Rural Emergency Medicine

Physical examination of a patient is an important component of forming a diagnosis and developing an appropriate management plan. There are number of methods that clinicians utilise to examine the patient. Two common methods used in conjunction are the tip-to-toe method and medical method.

Tip-to-toe: Examine the patient from the finger tips up to the head and then down to the toes via the chest, abdomen, pelvis, legs and feet. This is to ensure that the chance of missing an abnormality is greatly diminished.

Medical Method: Inspection, Palpation, Percussion and Auscultation.

Gastrointestinal or Abdominal examination is used in combination with suitable history taking to determine the likely disease (e.g. hepatitis, gastroenteritis, appendicitis and so on).

Red flags to look for in the history: 
  • Change in appetite or any unintentional weight loss/gain
  • Fever
  • Dysphagia (difficulty swallowing) 
  • Indigestion/heart-burn 
  • Nausea or vomiting 
  • Haematemesis (vomiting blood) (is blood fresh (red), or is it like ‘coffee grounds’) 
  • Abdominal pain or distension
  • Jaundice (yellow discolouration of eyes/skin - due to increased free bilirubin) 
  • Change in bowel motions (volume, frequency, consistency, etc)
  • Blood in stool
    • obvious red blood- lower GIT (e.g. haemorrhoids, cancer)    
    • mixed blood (e.g. inflammatory bowel)    
    • malaena – upper GIT – black digested blood (e.g. gastric ulcer)
Major Threats to Life

  • Abdominal Aortic Aneursyn (AAA) expansion or rupture 
  • Ruptured ectopic pregnancy
  • Severe infection leading to sepsis (e.g. bacterial peronitis, ascending cholangitis, pancreatitis)
  • Excessive bleeding leading to hypovolaemic shock (e.g. varices, perforated ulcer) 
  • Extra-abdominal causes (AMI, thoracic aortic dissection and/or DKA)

Basic Surface Anatomy
Before proceeding with learning how to perform the clinical examination, it is important to understand some basic surface anatomy. The diagrams below provide a basic illustration of the trunk surface anatomy.

Images from Mikael Häggström and Grays Anatomy

The video done by the Clinical Skills Online project from the University of London below, provides a good demonstration of how to perform a gastrointestinal exam. Importantly, always remember to wash your hand before beginning an examination.

Other Clinical Exams
Cardiovascular | Respiratory | Gastrointestinal | Neurological | Musculoskeletal

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