\documentclass[10pt,a4paper]{article}

% Packages
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\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
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%\usepackage[utf8x]{inputenc}    % For unicode character support
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\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{hjsdhaj}
\pdfinfo{
  /Title (git-examination.pdf)
  /Creator (Cheatography)
  /Author (hjsdhaj)
  /Subject (GIT Examination Cheat Sheet)
}

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% This two commands together give roughly
% the right line height in the tables
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% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
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\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{GIT Examination Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{hjsdhaj} via \textcolor{DarkBackground}{\uline{cheatography.com/201639/cs/42787/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}hjsdhaj \\
  \uline{cheatography.com/hjsdhaj} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 20th March, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{p{0.88 cm} x{7.12 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Preperation:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{W}} & Wash Hands \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{I}} & Introduce Yourself + Patient's Identity \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{P}} & Permission \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{P}} & Patient Position + Pain \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{E}} & Explaination \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.76 cm} x{4.24 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{General Inspection:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Medical paraphernalia:}} & NG Tube/Lines/Drains \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Obvious Muscle Wasting}}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{Patient's Colour:}} & \seqsplit{Pale/Yellow(Jaundiced)/Normal} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Hydration}}} \tn 
% Row Count 6 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Level of alertness}}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Weight/Cachexia}}} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{0.836 cm} x{3.42 cm} x{3.344 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Hands and Arms:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Nails:}} & •Leuconychia\{\{nl\}\}-White nails, pink rim at top\{\{nl\}\}•Koilonychia\{\{nl\}\}-Spoon shaped nail\{\{nl\}\}•Clubbing\{\{nobreak\}\} & •Chronic Liver disease\{\{nl\}\}•Iron Deficiency\{\{nl\}\}•Chirrosis/IBD/Malabsorption/Coeliac\{\{nobreak\}\} \tn 
% Row Count 7 (+ 7)
% Row 1
\SetRowColor{white}
{\bf{Hands:}} & •Nicotine Staining\{\{nl\}\}•Palmar creases\{\{nl\}\}(anaemia)\{\{nl\}\}•Palmar Erythema\{\{nl\}\}(Reddening)\{\{nl\}\}•Depuytren's Contracture\{\{nl\}\}(Permanent finger flexion) & \{\{nl\}\}\{\{nl\}\}•Chronic Liver Disease\{\{nl\}\}•Alcohol/Manual Labour\{\{nobreak\}\} \tn 
% Row Count 17 (+ 10)
% Row 2
\SetRowColor{LightBackground}
{\bf{Wrist:}} & •Pulse\{\{nl\}\}•Respiratory Rate\{\{nl\}\}•Metabolic Flap/Liver Flap/Asterixis & Asterixis: Arms outstretched, extend wrists, seperate fingers, close eyes, 30 sec \tn 
% Row Count 22 (+ 5)
% Row 3
\SetRowColor{white}
{\bf{Arms:}} & Inspect for: & Scratch marks, bruises, marks of IV drug use, muscle wasting \tn 
% Row Count 26 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & {\bf{Spider Naevi}} & Press on centre -\textgreater{} Blanches\{\{nl\}\}\textgreater{}5 =\textgreater{} Sign of chronic liver disease, can be normal in pregnancy \tn 
% Row Count 32 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.6 cm} x{6.4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Head and Neck:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Eyes:}} & \seqsplit{Pale/Yellow(Jaundiced)/Normal}, Iritis(Inflammation of the iris - IBD) \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Mouth:}} & Dental Health, Ulcers, Tongue affected by iron or B12 deficiencies, Dehydrated, Fungal infection, Angular stomatitis (Cracks at corner of mouth - Iron deficiency) \tn 
% Row Count 9 (+ 6)
% Row 2
\SetRowColor{LightBackground}
{\bf{Neck:}} & Enlarged Lymph Nodes - Patient must be sitting up\{\{nl\}\}\{\{nl\}\}Especially left supraclavicular node (Virchow's Node - Enlarged in GI malignancy) \tn 
% Row Count 14 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.12 cm} x{4.88 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Abdominal Examination:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Position - }}{\emph{Check if ok to lie flat{\bf{}}\{\{nl\}\}Lying flat, {\emph{only one pillow}} behind head, hands by side}}\{\{ac\}\}\{\{nl\}\}\{\{nl\}\}Expose Abdomen} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Inspect:}} & \seqsplit{Distention/masses/incisions/visible} peristalsis/dilated veins \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Check with patient for pain/tenderness}}\{\{ac\}\}\{\{nl\}\}\{\{nl\}\}{\emph{Warm hands before palpation}}} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Palpation:}} & Superficial: Checking for tenderness, guarding, rebound tenderness\{\{nl\}\}\{\{nl\}\}Begin {\bf{diagonally}} from the site of pain\{\{nl\}\}\{\{nl\}\}{\emph{Watch patient's face during palpation}}\{\{nl\}\}\{\{nl\}\}Place whole hand on abdomen, flex at MCP joints\{\{nl\}\}\{\{nl\}\}Palpate all areas of the abdomen \tn 
% Row Count 20 (+ 12)
% Row 4
\SetRowColor{LightBackground}
 & Deep: For masses/organomegaly\{\{nl\}\}\{\{nl\}\}{\bf{Only if comfortable for the patient}} \tn 
% Row Count 24 (+ 4)
% Row 5
\SetRowColor{white}
 & Liver Palpation - Hand parallel to costal margin, begin in RIF, breathe in/out slowly through mouth \tn 
% Row Count 29 (+ 5)
% Row 6
\SetRowColor{LightBackground}
 & Spleen Palpation - Start in RIF, move towards left hypocondrium \tn 
% Row Count 32 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.12 cm} x{4.88 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Abdominal Examination: (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
 & Palpate Aorta - Superior to umbilicus in midline \tn 
% Row Count 2 (+ 2)
% Row 8
\SetRowColor{white}
{\bf{Check for kidney:}} & Place one hand behind the patient's back pushing upwards and the other hand on the abdomen pushing downwards. \tn 
% Row Count 7 (+ 5)
% Row 9
\SetRowColor{LightBackground}
{\bf{Percussion:}} & Always start in the right iliac fossa\{\{nl\}\}\{\{nl\}\}1) Percuss each region of the abdomen\{\{nl\}\}2) Percuss upwards from the right iliac fossa - Liver\{\{nl\}\}3) Percuss diagonally upwards and to the left - spleen\{\{nl\}\}\{\{nl\}\}Check for shifting dullness\{\{nl\}\}-Keep hand in place, ask patient to roll on their side and percuss again\{\{nl\}\}\{\{nl\}\}Percuss for liver span/hyperresonance \tn 
% Row Count 23 (+ 16)
% Row 10
\SetRowColor{white}
{\bf{Auscultate:}}\{\{nobreak\}\} & •Below the umbilicus for bowel sounds\{\{nl\}\}Normal/Absent (Must wait 2-3min before declaring absent) /Tinkling (Tinkling is characteristic for intestinal obstruction)\{\{nl\}\}\{\{nl\}\}{\bf{Offer to auscultate for renal and aortic bruits}} \tn 
% Row Count 33 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{Rebound tenderness is exacerbated in peritoneal irritation}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.84 cm} x{6.16 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Conclusion:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Offer to examine hernial orifices/external genitalia/rectal exam}}\{\{ac\}\}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Check for peripheral oedema}}\{\{ac\}\}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{Summary:}} & No peripheral stigmata of GI disease \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
 & On examination pulse was: +rhythm was: \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Palpation of abdomen was soft and not tender \tn 
% Row Count 9 (+ 2)
% Row 5
\SetRowColor{white}
 & No masses \tn 
% Row Count 10 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & No organomegdaly \tn 
% Row Count 11 (+ 1)
% Row 7
\SetRowColor{white}
 & Bowel sounds normal \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & No bruits \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
 & No ankle oedema \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Thank patient and explain that the examination is finished}} \newline  \newline {\bf{{\emph{Sanitise Hands}}}}\{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}