Gastrointestinal Physical Exam Checklist Learnpediatrics.Com – Written by Dr

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Gastrointestinal Physical Exam Checklist Learnpediatrics.com – written by Dr. R. Acedillo, modified by Dr. E. Statham EXAMINATION OSCE ITEMS General Growth parameters (HC, L, Wt, BMI) Extra-intestinal Stigmata of Chronic Inspection Well/Unwell Manifestations of IBD: Liver Disease: Mental Status Aphtous Ulcers Muscle wasting Posture (writhing vs. minimal movement) Uveitis Palmar erythema Colour (icterus, jaundice, pale) Arthritis Leukonychia Nutritional status Clubbing Asterixis Peripheral edema Rashes Strawberry angiomas Rashes (eg. Dermatitis Herpetiformis) Caput medusae Gynecomastia Jaundice Edema Parotid enlargement Inspection Abdominal Scars (surgical – risk for Bowel obstruction) Abdominal contours (scaphoid, bulging Skin abnormalities (abdominal wall veins, flanks, protuberant, etc) hemangiomas) Peristaltic waves (eg in. Pyloric Stenosis) Protrusions (umbilical hernia, diastasis recti) Auscultation A. Bowel Sounds B. Vascular Sounds (Presence vs absence) Bruits (aorta, iliac, femoral, renal) Quality (Frequency and Pitch [high?]) Bruits/venous hums around palpable liver mass (if applicable) Percussion General: Splenomegaly (Traube’s space - below left 6th rib, Presence of tenderness above costal margin, medial to axillary line) Ascites Specific: o Shifting dullness Hepatomegaly o Fluid wave Palpation A. General Palpation Special tests for Appendicitis Superficial Palpation Rovsing’s sign (pressure wave) Tenderness (peritoneal irritation, somatic Obturator sign (pain on hip int. rotation) or visceral pain). Psoas sign (pain on hip flexion hip) Guarding (voluntary vs involuntary) Deep Palpation Sitting up: Rebound tenderness (peritonitis) Assess for CVA tenderness McBurny point tenderness (appendicitis) Murphy’s sign for cholecystitis Groin: Femoral hernia Organomegaly: Inguinal hernias Hepatomegaly (liver span, liver edge Inguinal lymphadenopathy consistency – boggy or fibrotic) Testicular mass or torsion Splenomegaly Anus – Imperforate, malpositioned, evidence of Enlarged kidneys (hydronephrosis or renal abuse or adrenal masses) .

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General Signs and Symptoms of Abdominal Diseases
General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid.
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The Abnormal Presentation of Complicated Appendicitis Goubeaux C* and Adams J Removed
Open Access Journal of Family Medicine Case Report The Abnormal Presentation of Complicated Appendicitis Goubeaux C* and Adams J removed. Heritage College of Osteopathic Medicine, Ohio University, Dublin, OH 43016, USA Discussion *Corresponding author: Craig Goubeaux, Heritage Acute appendicitis is one of the most common pathologies in College of Osteopathic Medicine, Ohio University, Dublin, medicine with more than 250,000 cases reported per year [5]. The OH 43016, USA lifetime prevalence is reported to be between 7-8% [5,7]. Diagnosis is Received: January 31, 2019; Accepted: March 12, typically based on a careful clinical history and physical examination 2019; Published: March 19, 2019 [1.7]. The signs and symptoms classically associated with appendicitis are periumbilical pain initially that migrates to right lower quadrant, The Case rebound tenderness, low-grade fever, anorexia, and elevated white A 60-year-old white male presented to our family practice with a blood cell count. chief complaint of isolated right upper quadrant (RUQ) abdominal There are pathologies that may mimic appendicitis such as an pain. It began one week prior after suspected food poisoning with anomalous congenital band, Meckel’s diverticulitis, spontaneous one episode of vomiting. The pain was a constant, dull ache ranging urinary extravasation, renal artery thrombosis or renal infarction between 1-5/10. It did not limit his activities as a farmer. He used [3]. Additionally, a mobile cecum is a congenital anomaly that may NSAIDs to help with the pain. During the past week all other review of systems were negative. Vitals signs were within normal lead to abnormal presentation of appendicitis which occurs in about limits.
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Acute Abdomen
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Missed Appendicitis Diagnosis: a Case Report Jocelyn Cox, Bphed, DC1 Guy Sovak, Phd2
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Acute Abdomen in the Emergency Department
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Positive Psoas Sign in a Disabled Child-Not Always Appendicitis, Seldomly Due to Duodenal Perforation by Sharp Foreign Body
Case Report Published: 01 Aug, 2019 SF Journal of Radiology and Clinical Diagnosis Positive Psoas Sign in a Disabled Child-Not Always Appendicitis, Seldomly due to Duodenal Perforation by Sharp Foreign Body Klein E1*, Merhav G1, Kassis I2 and Ilivitzki A1 1Department of Radiology, Rambam Health Care Campus, Haaliya Hashniya 8 st, Haifa, Israel 2Pediatric Infectious Disease Unit, Rambam Health Care Campus, Haaliya Hashniya 8 st, Haifa, Israel Abstract We present a rare cause for "positive psoas sign" secondary to duodenal perforation by an ingested wooden skewer in a disabled 13 years old male. The unreliable clinical evaluation made the appreciation of a "positive psoas sign" obscured. We highlight the possible occurrence of this pathology in young or disabled children, and the importance of CT leading to this diagnosis, with the utilization of multiplane MIP reconstructions. This case also points that the psoas muscle is a long structure in the retroperitoneum, and irritation of its upper most part may also present as positive psoas sign. Keywords: Psoas sign; Psoasabscess; Skewer; Perforation; Missed diagnosis Case Report A 13 years old male is seen in the pediatric emergency room (ER) due to new onset of limp on the right lower limb, nausea and agitation. His past medical history consists of prematurity with severe psychomotor delay including mental retardation as a sequalae. Past surgical history consists of fundoplication procedure due to diaphragmatic hernia and feeding jejunostomy which was thereafter closed. Medical history was negative for any recent illness with fever, nothing to support food poisoning OPEN ACCESS or any trauma. Physical examination revealed a positive psoas sign, with no tenderness upon deep palpation of the abdomen, and additional point tenderness upon palpation of the distal femur.
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Abdominal Pain
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Belly Pain and Vomiting: NO YES Perforation When to Worry? Hemmorrhage Hematoma Judith J
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General Medicine - Surgery IV Year
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Abdominal Pain
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