Вы находитесь на странице: 1из 2

GI Exam Introduce Inspection (Lay flat).

Comment on general appearance and things around the bed (oxygen, special food, diabetic diet, inhalers) Exposure nipple to knee but in reality just the abdo Hands Tar staining, Clubbing, Leuconychia (hypoalbuminaemia), Koilonychia (Fe++ def anaemia), palmar erythema, cyanosis, coarse liver flap (atersixis). Scars, flexion deformities (dupytrens = Chronic liver disease esp. cirrhosis) Face Spider navae, scars, psoriasis, parotid swelling|| Eyes Sclera red (iritis), Xanthelasma, anaemia, corneal arcus, uveitis, Jaundice, vitiligo, kayser-fleischer ring (Copper deposit)|| Mouth Angular stomatitis (corners of mouth), peutz jeughers (discolouration to lips), Apthous ulcers, dentition, tongue cyanosis, glossitis (meaty tongue), thrush Chest/abdomen Spider navae (check back also up to 6 = normal), gynaecomastia, Virchows nodes (L. Supraclavicular abdominal lymph drains here), Scars, bruising (Grey-Turners/Cullens signs flank/periumbilical bruising seen in pancreatitis Cullens sign = 4x more likely to die from pancreatitits), scars and psoriasis., caput medusae (veins) Shape & symmetry (scaphoid/sunk, protrusion/distension - 6 causes; Fat, flatus, faeces, foetus, fluid or flipping big tumour) or visible bulges (liver, spleen, kidney etc). Palpation Bring patient up to eye level, or get down to eye level! Ask if anywhere hurts first and start on the opposite side EYES ON FACE! Gentle palpation Deep palpation Liver Located on ribs 7-11 on the right which moves and crosses midline toward the left nipple. This moves down in inspiration and up in inspiration Spleen Located above rib 9 and just below rib 11. If you cant feel the spleen, move the patient onto their right side. Hold the hand on the back and palpate gently along the rib edge with your hand, moving along the costal margin of the left side Kidney Is it bolotable? As with the spleen but with the patient on their back. Three of four times, try and bounce the kidney up to your hand, by pushing your hand up from the back Gall Bladder R of the midline, halfway between the ziphesternum and the navel. Ask the patient to take a deep breath and apply pressure to the region. Inspiration stops with tensing of the abdomen due to pain (Murphys sign) in cholecystitis Causes of Ascites Check for ascites Ca For ascites, get assistant to hold their hand edge midline, put the palm of Pancreatitis your right hand Infection against patient left and left hand should tap the right abdomen and IVC/Hepatic Vein Obstr watch for waves Portal BP> Percussion CCF Tap out the liver from the bottom up and top down. Tap out the spleen Ovarian Tumour Shifting Dullness Causes of dec Bowel Sounds Pause for 10 seconds. If the note shifts from dull to resonant there Obstruction may be ascites GI Bleeding Auscultation (Normal bowel sounds every 5-10 seconds faster or Small bowel malabsorption slower?) Carcinoid Listen for three minutes before declaring absence Succussion splash. Sounds like a hot water bottle. This is normal up to 2 hours post fluid/food. Prolonged succession splash could be due to delayed emptying/obstruction

Renal bruits Would also: Like to examine: Rectal/testicular/vaginal, Hernial orifices, Pulses, Lymph glands Look at current obs chart
RIF Appendix Ca (Col/Rt ovary) Trans kidney Impacted faeces Crohns Ileocaccal TB Possible Masses: Midline AAA Lymphoma Pancre pseudo cyst Ca (gas/Pan/Col) Ov tumour/cyst Horseshoe kidney Urinary retention Uterine abcess LIF Diver abcess Ca (Col/L ovary) Trans kidney Impacted faeces Liver CCF Alcohol/fat Congenital Viral hepatitis Malignancy Possible Masses: Spleen Leukaemia Haem Anaemia Portal HTN RA SLE Infection Malaria Bact Endocarditis Spleen/Liver Mono Myelofibrosis Polycythaemia Cirrhosis

Похожие интересы