Git examination pediatrics awais

SYED AWAIS UL HASSAN SHAH TRAINEE 1ST YR PAEDIATRICS

Before starting GI Examination Wash hands / warm them Proceed calmly / don’t make sudden moves Shake hands and offer some candy or toy Introduce yourself / explain what you are going to do (older child/ parents) Ask the patient to point to the part which is tender(can be unreliable) Position the patient (depends upon child’s comfort) Expose the patient on required basis Approach from right side of the patient Gather as much data as possible by observation first Alter the sequence of examination if required but present it in a sequential manner Order of exam: least distressing to most distressing

Components of GIT Examination Abdominal examination Oral cavity examination Genitalia examination Rectal examination Relevant physical examination

ABDOMINALEXAMINATION

ABDOMEN INSPECTION  Shape of the abdomen  Movements of abdominal wall  Umbilicus  Visible loops of bowel/ visible peristalsis  Scar  Striae  Prominent veins  Pubic hair  Hernial orifices

ABDOMEN Palpation  Light palpation  To test muscle tone/ rigidity / guarding  Deep palpation  Tenderness and rebound tenderness  Palpation for viscera  Liver  Size, edge, surface, consistency, tenderness, pulsations  Spleen  Size, surface, consistency, splenic notch

 Kidneys  Bimanual technique (lower pole may normally be palpable)  Tenderness (Murphy’s renal punch) Urinary bladder  Grasping the upper border by thumb and index finger of left hand

One hand ballottement Bimanual ballottement

ABDOMEN Masses palpable other than viscera  Hard feces  Abdominal aorta  Gastric mass (HPS)  Abdominal lymph nodes  Para aortic lymph nodes / mesenteric lymph nodes Dipping method of palpation  Helpful in palpation of viscera in ascites  Placing hand over the abdomen and making quick dipping movements (also known as one hand ballottement) Skin turgor

PERCUSSION To determine boundaries of mass and organs To detect ascites

PERCUSSION LIVER  Percuss for both upper and lower borders Spleen  Start percussing from RIF to LHC  Place left middle finger parallel to the LCM Urinary Bladder  Percuss from epigastrium towards hypogastrium

 PERCUSSION FOR ASCITES  Shifting dullness  Fluid thrill

AUSCULTATION BOWEL SOUNDS  ABSENT  LOUD VENOUS HUMS  B/W XIPHISTERNUM AND UMBILICUS Renal Bruit Hepatic Bruit Succussion Splash Puddle Sign

ORAL CAVITY Lips Gums Teeth Tongue Mucous membrane Others ( aphthous ulcers, thrush, palate)

Examination of Genitalia and Groin Male  Urethral orifice (hypospadias, epispadias)  Size of penis (CAH)  Testes (swelling, cryptchordism, retractile testes, inguinal hernia, torsion)  Developmental abnormalities / ambiguous genitalia  Orchidometer (precocious puberty, macro orchidism)

Examination of Genitalia and Groin Female  Vulva  Vagina (discharge, FB, suspected abuse)  Clitoris  Developmental abnormalities / ambiguous genitalia

Rectal examination Normally done in  Acute abdomen  Chronic constipation  Rectal bleeding Look for  Tone of anal sphincter and tenderness (anal stenosis loose patulous anus [myelomeningocele], imperforate anus)  Masses ( feces, polyps, teratomas, foreign bodies)  Local abdominal tenderness  Blood or other staining  Rectal prolapse  Perianal area (thread worms, skin tags, protruding polyps, anal fissures, fecal soiling)

RELEVANT GENERAL PHYSICALEXAMINATION  Vital signs  Anthropometric measurements along with plotting on growth chart (PEM, malabsorption, obesity)  Dysmorphic features  Clubbing  Pallor  Dehydration  Edema (facial, sacral, pedal)  Odours

RELEVANT GENERAL PHYSICALEXAMINATION Bruising , petechiae , purpura Inspection of stools and urine Hair Skin Spider angiomatas Nails

RELEVANT GENERAL PHYSICALEXAMINATION Jaundice Lymph nodes Spinal examination such as swellings, tufts of hair, or indentations Meningeal signs

RELEVANT GENERAL PHYSICALEXAMINATION Eyes Gynaecomastia Thyroid (diarrhea) Papilledema Joint swelling Flapping tremors CVS examination Hyperreflexia and extensor plantars (CLD)

Git examination pediatrics awais

by Ali Shazir

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