digestive system examinationfhs.ufs.ac.za/faculties/documents/08/017/d017/skillslab/...2. palpation:...
TRANSCRIPT
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Gastro system
Examination
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ABDOMEN Nine regions
1. INSPECTION:
• Skin lesions- scars
• Blood vessels:
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.
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Scars
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Fistulas – Crohn’s disease
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Warm water bottle burns
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Caput medusae
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Inf. Vena caval obstruction
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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
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Abdominal-
wall
veins
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2. PALPATION:
• Palpate with a warm flat hand
• Light palpation for - Tenderness and obvious masses
• 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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3. PERCUSSION:
• Gas – resonant
• Tumour or fluid - dull
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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
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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
5. SPECIFIC EXAMINATIONS
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Normal
liver
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Riedel’s lobe
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Liver pushed
downwards
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Palpating of the liver
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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
5. SPECIFIC EXAMINATIONS
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5.1 Liver
• Pulsation:
Transmittend
Expansion
• Auscultation -
Murmurs
Systolic murmurs on nodule - hepatoma or av malformations
Venous hum- portal hypertension
Friction rub – inflammation
5. SPECIFIC EXAMINATIONS
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5. SPECIFIC EXAMINATIONS
5.2. Gall bladder
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Palpating the gallbladder
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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
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Palpating the spleen
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Palpating the spleen
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Percussion of the spleen
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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
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5. SPECIFIC EXAMINATIONS
5.4. Kidneys
• Palpation of both kidneys
• Movement late in inspiration
• Surface length, consistency
• Auscultation posterior and anterior
21
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Palpating the right kidney
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Palpating the left kidney
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Accessing punch tenderness over renal angle
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Abdomen bruits renal artery
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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
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Grey Turner’s sign in acute pancreatitis
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Palpating of the aorta
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5. SPECIFIC EXAMINATIONS
5.10. 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
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Ascites
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Testing for fluid wave
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Shifting dullness
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6. LEGS
• Oedema
• Bruising
• Neuropathy (alcohol)
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6. THREE REGIONS OF ABDOMINAL
EXAMINATION THAT ARE NOT
INCLUDED IN THE ABDOMEN
• Supra clavicular glands
• Scrotum
• Rectum
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7. RECTAL EXAMINATION
• Examine the external rectal area
• Sphincter: Tonus Tenderness Masses
• Rectum: Masses Tenderness Content Uterus/prostate
• Investigate gloves after examination
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Sims left lateral position
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Disease & Signs
• p187 -188 Tally NB!!!
• Summary of examination:
• p 194-196
• PLEASE prepare for practicals