L GIT

1.

Gastrointestinal Tract
Examination
Lecturer: Murat Faridovich Garipov

2.

Clinical topography of abdomen

3.

Subjective examination
Complaints of patients with gastrointestinal diseases depend on the organ
having the pathological changes.
Detailed elaboration of the pain syndrome includes
• localization of the pain with the statement of the following
questions
• character of the pain sensation;
• periodicity or persistence of it;
• connection with reception of nutrition (or defecation, physical
and emotional activity) and its quality;
• presence or absence of an irradiation;
• a position of the patient at the moment of an attack;
• how relive pains (a vomiting, medicines, a heater)
Symptoms of digestion disorders (dyspepsia) connect with affections
of digestion and/or passage of nutrition in definite parts of the
gastrointestinal tract

4.

Typical complaints in diseases of esophagus

5.

Typical complaints in diseases of
stomach and duodenum (1)

6.

Typical complaints in diseases of
stomach and duodenum (2)

7.

Typical complaints in diseases of
intestines (1)

8.

Typical complaints in diseases of
intestines (2)

9.

General survey in gastrointestinal
diseases (1)

10.

General survey in gastrointestinal
diseases (2)

11.

Percussion and Auscultation of
abdomen – by your self!

12.

Palpation of the Abdomen
Common rules of the abdominal palpation:
The patient should relax in his bed. The bed should not be too
soft.
Patient’s legs should be stretched or bent at the knees, and the
arms flexed on the chest or placed along the body.
The patient's breathing should not be deep; his head should
rest against a small firm pillow. This position ensures relaxation of the
abdominal muscles.
The physician takes his place by the right side of the bed,
facing the patient. The chair should be firm and level with the patient's bed.
The ambient temperature should be comfortable for the
patient,
The hands of the doctor should be warm and dry, nails must
be short
Abdominal palpation is performed only after an auscultation
and a percussion of the abdominal cavity
The examining movements should be careful and gentle so as
not to hurt the patient.

13.

Purposes of superficial and deep
palpation
• Superficial (light touch) palpation examines
condition of the anterior abdominal wall.
• Deep palpation is used to establish normal
topographic relations between the abdominal
organs and their normal physical condition;
the other object is to detect any possible pathology
that changes the morphological condition of the
organs and their topographic relations responsible for
their dysfunction, to locate the defect, and to
determine its nature.
The deep palpation gives information on the
topography of the abdominal cavity (topographic
palpation)

14.

The superficial (light touch) palpation
of the abdomen
Aims of the superficial (light touch) palpation are research of
properties of the anterior abdominal wall:
• location of the painful site;
• resistance and rigidity of anterior abdominal wall or its
muscle
strain;
• density formed in a wall, hernias, tumours;
• to differentiate a skin puffiness from augmentation of the
subcutaneous fatty tissue.

15.

The sequence of the superficial palpation
of the abdomen

16.

Technique of superficial (light touch)
palpation of the abdomen (1):
1. The examiner puts his right hand flat on the patient's
abdomen,
2. slightly flexes the fingers (it is possible to bend the
arm and metacarpophalangeal joints, but some) and
plunges the fingertips not more 2-3 cm in the
abdominal wall without sliding, wherein the base of
arm moves in the direction of the fingers, without
touching the skin of patient or sliding on it,
3. raises his hand over his stomach
4. moves in its new position

17.

Technique of superficial (light touch)
palpation of the abdomen (1):

18.

The deep (sliding methodical topographic)
palpation of the abdomen
Aims of the deep sliding palpation are research of
abdominal organs properties, such as:
• localization;
• mobility;
• tenderness;
• consistency;
• diameter;
• condition of the surface (smooth, tubercular);
• absence or presence of rumbling sounds during
palpation.

19.

The sequence of the deep palpation
• left ileum area – sigmoid
and descending colon;
• right ileum area – cecum,
ascending colon and
terminal end of ileum;
• further the epigastric and
umbilical regions - stomach
with its parts (greater
curvature and pylorus) and
transverse colon
• the following stage
palpation of liver, spleen
and kidneys

20.

The deep sliding palpation technique
includes the following four steps.
• I step: proper positioning of the physician's hands. The right hand
is placed flat on the anterior abdominal wall collateral to the axis
of the examining part or the edge of examining organ.
• II step: formation of the skin fold (in direction from examining
organ) to facilitate further movements of the examining hand.
• III step: moving the hand inside the abdomen. Deep palpation is
performed when the fingers are moved gradually with each of
expirations, into the abdomen when the abdominal wall is
relaxed. The explorative hand thus reaches the posterior wall of
the abdomen or the underlying organ.
• IV step: sliding movement of the fingertips in the direction
perpendicular to the transverse axis of the examining organ. The
organ is pressed to the posterior wall of the abdominal cavity,
and the explorative fingers continue moving over the examined
intestine or the stomach curvature.

21.

The deep sliding palpation technique

22.

Diagnostic value of the deep
palpation of the gastrointestinal tract

23.

Liver and biliary tract – by
yourself!!!!!!

24.

Thanks for your attention!