Cheatography
https://cheatography.com
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This is a draft cheat sheet. It is a work in progress and is not finished yet.
Preperation:
W |
Wash Hands |
I |
Introduce Yourself + Patient's Identity |
P |
Permission |
P |
Patient Position + Pain |
E |
Explaination |
General Inspection:
Medical paraphernalia: |
NG Tube/Lines/Drains |
Obvious Muscle Wasting |
Patient's Colour: |
Pale/Yellow(Jaundiced)/Normal |
Hydration |
Level of alertness |
Weight/Cachexia |
Hands and Arms:
Nails: |
•Leuconychia
-White nails, pink rim at top
•Koilonychia
-Spoon shaped nail
•Clubbing |
•Chronic Liver disease
•Iron Deficiency
•Chirrosis/IBD/Malabsorption/Coeliac |
Hands: |
•Nicotine Staining
•Palmar creases
(anaemia)
•Palmar Erythema
(Reddening)
•Depuytren's Contracture
(Permanent finger flexion) |
•Chronic Liver Disease
•Alcohol/Manual Labour
|
Wrist: |
•Pulse
•Respiratory Rate
•Metabolic Flap/Liver Flap/Asterixis |
Asterixis: Arms outstretched, extend wrists, seperate fingers, close eyes, 30 sec |
Arms: |
Inspect for: |
Scratch marks, bruises, marks of IV drug use, muscle wasting |
| |
Spider Naevi |
Press on centre -> Blanches
>5 => Sign of chronic liver disease, can be normal in pregnancy |
Head and Neck:
Eyes: |
Pale/Yellow(Jaundiced)/Normal, Iritis(Inflammation of the iris - IBD) |
Mouth: |
Dental Health, Ulcers, Tongue affected by iron or B12 deficiencies, Dehydrated, Fungal infection, Angular stomatitis (Cracks at corner of mouth - Iron deficiency) |
Neck: |
Enlarged Lymph Nodes - Patient must be sitting up
Especially left supraclavicular node (Virchow's Node - Enlarged in GI malignancy) |
Abdominal Examination:
Position - Check if ok to lie flat
Lying flat, only one pillow behind head, hands by side
Expose Abdomen |
Inspect: |
Distention/masses/incisions/visible peristalsis/dilated veins |
Check with patient for pain/tenderness
Warm hands before palpation |
Palpation: |
Superficial: Checking for tenderness, guarding, rebound tenderness
Begin diagonally from the site of pain
Watch patient's face during palpation
Place whole hand on abdomen, flex at MCP joints
Palpate all areas of the abdomen |
| |
Deep: For masses/organomegaly
Only if comfortable for the patient |
| |
Liver Palpation - Hand parallel to costal margin, begin in RIF, breathe in/out slowly through mouth |
| |
Spleen Palpation - Start in RIF, move towards left hypocondrium |
| |
Palpate Aorta - Superior to umbilicus in midline |
Check for kidney: |
Place one hand behind the patient's back pushing upwards and the other hand on the abdomen pushing downwards. |
Percussion: |
Always start in the right iliac fossa
1) Percuss each region of the abdomen
2) Percuss upwards from the right iliac fossa - Liver
3) Percuss diagonally upwards and to the left - spleen
Check for shifting dullness
-Keep hand in place, ask patient to roll on their side and percuss again
Percuss for liver span/hyperresonance |
Auscultate: |
•Below the umbilicus for bowel sounds
Normal/Absent (Must wait 2-3min before declaring absent) /Tinkling (Tinkling is characteristic for intestinal obstruction)
Offer to auscultate for renal and aortic bruits |
Rebound tenderness is exacerbated in peritoneal irritation
Conclusion:
Offer to examine hernial orifices/external genitalia/rectal exam |
Check for peripheral oedema |
Summary: |
No peripheral stigmata of GI disease |
| |
On examination pulse was: +rhythm was: |
| |
Palpation of abdomen was soft and not tender |
| |
No masses |
| |
No organomegdaly |
| |
Bowel sounds normal |
| |
No bruits |
| |
No ankle oedema |
Thank patient and explain that the examination is finished
Sanitise Hands
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