G.I. system examination in children
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This slide elaborates the examination of gastrointestinal system in a child.
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G.I. system examination in children
- 1. G.I. SYSTEM EXAMINATION by Dr. Gobinda Prasad Pradhan
- 2. Is it so ? • Upper GI • Lower GI Ligament of Treitz ©Dr. Gobinda Pr. Pradhan
- 3. Facts ©Dr. Gobinda Pr. Pradhan
- 4. How they present • Abd Pain • Nausea • Vomiting • Dysphagia • Diarrhoea • Constipation • Jaundice • Abd distension • Bleeding • Itching • Decr. Apetite • Lump/Mass ©Dr. Gobinda Pr. Pradhan
- 5. EXAMINATION • Upper GI tract a) Lips b) Oral cavity : Teeth/Gum/Tongue/Palate/Pharynx/Tonsil/Breathe • Abdomen ©Dr. Gobinda Pr. Pradhan
- 6. LIPS • Colour : Cyanosis/ Pallor • Deformity : CL • Corner : AS/AC/Rhagades ©Dr. Gobinda Pr. Pradhan
- 7. GUMS • Colour : Cyanosis, Anemia, Lead poisoning • Hypertrophy • Bleeding ©Dr. Gobinda Pr. Pradhan
- 8. Teeth • Age • Hygiene • Congenital teeth ©Dr. Gobinda Pr. Pradhan
- 9. What is this ? HUTCHINSON TEETH ©Dr. Gobinda Pr. Pradhan
- 10. What is this ? BOTLE BABY SYNDROME ©Dr. Gobinda Pr. Pradhan
- 11. Tongue • Colour • Size • Tremor • Deviation • Dry • Strawberry tongue • Magneta tongue • Beefy tongue • Bald tongue • Coated tongue • Geographical tongue ©Dr. Gobinda Pr. Pradhan
- 12. Breathe • Bad odour • Fruity odour ©Dr. Gobinda Pr. Pradhan
- 13. Others • Koplik spot • Apthous ulcer • Oral thrush • Patch/Membrane over tonsil ©Dr. Gobinda Pr. Pradhan
- 14. EXAMINATION OF ABDOMEN ©Dr. Gobinda Pr. Pradhan
- 15. • INSPECTION • PALPATION • PERCUSSION • AUSCULTATION ©Dr. Gobinda Pr. Pradhan
- 16. 1 2 3 7 8 9 4 5 6 ©Dr. Gobinda Pr. Pradhan
- 17. INSPECTION • Positioning and lighting • Shape • Skin • Movement with respiration • Umbilicus • Visible pulsation • Hernial orifices • External genitalia ©Dr. Gobinda Pr. Pradhan
- 18. Positioning and lighting • Important to properly visualize the child’s abdomen • The patient should be supine with his or her hips slightly flexed. This relaxes the abdominal muscles, giving better access to deeper structures. • Always examine the patient from the right side ©Dr. Gobinda Pr. Pradhan
- 19. 5F Shape • Scaphoid : N/Abn • Protuberant • Distension : a) Sym : Gas, Fluid, Obesity, Rickets, Hypothyroidism b) Asym : Mass, Kidney, Bladder, Liver, Spleen ©Dr. Gobinda Pr. Pradhan
- 20. Skin over abdomen • Tense & glistening • Wrinkled • Dilated veins • Striae • Caput medusae • Scar mark ©Dr. Gobinda Pr. Pradhan
- 21. Movement with respiration • AT • TA • Paradoxical • Asymmetry ©Dr. Gobinda Pr. Pradhan
- 22. Umbilicus • Normal : Inverted/ Flat • Everted • Smiling/Laughing umbilicus • Umbilical hernia ©Dr. Gobinda Pr. Pradhan
- 23. PALPATION ©Dr. Gobinda Pr. Pradhan
- 24. PALPATION • Feel : soft/ very soft/ doughy/ rigid • Skin turgor • Abd wall oedema • Tenderness • FT • Liver • Spleen • Kidney ©Dr. Gobinda Pr. Pradhan
- 25. Liver (Normal findings) • Soft or soft to firm • Smooth surface • Regular/rounded margin • Moving with respiration • Fingers cant be insunated ©Dr. Gobinda Pr. Pradhan
- 26. Liver examination • Size • Shape • Consistency • Border • Surface • Tenderness • Pulsation • HJ reflex ©Dr. Gobinda Pr. Pradhan
- 27. Liver palpable ; is it Normal • Upto 6 month : 2-3 cm • 6m to 4 yr : 2 cm • >4 yr : 1-2 cm AGE LIVER SPAN Birth 5.5 cm 1 yr 6 2 yr 6.5 3 yr 7 4 yr 7.5 5 yr 8 12 yr 9 579 RULE ©Dr. Gobinda Pr. Pradhan
- 28. So, when it is palpable • Visceroptosis • Pushed down • True hepatomegaly ©Dr. Gobinda Pr. Pradhan
- 29. Spleen • Size • Consistency • Surface • Tenderness ©Dr. Gobinda Pr. Pradhan
- 30. HACKETT CLASSIFICATION ©Dr. Gobinda Pr. Pradhan
- 31. • Mild(2 cm) : Typhoid, endocarditis • Moderate (3-7 cm) : PHTN • Massive (>7 cm) : Gaucher’s ds, Kala azar, CML, TSS ©Dr. Gobinda Pr. Pradhan
- 32. KIDNEY • Bimanual palpation ©Dr. Gobinda Pr. Pradhan
- 33. SPLEEN KIDNEY Finger insulation not possible Possible Spl notch No notch Palpable Ballotable Renal angle is resonant May dull Traubes space dull A band of colonic resonance Enlarged in spl axis (can cross midline) Can’t ©Dr. Gobinda Pr. Pradhan
- 34. Demonstration of direction of flow in distended vein ©Dr. Gobinda Pr. Pradhan
- 35. PERCUSSION ©Dr. Gobinda Pr. Pradhan
- 36. WHO AM I • It is used to differentiate supra-diaphragmatic from infra- diaphragmatic dullness. • While the patient seated find the upper level of dullness • Ask the patient to take deep inspiration and to hold it then percuss again. • If the note becomes resonant : infra-diaphragmatic cause. • If there is no change of the note : supra-diaphragmatic cause as pleural effusion ©Dr. Gobinda Pr. Pradhan
- 37. TIDAL PERCUSSION ©Dr. Gobinda Pr. Pradhan
- 38. WHAT AM I DOING ? ©Dr. Gobinda Pr. Pradhan
- 39. SIGNS OF ASCITES • Abd distension • Tr Slit like umbilicus • Horse shoe shaped dullness • Puddle sign • SD • Full flank • FT ©Dr. Gobinda Pr. Pradhan
- 40. METHOD VOLUME USG 100 ml PUDDLE SIGN 120 ml CLINICALLY 150 ml SD 500 Ml FT 100-1500 ml ©Dr. Gobinda Pr. Pradhan
- 41. AUSCULTATION ©Dr. Gobinda Pr. Pradhan
- 42. • Bowel sound • Borborgymi • Bruit ©Dr. Gobinda Pr. Pradhan
- 43. STILL CONFUSED !! ©Dr. Gobinda Pr. Pradhan