Gastrointestinal System Exam Overview

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Questions and Answers

Which of the following is NOT a stated objective of the gastrointestinal history and physical exam presentation?

Discuss humanistic skills relevant to a gastrointestinal problem-focused encounter.

List and discuss past medical and surgical history related to a gastrointestinal problem.

Analyze the efficacy of different medications used in gastrointestinal treatments. (correct)

Explain the performance of physical exams in a gastrointestinal problem focused encounter.

In a gastrointestinal problem-focused encounter, which history-taking component is MOST important for understanding the patient's current symptoms?

Family history.

HPI (History of Present Illness). (correct)

Social history.

Past surgical history.

During which week will the Suture and Knot Tying Competency take place?

During conference week (correct)

The second week of March

The last week of February

The first week of March

Which of the following best describes the focus of the physical exams done in a gastrointestinal problem-focused encounter as presented?

A physical exam specific to the gastrointestinal system. Signup and view all the answers

Which of the following is NOT a suture technique that students are responsible for, according to the provided content?

Figure-of-eight suture Signup and view all the answers

What is the primary purpose of identifying and interpreting normal versus abnormal findings during gastrointestinal specialty exams?

To formulate a differential diagnosis. Signup and view all the answers

A protuberant abdominal contour might be noted during abdominal inspection in a patient with which of these conditions?

Obesity Signup and view all the answers

According to the information provided, what portion of the FOM 7 Block Grade is attributed to CMR activities?

14%. Signup and view all the answers

Which of the following is an example of a skin abnormality that might be noted during an abdominal physical exam?

Rashes or lesions Signup and view all the answers

Which of the following CMR activities is worth 25 points?

Mock Hospital Rounds. Signup and view all the answers

Which of the following abdominal contour descriptions indicates a concave appearance?

Scaphoid Signup and view all the answers

If a student performed all CMR activities, what is the total amount of points they would receive?

150 points. Signup and view all the answers

What is the term for dilated veins that may be seen during an abdominal exam?

Caput medusae Signup and view all the answers

Which of the following is an element of gastrointestinal history taking?

Gathering information about the patient's medications and allergies. Signup and view all the answers

What is the primary reason why a patient's abdomen would be described as 'gravid'?

Pregnancy Signup and view all the answers

What could be interpreted from the sample documentation shown in the given content, 'Non-distended, no scars or rashes noted'?

The patient exhibits a normal abdominal exam for these specific findings. Signup and view all the answers

Study Notes

Gastrointestinal System - History & Physical Exam

Course Content: This presentation outlines the history and physical exam components for gastrointestinal (GI) complaints.
Conflict of Interest Disclosure: The speaker has no financial or other conflicts of interest related to this presentation.
Objectives:
- List and discuss HPI (history of present illness) components for painful vs. non-painful GI complaints.
- Discuss associated symptoms in GI patients.
- List and discuss history-taking elements for a GI focused encounter (past medical/surgical history, medications, allergies, family history, and social history).
- Explain physical exam procedures used in a GI encounter (details in PowerPoint).
- Identify/interpret normal vs. abnormal findings from GI specialty exams, and their diagnostic use.
- Discuss humanistic skills in GI patient encounters.
CMR Activities (Assessment):
- 1/15/25: Hospital Rounds Activity (SOAP note) - 5 points
- 2/5/25 & 2/6/25: Mock Hospital Rounds – 25 points
- 2/12/25 & 2/13/25: Endocrine SP Encounter SOAP note - 20 points Clinical Competency Exam (CCE) - 25 points
- 2/24/25 & 2/25/25: OSCE (2 SP Encounters, 1 graded SOAP note) - 150 points total (including 50 points for each SP encounter, 50 points for graded SOAP note)

Suture and Knot Tying Competency

Skill Assessment: Evaluation of suture and knot tying techniques learned during the Fall term.
Competency Requirements:
- Holding instruments correctly
- Two-handed knot-tying
- One-handed knot-tying
- Instrument tie
- Simple interrupted suture
- Vertical mattress suture
- Horizontal mattress suture
- Subcuticular running suture
- Subcuticular interrupted suture
Assessment Date: March 5-6, 2025 (Conference Week)

Abdominal Pain Differential Diagnosis

Organization: Pain location guides the differential diagnoses.
Differentials are by location: (presented in a table format, not suitable for bullet points)

Physical Examination: Inspection

Contour:
- Flat
- Rounded
- Scaphoid
- Protuberant (Obesity, Pregnancy)
Distention:
Asymmetry: Masses, hernias, enlarged organs,
Skin: Rashes, lesions, scars, striae, bruising, erythema, jaundice, dilated veins (caput medusae), visible pulsations.
Documentation Examples (Normal): Non-distended, no scars or rashes noted.
Documentation Examples (Abnormal): Distended with periumbilical bruising noted.

Physical Examination: Auscultation

Method: Listening in all four quadrants.
Bowel Sounds:
- Normoactive (5-34 sounds/minute) - high pitched gurgling.
- Hyperactive (>34 sounds/minute) - louder, more frequent.
- Hypoactive (<5 sounds/minute) - soft, infrequent.
- Absent
Bruits: Listen for bruits in renal arteries, aorta, iliac arteries, and femoral arteries.
Documentation Examples (Normal): Normoactive BS throughout
Documentation Examples (Abnormal): Hypoactive BS noted throughout. R renal bruit noted.

Physical Examination: Percussion

Method: Striking the abdomen with a finger.
Sounds:
- Tympany: Predominant sound, reflects gas in intestines.
- Dullness: Reflects fluid, solid mass or abdominal organs.
Documentation Example (Normal): Tympany to percussion throughout
Documentation Example (Abnormal): Dullness to percussion in the LLQ and tympany elsewhere.

Physical Examination: Palpation

Abdomen: Comprehensive palpation across all nine regions.
Method: Light to deep palpation using entire palmar surface.
Guarding vs. Rigid Abdomen:
- Guarding: voluntary muscle contraction (relaxable).
- Rigidity: involuntary muscle stiffness (due to peritoneal inflammation).
Assessment (Palpation): Tenderness, masses, hernias, organomegaly.
Documentation Examples (Normal): Abdomen is soft, not tender, non-distended, without rebound, guarding, or masses.
Documentation Examples (Abnormal): LLQ guarding and tenderness on palpation, rebound tenderness in LLQ.

Physical Examination: Rebound Tenderness

Method: Asses for peritoneal inflammation by applying pressure and quickly withdrawing.
Positive: Pain on release of pressure.
Documentation Examples (Normal): Abdomen soft, not tender, non-distended, without rebound tenderness.
Documentation Example (Abnormal): LLQ guarding and tenderness, rebound tenderness noted.

Physical Examination: Special Tests

Murphy's Sign: Checking for acute cholecystitis.
McBurney's Point: Assessing for appendicitis.
Rovsing Sign: Detecting appendicitis.
Psoas & Obturator Signs: Evaluating for appendicitis.
Fluid Wave: Identifying ascites (fluid in the abdomen)
Shifting Dullness: A second method for identifying ascites.
Ventral Hernia: Evaluating ventral abdominal wall hernias

Physical Examination: Liver Size

Percussion: Used to determine superior/inferior liver border.
Method: Percussion across the midclavicular line to find the dullness border.
Estimation: Measure the vertical distance between the borders.

Physical Examination: Palpation of the Liver and Spleen

Methods: Assessing for liver tenderness and spleen size

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Description

This quiz focuses on the history and physical exam components relevant to gastrointestinal (GI) complaints. Participants will explore key elements of history-taking and review procedures and findings associated with GI assessments. Enhance your skills in recognizing both normal and abnormal GI exam results.