GI Clinical Exam Guide
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This document provides information on examining the gastrointestinal (GI) tract and abdomen. It aims to increase knowledge of abdominal and GI anatomy and physiology (A&P), understand basic examination principles, learn how to perform a basic abdominal exam, and recognize abnormal findings. Key topics covered include the anatomy of the GI tract and abdomen, history taking, examination techniques, common signs and symptoms, and ongoing care options. The GI tract anatomy section describes the structures from the oral cavity through the large intestine. Common GI conditions are also listed. [END SUMMARY]
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GI Clinical Exam Guide
- 1. Clinical Examination of the GI tract and abdomen Andy Simmons 22 march 2013
- 2. Aims • Increase knowledge of abdominal & GI A&P • Understand basic principles of abdominal & GI examination • Be able to perform a basic abdominal examination • Be aware of abnormal findings and what to do when discovered
- 3. What we are covering today • Anatomy of abdomen and GI tract • History taking • Examination • Common signs and symptoms of conditions and abnormalities • Assessing the findings • Ongoing care-options
- 6. GI Tract • Oral Cavity • Oesophagus • Stomach-pylorus • Small intestine-5 metres long • Duodenum-duodenojejunal flexure • Jejunum • Ileum-ileocaecal juction • Large intestine • Caecum • Colon-ascending/transverse/descending/sigmoid • Rectum • Anal canal
- 7. Anatomy-GI tract Pylorus Duojejunal flexure Ileocaecal junction
- 8. GI tract • Begins at the oral cavity • Tongue/teeth/oropharynx • Saliva • Saliva production-produced in ancini cells/secreted by salivary glands(exocrine) • 99.5% water • Enzymes begin process of digestion-breaking down fats and starches • Lubricates food for swallowing • Protects oral mucosa • Swallowing • V, VII, IX, X, XI, XII cranial nerves involved with swallowing • http://www.youtube.com/watch?v=uxHUUgLeNzk&list=PL0F91E3E2F280FFF9
- 9. GI tract • Oesophagus • Transports food between mouth and stomach • Peristalsis(begins when food enters oesophagus) • Cardiac sphincter relaxes • http://www.youtube.com/watch?v=rJS-Kh5wCQU • Stomach-continuous with oesophagus-beyond the cardiac sphincter • Divided into 3 regions fundus/body/pylorus • Differs as has 3 layers of muscle • 2 litres gastric juice secreted into stomach daily
- 11. GI tract • Small intestine • Duodenum • Jejunum • Ileum • Ileocaecal junction • Functions • Food breakdown into nutrients • Absorbtion of nutrients
- 12. GI tract • Villus • Small finger like projections in small intestine-0.5-1.6 • Microvillus on surface • Increase surface area of intestine • More prevalent at start of small intestine • Small intestine joins bowel at ileocaecal joint
- 13. GI tract • Large intestine • 1.5M length • Digestion completed proximal portion • B12,thiamine,riboflavin & Vit K produced by bacteria and stored in the liver • Main function absorbtion of water and electrolytes • Gastrocolic reflex/mass movement
- 14. Common Conditions • Dysphagia • Carcinoma-Barretts oesophagus • GORD • Oesophageal stricture • Coeliacs disease • Ulcers- • Oesophageal/gastric varisces • Diverticulitis • Chrohns • Gastroenteritis • Ulcerative colitis
- 15. Abdominal Cavity Structures-Organs Other structures- • Liver • Gall bladder • Pancreas • Peritoneum • Spleen • Abdominal wall • kidneys • Aorta • GI tract • Inferior vena cava • Nerve supply
- 17. Peritoneum • Thin folded sack forming peritoneal cavity • Parietal and visceral layers- separated by serous fluid • Peritoneum- • Protects intraperitoneal organs • supports the organs • Serves as a conduit for blood, lymph vessels and nerves
- 18. Peritoneum • Peritonitis- • Sterile until punctured • Infection within viscera • Characterised by rebound tenderness
- 19. Intraperitoneum • Stomach • First 5cm of duodenum • Jejunum, ileum, Caecum, • Appendix • Transverse colon, sigmoid colon • Rectum • Upper 1/3 Liver • Spleen • Women: Uterus, Fallopian tubes, ovaries
- 20. Retroperitoneum • Mnemonic • SAD PUCKER is 112 212111 • S= Suprarenal glands (aka the adrenal glands) • A=Aorta/IVC • D=Duodenum (second and third segments [some also include the fourth segment] ) • P=Pancreas (tail is intraperitoneal) • U=Ureters • C=Colon (only the ascending and descending colons, as transverse and sigmoid retain mesocolon • K=Kidneys • E=Esophagus • R=Rectum
- 21. Omentum • Greater-large fold of visceral peritoneum • Functions- • Fat deposition • Immune contribution-milky spots of macrophage collections • Infection and wound isolation • Greater omentum can often be found wrapped around areas of infection and trauma • Lesser- • Forms ligaments which support hepatic vessels
- 22. Liver • 4 main lobes- Left/Right/caudate/quadrate • Largest internal organ • Anatomically-R upper quadrant beneath diaphragm • Covered by peritoneum
- 23. Liver
- 24. Liver
- 25. Liver • • • Fat metabolism Deamination of amino acids Transamination • Synthesis of plasma proteins • Vitamin A,D,E,K iron and copper Storage also B12 • Paracetamol • Alcohol • Negatve feedback • Opiates • Glycogen storage • Barbituates • Glycogen-glucose-Glycogenolysis • Drugs-GTN • Glucose –glycogen-glycogenesis • Filters blood from GI tract • Detoxifies as blood passes through • Kupfercells • Blood vessels • 500-1000mls bile secreted daily
- 26. Liver • Conditions • Signs • Hepatitis • Spider naevi • Cirrhosis • Jaundice • Hepato-megally • Enlarged liver • Carcinoma • Liver flap • Fatty liver • Haemorrhage • Clotting factor failure • Deranged GCS • Coma
- 27. Biliary tract & gall bladder • Hepatocytes synthesise constituents • Blood in sinusoids • Bile salts/pigments/cholesterol • Gall bladder- • Stores and concentrates bile • Releases stored bile • Bile-aids digestion of lipids
- 28. Biliary tract • Conditions • Signs • Cholecystitis • Jaundice • Gall stones • Shoulder tip pain • Cholangitis • Abdominal pain • Biliary cirrhosis
- 29. Pancreas • Endocrine and exocrine • Situated epigastric and Left hypochondriac regions • Head lies in curve of duodenum
- 30. Pancreas • Exocrine functions- • Lobules(ancini) • Pancreatic juice (enzymes) • Digests carbs/proteins/fats • Endocrine functions- • Production of hormones in Islets of Langerhans • α-cells-Glucagon • β-cells-Insulin • Delta cells-Somastatin • Gamma cells-Pancreatic polypeptide
- 31. Pancreas • Conditions • Signs • Exocrine- • Pancreatitis • EPI-CF • Raised amylase • Endocrine • Diabetes • Diabetes mellitis T1 & T2 • Raised blood sugar • Pancreatitis • Wt loss • Carcinoma • Neuropathy • Nephropathy • Retinopathy • Slow healing process
- 32. Spleen • Non vital organ • Situated-Left upper quadrant • Acts as a blood filter • Recycles red blood cells • Holds store of red blood • Part of lymphatic system
- 33. Spleen • Splenomegally- Ca • Asplenia • Ruptured spleen-blunt trauma
- 34. Kidneys • 2 kidneys • Retroperitoneal • Paravertebral gutter • L situated T12-L3 • R slightly lower (liver) • Blood supply renal arteries
- 35. Kidneys • Functions- • Whole body homeostasis • Acid base regulation- • HCO3 • BP regulation- • Renin angiotensin pathway • Filters toxins • Urine production
- 36. Kidneys-
- 38. Kidneys • Conditions • Signs • Renal cell Ca • Oliguria & anuria • Renal Failure • Deranged renal function • CKD • Deranged electrolytes • AKI- • ECG changes • Pre • Severe lower back pain • Renal • Post • Hydronephprosis • Renal calculi
- 39. Blood Vessels • Abdominal aorta • Inferior vena cava • Continuous with thoracic aorta • Formed by union of 2 common • T12 and L1 to L4 iliac veins • Ends at 2 common iliac arteries • Drains blood from lower limbs and abdomen • Travels alongside aorta • Conditions • AAA • Conditions • Obstructed IVC
- 40. Blood vessels
- 41. Other structures • Gynae structures • Male structures • Lymphatic system • Adrenal glands • Bladder, ureters etc • Unborn foetus
- 42. Abdominal History Key points • HPC • Curr • FHx • SHx
Editor's Notes
- Normal FindingsLiverUpper border – 5th right intercostal space on full expirationLower border – at costal margin in the midclavicular line on full inspirationSpleenUnderlies left ribs 9, 10, 11 to the mid axillary lineGallbladderIntersection of right lateral vertical plane and the costal marginPancreasNeck – level of L1Head below and rightTail above and rightKidneysUpper pole lies deep to the 12th rib posteriorly, 7cm from the midlineRight is 2-3cm lower than the left.
- Increase surface areaLymphatic capillary removes emulsified fats (CHYLE)
- Extends from the greater curvature of the stomachPassing in front of the small intestinesReflects on itself to ascend to the transverse colonTo the posterior abdominal wall