Summary - talley & o connor summary - gi PDF

Preview

Summary

Talley & O Connor Summary - GI...

Description

Dysphagia) Specific'questions'to'ask'a'patient'with'difficulty'swallowing:' • Do#you#have#trouble#swallowing#solids,#liquids#or#both?## − Trouble#with#solids#and#liquids#à฀#a#motor#problem#achalasia# − Trouble#with#liquids#only#à฀#pharyngeal#disorders#(globus#pharyngis#–#feeling#of#lump#in#throat)# − Trouble#with#solids#only#à฀#mechanical#obstruction#–#tumours/strictures# • Where#does#the#hold#up#occur#–#point#to#the#area.### • Is#the#trouble#swallowing#intermittent#or#persistent?# − Intermittent#suggests#eosinophilic#osophagitis.# • Has#the#problem#bee#getting# progressively#worse?# − Suggestive#of#stricture,# carcinoma#or#achalasia.# • Do#you#cough#or#choke#on#starting#to# swallow?# − Oropharyngeal#dysphagia.# • Is#it#painful#to#swallow?# − Odynophagia# • Have#you#been#losing#weight?# Examination' Intro,#explanation,#consent# • Position#patient#lying#flat#on#bed#with# pillow,#chest#an#abdomen#exposed.# • Wash#hands# General'appearance:' • Note#weight#loss#due#to#decreased# food#intake#or#oesophageal#cancer.## • Stridor/swelling/cyanosis/plethora/pal lor# Vital'signs:' • Pulse#(rate,#rhythm,#volume),#RR,#BP,# Temp,#BMI# Hands/Arms:' • Koilonychia#à฀#iron#deficiency# anaemia#is#associated#with#upper#oesophageal#web#N#Plummer#Vinson#Syndrome,#sometimes#also#called#PetersonNBrownNKelly#Syndrome.# • Palmar#crease#pallor#à฀#iron#deficiency#anaemia#à฀#Plummer#Vinson#Syndrome.## • Check#hands#for#scleroderma.## Face:' • Mouth#ulcerations/infections/#pallor/#food/#dentition/#tongue#(glossitis/angular#chelitis)# • Lower#cranial#nerves#–#bulbar#or#pseudobulbar#palsy# • Signs#of#URTI/pharyngeal#inflammation/tonsillar#enlargement# • Muscle#wasting#of#mouth#à฀#CN#V# Neck:' • Inspect:#Any#gross#abnormalities,#deformities#or#growths#on#inspection# • Palpate:#supraclavicular#lymph#nodes,#superficial#cervical#lymph#nodes,#thyroid# • Auscultation:#of#an#enlarged#thyroid##N#bruit#may#be#heard.# • Auscultation:#of#Zenker’s#diverticulum#–#outpouching#of#the#posterior#pharyngeal#wall#à฀#gurgling#sound.# Chest:' • Inspect:#any#obvious#deformities:# • Palpate:#evidence#of#aspiration#pneumonia#à฀#reduced#lung#expansions#with#pneumonia# • Percussion:#dullness# • Auscultation:#crackles,#reduced#air#entry# Abdomen:' • Inspection:#varices#on#stomach#wall' • Palpation:#hepatomegaly#due#to#secondary#deposits' Other:' • PR#exam#–#rule#out#malaena' • Neurological#examination#to#rule#out#neurological#cause.#'

' # #...