Gastro system

Examination

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.

Scars

Fistulas – Crohn’s disease

Warm water bottle burns

Caput medusae

Inf. Vena caval obstruction

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

Abdominal-

wall

veins

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

3. PERCUSSION:

• Gas – resonant

• Tumour or fluid - dull

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

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

Normal

liver

Riedel’s lobe

Liver pushed

downwards

Palpating of the liver

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

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

5. SPECIFIC EXAMINATIONS

5.2. Gall bladder

Palpating the gallbladder

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

Palpating the spleen

Palpating the spleen

Percussion of the spleen

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

5. SPECIFIC EXAMINATIONS

5.4. Kidneys

• Palpation of both kidneys

• Movement late in inspiration

• Surface length, consistency

• Auscultation posterior and anterior

21

Palpating the right kidney

Palpating the left kidney

Accessing punch tenderness over renal angle

Abdomen bruits renal artery

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

Grey Turner’s sign in acute pancreatitis

Palpating of the aorta

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

Ascites

Testing for fluid wave

Shifting dullness

6. LEGS

• Oedema

• Bruising

• Neuropathy (alcohol)

6. THREE REGIONS OF ABDOMINAL

EXAMINATION THAT ARE NOT

INCLUDED IN THE ABDOMEN

• Supra clavicular glands

• Scrotum

• Rectum

7. RECTAL EXAMINATION

• Examine the external rectal area

• Sphincter: Tonus Tenderness Masses

• Rectum: Masses Tenderness Content Uterus/prostate

• Investigate gloves after examination

Sims left lateral position

Disease & Signs

• p187 -188 Tally NB!!!

• Summary of examination:

• p 194-196

• PLEASE prepare for practicals