Sunday, November 2, 2008

Gastrointestinal and Abdominal Examination

I'm not going into detail step because i'm sure everyone can do GIT examination. What i'll do is highlight the signs which may be present but frequently overlooked

Hands- Koilonychia, leuconychia, Plummer's nail(partial detachment of the nail from nail bed
Dupuytren's-alcoholism, excess use of the hand as in carpenter,NOT a sign of chronic liver
disease
Asterixis-->always forgotten
scratch marks-obstructive jaundice causing pruritus
jaundice, anaemia
mouth-leucoplakia, erythroplakia,stomatitis, glossitis, Pigmentation as in peautz jegher polyposis,
neck-virchow nodes and troisier's sign
chest-differentiate between venous stars,spider naevi and campbell de morgan's spots
abdomen inspection- cullen's and grey turner(discoloration)
abdomen palpation-sister mary joseph nodule, differentiate from fat hypertrophy in chronic insulin injection
Auscultation-renal bruit, differentiate from portal hypertension bruit by compression(portal vein bruit disappear on compression)

Signs that can be elicited for fun, but not compulsory:
Murphy's sign-> who dunno dis can go hang themself
Boas sign-> who dunno dis can also go hang themself
Rovsing sign-->erm...here we go again.who dunno dis can go hang themself
Psoas sign--> in acute appendicitis, attempt to extend a flexed knee will result in right iliac fossa pain
Cartnet sign--> if the pain is visceral, palpation of the abdomen after the patient sitted 45 degree with arm cross over the chest will not cause pain, because the pain is inside, not the abdominal wall.
The sign of hippocrates--> if gastric outlet obstruction, after warning the patient what is about to happen, the patient is rocked from side to side with the stethoscope diaphragm on the stomach. If there is GOO, succusion splash is heard.

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