so enlargement may indicate metastatic oesophageal cancer or other thoracic malignancies.

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20
Q

How does the drainage area differ between right and left supraclavicular lymph nodes?

A

Left (Virchow’s) → Abdominal cavity

Right → Thoracic cavity

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21
Q

How are axillary lymph nodes examined in a GIT context?

A

Part of systemic assessment for lymphadenopathy. Palpate all four walls of the axilla with the patient relaxed. Relevant in lymphoma or metastatic GI cancers.

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22
Q

List key points for performing abdominal palpation.

A

Warm hands

Ask about pain areas and palpate them last

Ensure adequate coverage/exposure

Use right hand

Adduct four fingers to make a paddle

Use flat pads of fingers

Keep forearm parallel to couch

Watch patient’s face for discomfort.

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23
Q

What are the two main types of abdominal palpation?

A

Superficial palpation and Deep palpation.

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24
Q

What is the purpose of deep palpation?

A

To identify deeper masses, further assess superficial ones, and detect guarding (voluntary) or rigidity (involuntary).

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25
What is the purpose of superficial palpation?
To detect tenderness and superficial masses in the nine abdominal regions.
26
Where is McBurney’s point and why is it important?
Located one-third from right ASIS to umbilicus; it’s the point of maximal tenderness in appendicitis.
27
How is Rovsing’s sign elicited and what does it indicate?
Press on the left iliac fossa; pain in the right iliac fossa suggests appendicitis.
28
What are the 9 S’s used to describe a mass?
Site Size Shape Slide (mobility) Sensitivity (tenderness) Surface Surroundings Slip (can fingers move above/below?) Skin temperature.
29
How might you report normal findings after general abdominal palpation?
“Abdomen soft and non-tender. No guarding or palpable masses. No tenderness at McBurney’s point. Rovsing's sign negative.”
30
How do you start palpating the liver?
Begin in the right iliac fossa. Ask the patient to breathe in and out through the mouth to encourage relaxation of the abdominal wall.
31
Describe the hand movement during liver palpation.
During expiration, advance your hand 1–2 cm toward the right costal margin, keeping it flat and parallel. Keep your hand still during inspiration.
32
How is the edge of an enlarged liver detected?
It is felt as it moves downward during inspiration, touching the examiner's fingers.
33
If the liver edge is palpable, what features should be noted?
Assess if it’s hard or soft, regular or irregular, and pulsatile or non-pulsatile.
34
Is the liver typically palpable in healthy people?
No, but occasionally it may be felt. More likely in thin individuals.
35
How do you percuss for liver span?
If the lower border is palpable, percuss the midclavicular line from a resonant lung area downward to dullness (upper liver border), then measure the distance to the lower border.
36
What is the normal liver span?
Less than 13 cm, though it can vary with height and gender.
37
How might you report findings for liver examination?
The liver is not palpable. It has a normal span of less than 13 cm.
38
How do you position your hand to examine the gallbladder?
Place the hand perpendicular to the right costal margin and move from medial to lateral.
39
Where might the gallbladder be felt?
At the lateral border of rectus abdominis, midway between the xiphoid and right anterior axillary line.
40
What does a palpable gallbladder feel like?
A localized mass that moves inferiorly on inspiration. Average capacity is 60 ml.
41
How is Murphy’s sign elicited?
Place your hand over the gallbladder area and ask the patient to inhale.
42
When is Murphy’s sign positive?
If inspiratory pain occurs during palpation.
43
What does a positive Murphy’s sign suggest?
Acute cholecystitis.
44
Are all dilated gallbladders palpable?
No, about 50% are non-palpable.
45
What is Courvoisier’s sign and its significance?
A palpable, non-tender gallbladder in a jaundiced patient. Suggests malignancy (e.g., pancreatic cancer), not gallstones.
46
What might a palpable gallbladder in a non-jaundiced patient suggest?
Acute cholecystitis or gallbladder carcinoma.
47
How might you report gallbladder findings?
Murphy’s sign is negative.
48
How should the patient breathe during spleen examination?
Ask for slow, deep breaths. The spleen moves inferomedially on inspiration.
49
Describe hand positioning for spleen palpation (supine).
Right hand in right lower quadrant, parallel to the left costal margin. Left hand posterolaterally over left lower ribs.
50
How do you detect the spleen border during palpation?
Advance your hand to the left upper quadrant during expiration. Use the radial edge of your index finger to feel for the spleen.
51
What if the spleen is not palpable supine?
Roll the patient onto their right side and palpate from umbilicus to left costal margin.
52
How can the left hand assist in spleen palpation?
Push the spleen forward by pressing behind the posterior costal margin.
53
Where is Traube’s area and its significance?
A triangle bordered by the left 6th rib (top), left 9th rib (bottom), and mid-axillary line (side). Percussion here helps detect splenic dullness.
54
How might you report spleen findings?
The spleen is not palpable.
55
What technique is used to palpate the kidneys?
Ballotment.
56
Describe hand positions for balloting the right kidney.
Left hand under the renal angle (below 12th rib), right hand on right upper quadrant, lateral to rectus muscle.
57
How is the kidney felt during ballotment?
Push both hands together as the patient breathes out, then ask for deep inspiration. You may feel the lower pole descend and can gently move it between hands to confirm.
58
How might you report kidney findings?
The kidneys are not palpable.
59
What might be felt as a pulsatile mass in the abdomen?
The abdominal aorta.
60
Is it normal to see the abdominal aorta in thin individuals?
Yes, and it's not abnormal.
61
How do you palpate the abdominal aorta?
Use fingertips of both hands just above the umbilicus. Shift laterally until pulsation is no longer felt under each fingertip.
62
How do you estimate the abdominal aorta's width?
Measure the distance between the fingertips when pulsation is no longer directly beneath them.
63
What is the normal aortic width, and when is it concerning?
Normally <3 cm. Width ≥5 cm is concerning and needs further evaluation/intervention.
64
How might you report abdominal aorta findings?
The abdominal aorta is … cm. (Insert specific measurement.)
65
What are the four methods mentioned for detecting ascites?
Inspect the flanks for bulging. Percuss for flank dullness. Percuss for shifting dullness. Assess for fluid thrill.
66
When inspecting the flanks for bulging in suspected ascites, how can you distinguish fluid from fat in obese patients?
Fat tends to accumulate posteriorly and hangs evenly. Fluid collects dependently, pushing the flanks outward when the patient is supine. ## Footnote Look for lateral bulging of the abdomen.
67
What is percussing for flank dullness, and what volume of fluid is typically needed to detect it?
Percussing from the umbilicus to the flank to detect a change from resonant to dull note. At least 2 litres of fluid is usually required before flank dullness is detectable.
68
How is percussing for flank dullness performed?
Percuss across the abdomen starting at the midline (umbilicus) toward the flanks. Mark the point where resonance (tympany) becomes dullness, indicating fluid presence.
69
When should you seek shifting dullness?
If flank dullness is found, check for shifting dullness to confirm ascites.
70
How is shifting dullness assessed?
Stand on the right of the patient. Percuss to the left flank until dullness is heard. Mark that point. Roll the patient toward you (right side down), wait 30 seconds. Re-percuss over the marked area.
71
When is shifting dullness considered present?
If the dull area becomes resonant after the patient is turned, shifting dullness is present, confirming free peritoneal fluid.
72
How is a fluid thrill (fluid wave) assessed?
Ask an assistant (or patient) to place both palms firmly on the midline of the abdomen. Flick one flank, and feel for a ripple or tap on the opposite side. ## Footnote This dampens skin vibrations and helps confirm the wave is transmitted through fluid, not fat.
73
When is a fluid thrill most valuable?
Best in cases of massive ascites, when fluid is under tension and easily transmits waves.
74
How might you report findings regarding ascites?
There were no signs of ascites. Or, if present: Shifting dullness was present, suggestive of free intraperitoneal fluid.
75
What is auscultated for in a GIT abdominal examination?
Bowel sounds (to assess peristalsis) Succussion splash (air/fluid levels in the stomach) Bruits (vascular sounds from narrowed arteries)
76
How are bowel sounds auscultated?
Patient should be supine Use the diaphragm of the stethoscope Auscultate below the umbilicus, but remember most sounds come from the stomach
77
What are the categories used to describe bowel sounds?
Normal Absent High-pitched tinkling Borborygmi (very active gurgling)
78
How long should you listen for absent bowel sounds? What does it suggest?
Listen for at least 4 minutes Absent sounds suggest paralytic ileus (no bowel activity)
79
How are normal bowel sounds described?
Simply stated as 'present' and not abnormal (not absent, high-pitched, or excessive)
80
Describe high-pitched tinkling bowel sounds and what they indicate.
Sounds like tiny gas bubbles under pressure Sign of intestinal obstruction, where fluid and gas are trapped
81
Describe borborygmi and what they may be related to.
Very loud, active gurgling noises Often associated with diarrhoea or hyperactive gut 'Borborygmi' is onomatopoeic (word sounds like the noise)
82
How is a succussion splash elicited?
Shake the patient gently while keeping the stethoscope diaphragm on the abdomen Used to detect fluid and gas sloshing in the stomach
83
What does a succussion splash indicate?
Indicates liquid + gas in a hollow organ (usually stomach) Normal if patient recently ate/drank Abnormal (suggests obstruction) if nil-by-mouth for >6 hrs (solids) and >2 hrs (fluids)
84
How do you auscultate for bruits?
Use the bell of the stethoscope to detect low-frequency vascular sounds
85
What are the locations to auscultate for bruits in the abdomen?
Epigastrium → Aortic bruits 2cm lateral to midline between xiphoid and umbilicus → Renal artery bruits Right and left iliac fossae → Iliac artery bruits
86
How might you report findings from abdominal auscultation?
Bowel sounds are normal. No succussion splash. No epigastric, renal, or iliac bruits heard.
87
What are the four quadrants of the abdomen?
Right Upper Quadrant (RUQ), Left Upper Quadrant (LUQ), Right Lower Quadrant (RLQ), Left Lower Quadrant (LLQ)
88
Name the nine regions of the abdomen.
Right Hypochondriac, Epigastric, Left Hypochondriac, Right Lumbar (or Flank), Umbilical, Left Lumbar (or Flank), Right Iliac (or Inguinal), Hypogastric (or Suprapubic), Left Iliac (or Inguinal)
89
What anatomical landmarks help divide the abdomen into quadrants?
The umbilicus (navel) and a vertical and horizontal line crossing at the umbilicus (midline and transumbilical line)
90
What two planes divide the abdomen into nine regions?
Horizontal planes: Subcostal plane (or transpyloric), and Transtubercular plane. Vertical planes: Midclavicular lines (right and left)
91
Which organs are primarily located in the Right Upper Quadrant (RUQ)?
Liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal gland
92
What organ lies in the Left Upper Quadrant (LUQ)?
Stomach, spleen, left lobe of liver, body and tail of pancreas, left kidney and adrenal gland
93
What surface landmark corresponds to the gallbladder?
The intersection of the right midclavicular line and the costal margin (Murphy's point)
94
What structure is located at the umbilical region?
Small intestine, parts of the transverse colon, and in thin individuals, the abdominal aorta.
95
What is the surface landmark of the spleen?
Lies under the 9th–11th ribs on the left side, posterior to the midaxillary line.

History and Examination (10 decks)

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