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Taking History & Methods of Physical Examination For: Koray Topgül

The document outlines the important steps in taking a thorough history and performing a physical examination for gastrointestinal (GI) complaints, including obtaining details of the present illness and performing a systemic review of other body systems, as well as the patient's medical, family, and social history. It describes examining the abdomen through inspection, palpation, percussion, and auscultation to evaluate for tenderness, masses, organomegaly, and bowel sounds. The goal is to gather all relevant information to make an accurate clinical diagnosis.

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ayadalshawki7
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117 views38 pages

Taking History & Methods of Physical Examination For: Koray Topgül

The document outlines the important steps in taking a thorough history and performing a physical examination for gastrointestinal (GI) complaints, including obtaining details of the present illness and performing a systemic review of other body systems, as well as the patient's medical, family, and social history. It describes examining the abdomen through inspection, palpation, percussion, and auscultation to evaluate for tenderness, masses, organomegaly, and bowel sounds. The goal is to gather all relevant information to make an accurate clinical diagnosis.

Uploaded by

ayadalshawki7
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Taking History &

Methods of Physical Examination


for GIT

Koray Topgül
Department of Surgery, MD, Prof.
ALL PATIENTS HAVE A PROBLEM!

HOW TO SOLVE IT?


We can, we should….

 HISTORY ……70%
 CLINICAL EXAMINATION (history+physical exam..80%)

 CLINICAL DIAGNOSIS
 INVESTIGATIONS
 FINAL DIAGNOSIS
 TREATMENT
IMPORTANT POINTS BEFORE
HISTORY-TAKING
 Introduce yourself
 Explain yourself
 Full attention (eye contact☺)
 Treat with respect
 Let patient talk
 Guide, not dictate
 No leading question
 No short-cuts
 Try not to write and talk to the patient at the same time
Different parts of a history
 PERSONAL DETAILS
 PRESENTING COMPLAINT
 HISTORY OF PRESENT ILLNESS
 SYSTEMIC INQUIRY
 PAST MEDICAL/SURGICAL HISTORY
 FAMILY HISTORY
 HISTORY OF MEDICATIONS
 SOCIAL HISTORY
 OTHER HISTORY
PERSONAL DETAILS
 NAME
 AGE
 SEX
 NATIONALITY
 MARITAL STATUS
 OCCUPATION
Record date of history taking and examination
PRESENTING COMPLAINT

 What are you complaining of?


(record in patient’s own words)

 When more than one complain:


(record in order of severity)
HISTORY OF PRESENT ILLNESS
 Full details of the complaint or complaints.
 Get right back to the beginning of the trouble.
 Each complain- fully analyzed e.g., pain
 Site
 Time and mode of onset ( sudden, gradual)
 Severity
 Nature (aching, burning, stabbing, constricting, throbbing)
 Progression
 Duration
 Aggravating/ relieving factors
 Radiation
 Cause
SYSTEMIC INQUIRY
of the involved or affected system

Example:
Chief complaint related to
gastrointestinal system(GI)-
continue with the GIT inquiry.
SYSTEMIC INQUIRY
GASTRINTESTINAL SYSTEM

 Weight  Jaundice
 Appetite  Abdominal pain
 Dysphagia  Fat intolerance
 Nausea  Constipation
 Vomiting  Diarrhoea
 Heartburn  Melaena
 Haematemesis  Rectal bleeding
 Flatulence  Stool
SYSTEMIC INQUIRY
RESPIRATORY SYSTEM

 Cough
 Sputum
 Hemoptysis Hemoptysis[a] or haemoptysis is the act of coughing up blood
or blood-stained mucus from the bronchi, larynx, trachea, or lungs.

 Wheeze
 Dyspnoea
 Chest pain
 Smoking
SYSTEMIC INQUIRY
UROGENITAL SYSTEM

 Loin pain
 Dysuria
 Nocturia
 Frequency
 Haematuria
 Urinary stream
 Incontinence
 Urethral discharge
SYSTEMIC INQUIRY
CARDIOVASCULAR SYSTEM

 Angina (cardiac pain)


 Dyspnoea ( rest/ exercise)
 Palpitations
 Ankle swelling
 Claudication
 Varicose veins
SYSTEMIC INQUIRY
Obstetric & Gynecology Nervous system

 Vaginal discharge  Headache


 Vaginal bleeding  Fits
 Pregnancies  Depression
 Facial/limb weakness
SYSTEMIC INQUIRY
MUSCULOSKELETAL

 Muscular pain
 Bone & Joint pain
 Swelling of joints
 Limitation of movements
 Weakness
SYSTEMIC INQUIRY
METABOLIC/ENDOCRINE

 Bruising/ bleeding
 Sweating
 Thirst
 Pruritus
 Alcohol
 Weight
PAST MEDICAL/SURGICAL
HISTORY

 Rheumatic Fever
 Tuberculosis/ Asthma
 Diabetes
 Jaundice
 Operations/ Accident
 Blood transfusion
 Mental illness
FAMILY HISTORY
 Diabetes
 Hypertension
 Heart disease
 Malignancy
 Cause of death

Father/Mother/Siblings/Spouse/Children/Close relatives
HISTORY OF MEDICATIONS
 Insulin
 Steroids
 NSAID
 Contraceptive pills
 Antibiotics
 Others
SOCIAL HISTORY
 Marital status
 Occupation
 Travel abroad
 Accommodation
 Habits ( smoking, alcohol )
 Dependent relatives
OTHER HISTORY
 Psychiatric/ Emotional background

 Allergies
Food
Drugs

 Immunizations
Tetanus
Diphtheria
Tuberculosis
Hepatitis
Others
Review and analyse

 More questions looking for clues?


 Questions
Questions
Questions
Questions
ABDOMINAL EXAMINATION
GASTROINTESTINAL EXAMINATION
General examination
General inspection
Hands and arms  Abdominal examination
Face, eyes and mouth
⚫ Inspection
Neck
⚫ Palpation
⚫ Percussion
⚫ Auscultation
GENERAL INSPECTION
Nutritional state (wasting)
Pallor
Jaundice (liver disease)
Pigmentation (hemochromatosis)
Mental state (encephalopathy)
FACE, EYES …
Conjuctival pallor (anaemia)
Sclera: jaundice, iritis
Cornea: Kaiser Fleischer’s rings (Wilson’s disease)
Xanthelasma (primary biliary cirrhosis)
Parotid enlargement (alcohol)
ABDOMINAL EXAMINATION
POSITIONING
Abdomen can be divided in four quadrants
Patient should be lying on supine position
ABDOMINAL EXAMINATION
INSPECTION
Shape and movements
Scars
Distension
Localised: mass, organomegaly
Generalized: 5 F’s
Prominent veins (caput medusae)
Striae
Bruises
Pigmentation
Visible peristalsis
Ascitic abdomen
ABDOMINAL EXAMINATION
PALPATION
1. Ensure that your hands are warm
2. Stand on the patient’s right side
3. Help to position the patient
4. Ask whether the patient feels any pain
before you start
5. Begin with superficial examination
6. Move in a systematic manner through the
abdominal quadrants
7. Repeat palpation deeply.
ABDOMINAL EXAMINATION
PALPATION
Tenderness: discomfort and resistance to palpation
Involuntary guarding: reflex contraction of the
abdominal muscles
Rebound tenderness: patient feels pain when the
hand is released
Tenderness + rigidity: perforated viscus
Palpable mass (enlarged organ, faeces, tumour)
Aortic pulsation
ABDOMINAL EXAMINATION
MURPHY’S SIGN
Pain in RUQ
Inflammation of gallbladder
(cholecystitis)
Courvoisier's law
ABDOMINAL EXAMINATION
BLUMBERG’S SIGN
a.k.a. rebound tenderness
Pain upon removal of pressure rather than
application of pressure to the abdomen
Peritonitis and/ or appendicitis
ABDOMINAL EXAMINATION
MCBURNEY’S POINT
1/3 ASIS to umbilicus
Location of AV in retrocecal position
Deep tenderness (= acute appendicitis)
ABDOMINAL EXAMINATION
FLUID THRILL
 Place the palm of your left hand
against the left side of the
abdomen
 Flick a finger against the right
side of the abdomen
 Ask the patient to put the edge of a
hand on the midline of the
abdomen
 If a ripple is felt upon flicking we
call it a fluid thrill = ascites
ABDOMINAL EXAMINATION
PALPATION OF THE LIVER
1. Start palpating in the right iliac fossa
2. Ask the patient to take a deep breath in
3. Move your hand progressively further up the abdomen
4. Try to feel the liver edge
ABDOMINAL EXAMINATION
PALPATION OF THE SPLEEN
1. Roll the patient towards you
2. Palpate with your left hand while using your left hand to
press forward on the patient’s lower ribs from behind
3. Feel along the costal margin
ABDOMINAL EXAMINATION
PERCUSSION
Dull sounds: solid or fluid-filled structures

Resonant sounds: structures containing air or gas


ABDOMINAL EXAMINATION
AUSCULTATION
Place the diaphragm of the stethoscope to
the right of the umbilicus

Bowel sounds (borborygmi) are caused by


peristaltic movements

Occur every 5-10 sec.

Absence of b.s.: paralytic ileus or


peritonitis

Bruits over aorta and renal a. could be a


sign of an aneurysm and stenosis

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