GIT Examination

What’s this called & what’s it a sign of

What’s this called & what’s it a sign of

What’s this called & what’s it a sign of

What’s this called & what’s it a sign of

What’s this called & what’s it a sign of

What’s this called & what’s it a sign of

What’s this called & what’s it a sign of

What is Asterixis & what’s it a sign of

Asterixis, or "flapping tremor," is an involuntary, rhythmic, jerking movement commonly in the hands, wrists, and feet

Associated with Encephalopathy

What’s Ecchymosis

Bruising

What’s that

Spider naevus/naevi

(to tell that its a spider naevus & not anything else you press it down to blanch it & if it fills out red again starting with the centre it is spider naevus)

What could cause Spider naevi?

cirrhosis / pregnancy

What are Petechiae & what are they a sign of

Tiny dots of bruises associated with portal HTN... Hypersplenism... low platelets

What’s muscle wasting associated with

malnutrition / chronic liver disease

What could Scratch marks be a sign of

obstructive jaundice / bile salt retention

Where would you spot Lymphadenopathy

cervical and supraclavicular region

Where is Virchow’s node & what is it a sign of

Left supraclavicular node associated with gastric cancer

What is jaundice

Elevated Bilirubin

What level of bilirubin in umol/L = jaundice

> 35 umol/L

3 types of jaundice

Pre-hepatic

Hepatic

Posthepatic

Where is jaundice often first detected

sclera & soft palate - due to high elastin content

What 2 things do you look out for in someone’s eyes & where in the eyes do you see it

Icterus seen when pull up top lip & look at white of eye

Pallor seen when pull down bottom lid & look at inner lid

When examining the mouth, what is Peri-oral pigmentation a sign of?

Peutz Jeghers Syndrome

When examining the mouth, what is Angular Stomatitis a sign of?

IDA - iron-deficiency anemia

When examining the mouth, what is Ulceration of oral mucosa a sign of?

Crohn’s disease

When examining the tongue, what is Glossitis a sign of?

Iron-def/B12 def

Other than Glossitis what do you look for in examination of the tongue

Leukoplakia

Lesions in the gums are associated with what

Crohn’s

Bleeding of the gums are associated with what

scurvy

What would you call this

Gynaecomastia

What’s up with this person

JVP - associated with right heart failure

On inspection of the abdomen what do you look out for

Epigastrium: pulsation

Visible peristalsis

Skin lesions:

- Vesicles of Herpes Zoster

- Sister Joseph nodule

- Cullen’s sign

- Grey Turner’s sign

What’s this called & what’s it associated with

Cullen’s sign

- haemoperitoneum

- acute pancreatitis

What’s this called & what’s it associated with

Grey Turner’s sign

- severe acute pancreatitis

What’s this called

Striae

What’s guarding

resistance to palpation (contraction of abdominal muscles)

What is rigidity

constant involuntary contraction of the abdominal muscles, always associated with tenderness & peritoneal irritation

What is rebound tenderness

compress abdomen slowly, release suddenly + sudden stab of pain = suggests peritonitis

How do you examine the liver with just your hands

Start in RIF

Move towards RUQ

Remember liver descends with respiration

Percuss out the liver span

How do you examine the spleen with just your hands

Start in RIF

Move towards LUQ

Remember spleen descends with respiration

How do you examine the kidneys with just your hands

Balloting the kidneys

Dominant hand under patient and flex at MCPJ

Non dominant hand apply continous pressure in Flank while dominant hand does all the work

If kidney is enlarged it should hit off non-dominant hand

Are the spleen/kidney dull/resonant on percussion

Spleen - Dull to percussion

Kidney - Kidney is resonant to percussion due to overlying bowel gas

How to test for Murphy’s sign

Place had just below the costal margin

Ask patient to take a deep breath in

If the gallbladder is inflamed i.e. cholecystitis, the patient may catch their breath when the gallbladder hits off your hand

The sign is only positive if negative on left side

Why must we percuss

Defines size & nature of organs & masses e.g. percussing for the upper border of the liver in the mid-clavicular line

To detect free fluid

What would suprapubic dullness on percussion suggest

distended bladder

What would percussion of free fluid suggest

Ascites

Borgorygmi

audible bowel sounds

What do we suspect if there are no bowel sounds on auscultation for 3 mins

paralytic ileus

Where could you auscultate Renal artery stenosis

either side of the mid-line just above the umbilicus

On auscultation what could Hepatic bruit be a sign of

hepatocellular CA or an AV malformation

On auscultation what could Epigastric bruit be a sign of

mesenteric artery stenosis

After all the examination you’ve already done, what else do you check

Hernias (direct and indirect inguinal, femoral)

Digital rectal exam

Testicular exam (masses, hydrocoeles, torsion)

Urinalysis

What are some signs of chronic liver disease you’d spot in each place:

• Hands

• Face

• Chest

• Abdomen

• Legs

• Overall

Hands: leuconychia, clubbing palmar eythema, bruising, asterixis

Face: jaundice, scratch marks, fetor hepaticus

Chest: gynaecomastia, spider naevi, loss of body hair, bruising

Abdomen: hepatomegaly, ascites, testicular atrophy, spleomegaly (portal HTN)

Legs: oedema, muscle wasting

Fever (infected ascites)

A 65-year-old male presents with painless jaundice

History of presenting complaint: loss of appetite, weight loss of 1 stone over 3 months, low energy

On examination: (General and hands) jaundice, palmar erythema, clubbing, leukonychia

Abdomen: tenderness in RUQ, palpable liver with nodular liver edge (enlarged)

Which of the following is the most likely diagnosis:

 A. Choledochelithiases

 B. Fatty liver disease

 C Haemolytic anaemia

 D. Gallstones

 E. Liver metastases

E. Liver metastases