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    History and Examination: GIT System: Ahmed Laving Paediatric Gastroenterologist

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    okwadha simion
    This document provides guidance on performing a thorough history and physical examination for gastrointestinal (GI) issues. It outlines how to take a patient history, including establishing rapport, collecting demographics, reviewing primary complaints and symptoms, and conducting systemic inquiries. For the physical exam, it describes how to inspect, palpate, percuss, and auscultate the abdomen, examining for signs of GI diseases and abnormalities. Key assessment techniques are outlined, including characterizing abdominal pain, detecting ascites, and examining the anus and rectum. The goal is a logical, comprehensive evaluation to reveal a diagnosis in most cases of GI disease.

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    History and Examination: GIT System: Ahmed Laving Paediatric Gastroenterologist

    Uploaded by

    okwadha simion
    66 views27 pages
    This document provides guidance on performing a thorough history and physical examination for gastrointestinal (GI) issues. It outlines how to take a patient history, including establishing rapport, collecting demographics, reviewing primary complaints and symptoms, and conducting systemic inquiries. For the physical exam, it describes how to inspect, palpate, percuss, and auscultate the abdomen, examining for signs of GI diseases and abnormalities. Key assessment techniques are outlined, including characterizing abdominal pain, detecting ascites, and examining the anus and rectum. The goal is a logical, comprehensive evaluation to reveal a diagnosis in most cases of GI disease.

    Original Title

    Abdominal Exam Hutchinsons 20180131 232310477

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    This document provides guidance on performing a thorough history and physical examination for gastrointestinal (GI) issues. It outlines how to take a patient history, including establishing rapport, collecting demographics, reviewing primary complaints and symptoms, and conducting systemic inquiries. For the physical exam, it describes how to inspect, palpate, percuss, and auscultate the abdomen, examining for signs of GI diseases and abnormalities. Key assessment techniques are outlined, including characterizing abdominal pain, detecting ascites, and examining the anus and rectum. The goal is a logical, comprehensive evaluation to reveal a diagnosis in most cases of GI disease.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    66 views27 pages

    History and Examination: GIT System: Ahmed Laving Paediatric Gastroenterologist

    Uploaded by

    okwadha simion
    This document provides guidance on performing a thorough history and physical examination for gastrointestinal (GI) issues. It outlines how to take a patient history, including establishing rapport, collecting demographics, reviewing primary complaints and symptoms, and conducting systemic inquiries. For the physical exam, it describes how to inspect, palpate, percuss, and auscultate the abdomen, examining for signs of GI diseases and abnormalities. Key assessment techniques are outlined, including characterizing abdominal pain, detecting ascites, and examining the anus and rectum. The goal is a logical, comprehensive evaluation to reveal a diagnosis in most cases of GI disease.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    History and Examination:

    GIT system
    Ahmed Laving
    Paediatric Gastroenterologist
    Art of History Taking
    • Establish rapport:
    – greet the patient and guardian
    – introduce self
    – get permission from the patient/guardian
    • Demographics + who provided the history
    • List the P/C
    – In chronological order
    – maximum no. of P/C?
    Art of History Taking: HPI
    – Describe the complaints e.g. Abdominal pain: site,
    origin, character, radiation, aggravating/relieving
    factors
    – Any associated problems in the same system, e.g.
    important “negative” symptoms (no h/o vomiting)
    – Any systemic symptoms (fever, weight loss)
    – Any associated risk/aetiological factors (e.g. history
    of contact with a jaundiced person)
    – Any complications e.g. bleeding in child with liver
    disease
    History Taking (3)
    • Systemic Enquiry
    – Not stated for sake of it
    • Past Medical/Surgical/Drug History
    – Don’t forget to ask for drug allergies
    • Perinatal History, Developmental History
    – Important for neonates/infants and in certain
    conditions
    • Summary: demographics, P/C, important points
    in HPI
    Introduction: GIT System
    • The human gastrointestinal (GI) tract is a
    complex system of serially connected organs
    approximately 8m in length

    • Careful analysis of the clues from the gut and


    from the effect of gut disease on the body
    required for making a diagnosis
    The common symptoms of gastrointestinal
    and abdominal disease
    • Dysphagia, odynophagia • Abdominal pain
    • Heartburn and reflux • Abdominal distension
    • Flatulence • Weight loss
    • Vomiting • Haematemesis
    • Anorexia • Rectal bleeding
    • Constipation • Melaena
    • Diarrhoea • Jaundice
    • Alteration of bowel
    pattern
    ABDOMINAL PAIN
    • As with any pain it is important to characterize
    (SOCRATAS)
    – Site,
    – Onset,
    – Character,
    – Radiation,
    – Aggravating and relieving factors,
    – Timing (duration and frequency),
    – Associated features and
    – Severity
    ABDOMINAL DISTENSION
    • Generalised (5 Fs):
    – Fat
    – Fluid
    – Flatus
    – Feces
    – Fetus

    • Localised:
    – Marked enlargement of the major organs
    HAEMATEMESIS
    • vomiting of blood
    • results from bleeding in the upper GI tract
    (above the duodenojejunal flexure)

    • Blood that lies in gastric juice for a while turns


    black, and when vomited may look like ground
    coffee
    MELAENA and RECTAL BLEEDING
    • altered blood that looks tarry
    • indicates bleeding above the ileocaecal valve
    (occasionally may originate in the right colon)

    • If blood is bright red, or just on wiping:


    indicates a source in sigmoid colon, rectum or
    anal canal
    • darker red and blood mixed with the stool:
    usually indicates a source above the rectum
    JAUNDICE
    • yellowness of the skin and conjunctiva

    • implies disease of the liver or the biliary tract


    (may also occur from excessive haemolysis)
    PHYSICAL EXAMINATION OF THE GI TRACT
    AND ABDOMEN
    • Positioning of patient
    • General signs
    • Inspection
    • Palpation
    • Percussion
    • Auscultation
    • The groins
    • The anus and rectum
    Positioning of the patient
    • The patient should be lying supine with the
    arms loosely by his or her sides
    • Stand on the patient's right side
    • Expose the abdomen:
    – above the xiphisternum and the sheet folded down
    to the level of the symphysis pubis
    – Traditional teaching:
    • from nipples to knees
    • nowadays this approach is not acceptable
    • However, inspection of the groins and genitalia must not
    be neglected
    GENERAL SIGNS
    • Nutritional state
    • Pallor (Anaemia)
    • Jaundice
    • Oedema
    • Lymphadenopathy
    • Peripheral signs of chronic liver disease: spider
    neavii, palmar erythema
    • Inflammatory bowel disease: clubbing, arthritis,
    uveitis and skin changes (erythema nodosum)
    Regions of the Abdomen
    • lateral vertical planes
    pass from the femoral
    artery below to cross
    the costal margin close
    to the tip of the ninth
    costal cartilage
    • two horizontal planes,
    subcostal and interiliac
    INSPECTION
    • Shape:
    – normal contour and fullness
    – distended: Generalized or Localized (from foot of
    bed)
    – scaphoid (sunken)
    • The Umbilicus
    • Movements of The Abdominal Wall: gentle rise
    in inspiration and a fall during expiration
    • Visible Peristalsis: usually suggests obstruction
    INSPECTION (2)
    • Skin And Surface Of The Abdomen:
    – Scars
    – prominent superficial veins:
    • peripheral abdominal wall - suggest IVC obstruction
    • caput medusae (peri-umbilical) – suggest portal
    hypertension
    – Pigmentation: linea nigra (sign of pregnancy)
    • Finally, uncover and inspect both groins, and
    the penis and scrotum of a male (look for any
    swellings and if testes descended bilaterally)
    PALPATION
    • most important part of the abdominal exam
    • enquire about site of any pain and come to this
    region last
    • wrist and forearm should be in same horizontal
    plane; avoid sudden poking with fingertips
    • logical sequence: start from left lower quadrant
    of the abdomen and move in anticlockwise
    direction coming to umbilical region last
    • start with superficial and then repeat above
    sequence with deep palpation
    PALPATION (2)
    • If patients find it difficult to relax their abdominal
    muscles, ask them to breathe deeply or to flex
    their knees
    • WHEN AN ABDOMINAL MASS IS PALPABLE :
    describe
    – Site
    – Size and shape
    – Surface, edge and consistency
    – Mobility and attachments (e.g. with breathing)
    – Is it bimanually palpable
    – Is it pulsatile
    PERCUSSION
    • The middle finger of the left hand is placed on
    the part to be percussed and pressed firmly
    against it. The back of the middle phalanx is
    then struck with the tip of the middle finger of
    the right hand (vice versa if you are left-
    handed)
    • The normal percussion note over most of the
    abdomen is resonant (tympanic)
    PERCUSSION (2)
    Importance:
    • Defining the boundaries of abdominal organs and
    masses:
    – Liver
    – Spleen
    – Bladder
    • Detection of ascites (shifting dullness and fluid thrill)
    AUSCULTATION
    • Bowel sounds:
    – Normal bowel sounds: intermittent low- or medium-
    pitched gurgles interspersed with an occasional high-
    pitched noise
    – excessive and exaggerated: In acute mechanical
    obstruction of the small bowel
    – Reduced in: peritonitis and prolonged bowel obstruction
    • Vascular bruits:
    – above and to the left of the umbilicus: aorta
    – laterally in the mid-abdomen: renal arteries
    – over the liver: tumours
    THE GROINS
    • ask the patient to turn the head to one side
    and cough. Look and palpate both inguinal
    canals for any expansile impulse
    • palpate and auscultate for the femoral vessels
    • palpate along the femoral artery for enlarged
    inguinal nodes
    THE ANUS AND RECTUM
    • Abdominal exam incomplete without a rectal
    exam
    • Patient lies in left lateral position- 2 parts:
    – INSPECTION
    • Inflammation
    • skin tags, anal warts
    • anal fissure
    – DIGITAL EXAMINATION (PALPATION)
    • Anal sphincter tone
    • Polyps
    Parting Thoughts
    • Symptoms of GI disorders are often vague,
    and signs of abnormality few

    • A logical approach to history taking and


    examination is essential and will reveal a
    diagnosis in up to 80% cases
    References
    • Hutchinson’s clinical methods. 22nd edition.
    Saunders Elsevier 2007

    • NB: Handouts- presentation will be emailed to


    group email address
    Thank You!
    • Questions/comments?

    • Assignment:
    – 3 techniques of detecting ascites
    – Practice and perfect the techniques

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