Clinical Skills Gi

Front 1

Interview points for N/V?

Back 1

Onset? relationship to food/meals? Hematemesis? Fever? Diarrhea? Pain - before or after? Pain before = appendicitis or cholecystitis
Pain after = obstruction

Front 2

Interview pts for Change in bowel movements

Back 2

Normal: 3/day - 3x/week -- whats normal for pt

Onset? Frequency - incr or decr? appearance/consistency -- thin, blood, tarry, color?

thin stool = sign of colon cancer
pale color = hepatic disorder

Front 3

Interview pts for Ab pain

Back 3

Type: burning? knife-like? cramps?

Location: which quadrant? generalized (radiating) or localized

Front 4

Name of Quadrants & Other areas of body

Back 4

Direction based on patient's R &L!
Upper right, Upper left, lower right, lower left (split at belly button)

Epigastric region (above belly button)
Periumbilical region (on side of bb)
Pelvic region (below bb)

Front 5

Whats in the RUQ?

Back 5

Liver, gallbladder, head of pancreas, right kidney, hepatic fissure of colon

Front 6

Whats in the LUQ?

Back 6

stomach, spleen, splenic fissure of colon, tail of pancreas, left kidney

Front 7

Whats in the RLQ?

Back 7

Appendix, cecum

Front 8

Whats in the LLQ?

Back 8

sigmoid colon

Front 9

Indication of substernal pain?

Back 9

GERD

Front 10

Indication of Epigastric pain?

Back 10

Ulcer, cholecystitis, hepatitis, pancreatitis

Front 11

Indication of Umbilicicus pain?

Back 11

obstruction, crohn's

Front 12

Indication of hypogastric pain?

Back 12

crohn's, ulcerative colitis, diverticulitis (pain in pouch of colon)

Front 13

Inspection of Color?

Back 13

Nonicteric vs. icteric

Front 14

Inspection of contour?

Back 14

Flat, nondistended, absence of mass/nodules, absence of scars

Front 15

Inspection of skin?
Inspection of vascularity?

Back 15

Skin should be smooth
Vascularity: spider angiomas? dilated veins?

Front 16

Auscultation of bowel sounds and vascular sounds

Back 16

Diaphragm used.
- usually high pitched
- gurgling sounds in a random pattern
- normal: 5-20/min
- hyperactive vs. hypoactive
- friction rubs

Vascular sounds - diaphragm used
- bruits

Front 17

Percussion of liver size

Back 17

Det. presence of fluid, gas, or masses
Det size of liver
normal: 6-12cm

Percuss along MCL line
dull sound = liver

Front 18

Percussion for Ascites

Back 18

shifting dullness - pt should be in supine.
dullness heard over flank area (side of bb)
tympany heard medially

lie pt on side: dullness now heard medially near bb

Front 19

Palpate for areas of tenderness -- from light to deep

Back 19

liver: 11th-12th ribs -- edge is firm, smooth, nontender

Guarding (tensed muscle wall): voluntary or involuntary
rebound tenderness: when pushing in.. no pain, when release, pain occurs

Front 20

LFTs (liver funct test)

Back 20

test of AST, ALT, Alk Phos, Albumin, Protein, Total & direct Bilirubin

Could indicate hepatic inflammation or necrosis; liver etiologies; cirrhosis; malnutrition; biliary obstruction

Front 21

GGT (Gamma glutamyl transpeptidase)

Back 21

looks at: liver, kidneys, pancreas, spleen, heart, brain.

incr Alk Phos + incr GGT = hepatic etiology

incr Alk Phos + normal GGT = nonhepatic etiology

Front 22

LDH (Lactic Dehydrogenase)

Back 22

sign of hepatic injury

looks at heart, liver, skeletal muscle, brain, kidneys, lungs, RBCs

Nonspecific!

Front 23

PT/INR

Back 23

increased PT --> bleeding risk

changes in response to hepatic status

INR (Intl normalized ratio)

Front 24

S&S of Hepatic Encephalopathy

Back 24

Elevated Ammonia

altered mental status

Front 25

Amylase


Lipase

Back 25

Amylase: sign of acute pancreatitis -- quick t1/2 --- low sensitivity and specificity

Lipase: acute pancr. t1/2 7-14hrs; more specific

Front 26

Hepatitis lab values for:
HAV

HBV

HCV

Back 26

HAV: IgM - acute; IgG - past illness; ALT

HBV: HBsAg (1st to appear); Anti HBc/e/s; elevated AST/ALT/LDH/GGT/Bilirubin

HCV: Anti-HCV; mild elevation in AST/ALT; genotype

Front 27

S&S of Pancreatitis

Back 27

elevated Alk Phos, AST/ALT, Serum AMYLASE & LIPASE

Midepigastric pain on back; ab distention; N/V; jaundice; STABBING pain

Front 28

S&S of Cholecystitis

Back 28

Incr bilirubin; Alk Phos

Fever; ab pain; N/V; anorexia

Front 29

S&S of Hepatitis all 3 types

Back 29

HAV: asympt.

HBV: malaise, anorexia, myalgias/arthralgias, pruritis, jaundice

HCV: most are asymptomatic

Front 30

Asterixis

Back 30

Flapping tremor; repetitive movement; coarse and slow

Front 31

Jaundice

Back 31

Total bilirubin

yellow skin, pale stool

Conj: dark/brown urine

Front 32

Cirrhosis

Back 32

Signs: ascites, GI bleeding, N/V/D/ anorexia, jaundice, fatigue