Gastrointestinal System

INSPECTION

Mouth and throat

Lips symmetric right left downturning cyanosis cheilitis herpes

Pharynx pink hyperemia inflammation

Tonsils not changed enlargement hyperemia inflammation

Edges of the palatine arches not reddened hyperemia

Mucous membrane not changed pink hyperemia aphthae thrush

Gingivae pallor hyperemia ulceration pigmentation haemorrhage not loosened gum’s bleeding absent present

Tongue moist dry

Size normal abnormal teeth traces

Colour pink red crimson red

papillae expressed normally papillary atrophy

clear fur whole root center white grey yellow brown

ulceration absent present

symmetry right left deviation

Teeth caries missing teeth dental repair

Swallowing not changed difficulty painful free

Abdomen

Shape oval sunken protuberant distended pendulous board-like frog inflated retracted

Symmetry symmetrical asymmetrical

Striae absent

Scars absent postoperative

dilated veins absent dilated venous network caput medusa

visible peristalsis absent antiperistaltic movements

hernias absent

respiratory movements actively reduced

Sites and description of any abnormality ________________________________

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PALPATION

Surface tentative palpation (light)

Soft inflated rigid abdomen

Tenderness non-tender tender

muscle tone not changed

divarication of the rectus abdominis muscles absent present

distention absent present

resistance absent present

enlargement gallbladder liver spleen kidneys masses

hernia orifices

presence of ascites

Sites and description of any abnormality ________________________________

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Deep sliding palpation (according to Obraztsov&Strazhesko):

· sigmoid colon impalpable palpable painless tender movable (easily moderately) motionless fixed elastic dense smooth tubercular cylinder of ___ cm in diameter

rumbling sounds absent present

· caecum impalpable palpable painless tender movable (easily moderately) motionless fixed elastic dense smooth tubercular cylinder of ___ cm in diameter

rumbling sounds absent present

· ileum terminal impalpable palpable painless tender movable (easily moderately) motionless fixed elastic dense smooth tubercular cylinder of ___ cm in diameter

rumbling sounds absent present

· McBurney’s point painless tender

· ascending colon impalpable palpable painless tender movable (easily moderately) motionless fixed elastic dense smooth tubercular cylinder of ___ cm in diameter

rumbling sounds absent present

· descending colon impalpable palpable painless tender movable (easily moderately) motionless fixed elastic dense smooth tubercular cylinder of ___ cm in diameter

rumbling sounds absent present

· transverse colon impalpable palpable at the level of navel ____ cm above lower

painless tender movable (easily moderately) motionless fixed elastic dense smooth tubercular cylinder of ___ cm in diameter

rumbling sounds absent present

· the stomach at the level of navel ____ cm above lower

techniques by percussion stethacoustic palpation the splashing sound

greater curvature impalpable palpable painless tender elastic dense smooth tubercular ledge cylinder

· the pylorus impalpable palpable as band tense relaxed

· the lower edge of the liver impalpable

position at the level of right costal margin ____ cm lower

surface smooth tubercular

consistency densely-elastic hard rough

edge soft firm sharp rounded tender readily bending edge insensitive

· the gallbladder impalpable palpable painless tender

Biliary-cystic point pancreato-biliary-cystic point point of phrenic nerve free ends of right 11^th and 12^th ribs point of the scapular angle paravertebral points to the right of the 8^th to 11^th thoracic vertebra epigastric area shoulder zone

Zakharyin’s symptom (sharp pain in the region of the gallbladder when it is tapped or pressed), Vasilenko’s symptom (sharp pain in the region of the gallbladder when it is tapped over at the height of inspiration)

Obraztsov-Murphy symptom (sharp pain in the right hypochondrium when the examiner’s hands press the gallbladder at the height of inspiration)

Ortner’s symptom (pain during tapping over the right costal arch by the edge of the hand)

· the spleen

impalpable palpable at the level of left costal margin ____ cm lower

in the recumbent position on patient’s right side

· the pancreas

impalpable palpable soft firm cylinder band _____ cm immobile mobile

painless tender

Desjardin’s point Gubergritz’s point Mayo-Robson’s point

Shauffard’s zone Gubergritz’s zone

PERCUSSION

Liver

The height of absolute liver dullness by Vinogradov:

The right parasternal line ______ cm

the right midclavicular line ______ cm

the right anterior axillary line ______ cm.

The height of absolute liver dullness by Kurlov:

The anterior median line ______cm

the right midclavicular line ______ cm

along the left costal arch ______ cm.

Spleen: _____ × _____ cm

Tympany over the abdominal cavity

Dullness absent present shifting

Fluid wave

AUSCULTATION

intestinal murmurs (peristalsis bowel sounds) over the abdominal cavity

peritoneal friction rub arterial bruits venous hum

Sites and description of any abnormality ________________________________

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Дата добавления: 2015-11-14