Gastro system. Examination
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1 Gastro system Examination
2 1. INSPECTION: Skin lesions- scars Blood vessels: ABDOMEN Nine regions Inf vena cava Obstruction shows veins in flanks and emptying from distal to proximal SVC Portal vein Obstruction shows vessels central with caput medusae and emptying in all directions from the umbilicus.
3
4 Scars
5 Fistulas Crohn s disease
6 Warm water bottle burns
7 Caput medusae
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9 Inf. Vena caval obstruction
10 1. INSPECTION (CONTINUE) Hair Contour of the Abdominal wall: distension (5 f's) (fluid, food, flatulence, faeces, fat) - beware of the bladder and huge tumour Asymmetry Movement and pulsations - aorta and peristalsis Umbilicus - in (obesity) - (ascites) out
11 Abdominalwall veins
12 2. PALPATION: Palpate with a warm flat hand Light palpation for masses - Tenderness and obvious Deep palpation - specific organs en massas Massas - position, colour overlying it, temperature, tenderness, form, size, surface, character of the edge, consistency, fluctuation, pulsation, mobility, translucency, murmurs or thrills, surrounding structures Mass in rectus muscle - pickup the head or leg
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15 3. PERCUSSION: Gas resonant Tumour or fluid - dull
16 4. AUSCULTATION Bowel sounds - absent if nothing in 4 minutes Hyperactive - borborygmi Splashing Murmur: Systolic murmur: Liver hepatoma, a.v. malformation aorta and kidney vessels Venous hum over spleen (portal hypertension) Venous murmur louder in upright position. Friction rub - liver and spleen
17 5. SPECIFIC EXAMINATIONS 5.1 Liver Regional anatomy Start examination right iliac fossa Situated right hypochondrium Cannot pass hand between rib and mass Definite edge palpable Movement early on inspiration
18
19 Normal liver
20 Riedel s lobe
21 Liver pushed downwards
22 Palpating of the liver
23 5. SPECIFIC EXAMINATIONS 5.1 Liver Report: Length of liver Upper border percussion - 5th rib Lower edge percussion (total length 12-15cm) - palpation (total length 10-12cm) Everything during INSPIRATION Surface Consistency Tenderness Nodules surface of liver
24 5. SPECIFIC EXAMINATIONS 5.1 Liver Pulsation: Transmittend Expansion Auscultation - Murmurs Systolic murmurs on nodule - hepatoma or av malformations Venous hum- portal hypertension Friction rub inflammation
25 5. SPECIFIC EXAMINATIONS 5.2. Gall bladder
26 Palpating the gallbladder
27 5. SPECIFIC EXAMINATIONS 5.3. Spleen Regional anatomy (T10) Start examination at the umbilicus Grow towards umbilicus Movement early in inspiration Medial notch Cannot pass hand between rib and mass 19
28 Palpating the spleen
29 Palpating the spleen
30 Percussion of the spleen
31 5. SPECIFIC EXAMINATIONS 5.3. Spleen Report: Surface Consistency Tenderness Edge Length - measure from rib (mid clavicular line) to point of growth Auscultation Venous hum - portal hypertension Friction rub - infarction 20
32 5. SPECIFIC EXAMINATIONS 5.4. Kidneys Palpation of both kidneys Movement late in inspiration Surface length, consistency Auscultation posterior and anterior 21
33 Palpating the right kidney
34 Palpating the left kidney
35 Accessing punch tenderness over renal angle
36 Abdomen bruits renal artery
37 5. SPECIFIC EXAMINATIONS 5.5. Pancreas Colouring of flanks and umbilicus 5.6. Aorta 5.7. Bladder 5.8. Hernia 5.9. Colon Left and right flank
38 Grey Turner s sign in acute pancreatitis
39 Palpating of the aorta
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43 5. SPECIFIC EXAMINATIONS Ascites: Ascites Central tumour Shifting dullness No shifting dullness Resonant in flanks Fluid thrill None Liver dipping None Umbilicus out Umbilicus in No pulsations Transmittend pulsations occasionally 14
44 Ascites
45 Testing for fluid wave
46 Shifting dullness
47 6. LEGS Oedema Bruising Neuropathy (alcohol)
48 6. THREE REGIONS OF ABDOMINAL EXAMINATION THAT ARE NOT INCLUDED IN THE ABDOMEN Supra clavicular glands Scrotum Rectum
49 7. RECTAL EXAMINATION Examine the external rectal area Sphincter: Tonus Tenderness Masses Rectum: Masses Tenderness Content Uterus/prostate Investigate gloves after examination
50
51 Sims left lateral position
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56 Disease & Signs p Tally NB!!! Summary of examination: p PLEASE prepare for practicals
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