PHYSICAL DIAGNOSIS EXAMINING THE GI SYSTEM. Stephen J. Goldberg, M. D. Phone: 513.686.5444. HISTORY - GETTING THE FACTS. General nutrition/appetite Swallowing/esophagus Upper GI/stomach Digestion/intestinal Elimination/colon. GENERAL NUTRITION. Stability of weight Appetite Excessive
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Stephen J. Goldberg, M. D.
Relation to meals
Time of day
?Explainable on a physiologic basis
RLQ-->terminal ileum, gyn, appendix, sigmoid?
LUQ-->splenic flexure, ?pancreas
Epigastric--> stomach, pancreas
RUQ-->liver, gall bladder, duodenumEVALUATING GI SYMPTOMS-1
Post-prandial--> mal-digestion? acid? obstruction?
Eating --> acid neutralization
Position - ->sedation, pancreatitis?
Passage of flatus --> colonic distension?
Bowel movement--> colonic distension? peristalsis?EVALUATING GI SYMPTOMS-2
Striae - stripe or line in skin distinguished by color or texture
Scaphoid - concave
Tympany- resonant sound
Bruit - “abnormal vascular sound heard on auscultation”
Fissure - break or slit in tissue
Fistula - abnormal passage between two organs or structures, permitting passage of fluids or secretionsPHYSICAL EXAM 1
?Normal, ?Increased, ?Decreased, ?Absent
Percuss abdomen to outline dullness/tympany
Have patient roll away from you
Percuss again to outline dullness/tympany
If dullness has shifted to areas of prior tympany, ascites may be present
NORMAL LIVER SPAN = 6-12 CM AT RIGHT MID-CLAVICULAR LINE
THE SPLEEN IS NOT NORMALLY PALABLE IN ADULTS