Session 8 yr 2 GI examination Flashcards
Give a brief outline of what a GI examination entails
General inspection/consent
Hands
Face:
- eyes
- mouth
Neck:
- nodes
General inspection
Palpation
percussion
hernias,PR
summary
What must we check on general inspection?
Lie down – discomfort, ease of movement breathlessness, jaundice, abdominal distension
Ward- drips catheters
What do we check in hands
Hands- Nails clubbing, leukonychia, koilonychia
Palmar erythema duputrens contractures
Pulse rate rhythms general fitness
Liver flap (if jaundiced) - boozer on a liver ward
Why do we check nail clubbing?
IBD
Why do we check hands for leukonychia, koilonychia
Why do we check for palmar erythema duputrens contractures?
Why is do we check for pulse rate and rhythms?
general fitness -> sepsis -> peritonitis -> perforation of bowel, appendicitis
What do we check for in face
conjunctiva danaemia and scleara jaundice -> liver disease, gall sones
Eyes
conjunctivadanaemia and scleara jaundice -> liver disease, gall sones
Mouth
- angular somais
- mouth ulcers
- glossiis
- dental hygiene
Neck
What do u check for on inspection
What do you do on palpation?
Ask patient if they are in any pain
Light palpation - less painful
Same level
Pic mass detected: Size shape position
Rebound tenderness (pressing deeply then release) – pain- perineal irritation, guarding muscles contract involuntarily (even with pain relief)
Breaths – press RIF up to the liver during inspiration (upwards vertically)
spleen RIF to left hypochondrium (normally not palpable)
What do you do in percussion
Ascites -shifting dullness and fluid fill
When supine percussion horizontally hyperesonant but dull on the sides
turn to the right hyperresonant but dull on the right (as fluid has moved)
Percussion all nine areas should all be resonant
Bowel sounds -RIF
TINKLING – intestinal obstruction -Before obstruction
After -> quiet or absent
What do you do in auscultation?
What to do when completing the examination?
