examination medicine

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dr. mohcen al. haj 1 examination medicine gastro intestinal tract system chapter dr. mohcen al. haj 2 gastro-intestinal-tract system (git) the possible short cases in clinic exam are: 1- jaundice. 2- ascites. 3- hepatomegaly. 4- splenomegaly. 5- hepato-splenomegaly. abdominal examination means  examination locally only for the abdomen. git examination means  abdominal examination & general examination related to git system. abdominal examination: in abdominal examination; the patient has to be lying flat (supine position) and the hands should lie by his sides. the exposure  from xiphoid process to suymphysis pubis. introduce your self,, stand on the right side of the patient & take permission from the patient for examination & exposure. .. طالب سنة خامسة في كلية الطب البشري ( فالن فالن)أني .. صباح الخير يا حاج.. السالم عليكم لو سمحت يا حاج ومن بعد إذنك لو تقدر تفتح السورية .. من بعد إذنك يا حاج نبي اندير …

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tiel scar): indicate  caesarian section. (4). right sub-costal scar (kocher scar): indicate  cholecystectomy. (5). left sub-costal scar: indicate  splenectomy. (6). right iliac fossa scar (gridiron scar): indicate  appendectomy. --------------------------------------------------------------------------------------------------- 5- scratch mark: due to  pruritis in case of  jaundice. 6- striae: *differential diagnosis of striae: 1. ascites. 2. cushing syndrome. 3. obesity. 4. pregnancy. dr. mohcen al. haj 5 7- visible dilated veins: veins around umbilicus  caput medusa; indicate portal htn. lateral abdominal veins, indicate  ivc obstruction. check direction of blood flow by milking test  to differentiate between ivc obstruction & caput medusa. 8- visible pulsation:  epigastric pulsation: indicate aortic aneurysm, tricuspid regurgitation & thin patients. 9- visible peristaltic movement: indicate  intestinal obstruction & gastric outflow obstruction. 10- hair distributions: loss of pubic hair; indicate  liver cirrhosis. 11- hernia (cough impulse test): ask the patient to cough, and …

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s in the picture in all abdominal areas & look at the patient’s eyes. 3. tense abdomen: while you are putting your hand on abdomen, check if it is soft or tense; *guarding; means tense abdomen due to voluntary muscle contraction. *rigidity; means tense abdomen due to involuntary muscle contraction. to differentiate between guarding & rigidity; ask patient to flex his knees and relax, then take breathing from mouth; *if the abdomen changed from tense to lax abdomen;  it is guarding, *if the abdomen still tense abdomen;  it is rigidity. dr. mohcen al. haj 7 4. mass: while you are putting your hand on abdomen, check if there is any superficial mass. if there is any mass; you have to comment on: site, size, shape, surface, consistency, tenderness, fixed or mobile, pulsatile or not pulsatile. note: if the mass associated with pulsation (pulsatile): put your index & middle …

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neys): 1. liver liver palpation: 1. right hand placed in right iliac fossa. 2. ask the patient to take slow deep breathing from his mouth. 3. palpate deeply in upward direction by radial border of index finger parallel to costal margin (or palpate by tip of the fingers), until reach costal cartilage along mid clavicular line. 4. when the patient do expiration;  pressure applied by your hand, and when the patient do inspiration;  you will feel the liver coming to your hand, (because during inspiration diaphragm descends and push the liver down). 5. normally liver not palpable (may liver palpable but only just 2cm below costal margin), but if it was palpable; you have to differentiate between hepatomegaly and pushed liver , (pushed liver means  liver pushed down due to hyper inflated chest as in copd). dr. mohcen al. haj 9 in case of huge ascites do …

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nd measure liver span between upper border of liver & lower border of liver, (normally between 8 – 12 cm). dr. mohcen al. haj 10 if you detect liver enlarged; you have to comment on: tenderness, surface, edge & consistency. if you didn’t palpate the liver; do percussion but only for upper border of liver. differential diagnosis of hepatomegaly: 1. heart failure. 2. early liver cirrhosis. 3. malignancy: primary or secondary metastasis, leukemia. 4. infection: hepatitis, hydatid cyst. dr. mohcen al. haj 11 2. spleen spleen will be palpable if it is 3 times more enlarged than normal. massive splenomegaly is more than 8 cm below costal margin. 1. right hand placed in right iliac fossa. 2. ask the patient to take slow deep breathing from his mouth. 3. palpate deeply in upward direction by tip of the fingers toward right hypochondrium cross above umbilicus. 4. put your left hand …

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dr. mohcen al. haj 1 examination medicine gastro intestinal tract system chapter dr. mohcen al. haj 2 gastro-intestinal-tract system (git) the possible short cases in clinic exam are: 1- jaundice. 2- ascites. 3- hepatomegaly. 4- splenomegaly. 5- hepato-splenomegaly. abdominal examination means  examination locally only for the abdomen. git examination means  abdominal examination & general examination related to git system. abdominal examination: in abdominal examination; the patient has to be lying flat (supine position) and the hands should lie by his sides. the exposure  from xiphoid process to suymphysis pubis. introduce your self,, stand on the right side of the patient & take permission from the patient for examination & exposure. .. طالب سنة خامسة في كلية الطب …

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