Gastric carcinoma patient examination (suspected case)

Gastric carcinoma patient examination (suspected case)Created OnMarch 15, 2020Last Updated OnApril 15, 2020byadmin You are here: Main Clinical Examination Gastric carcinoma patient examination (suspected case) < All Topics Table of Contents Physical examination of gastric carcinoma patient Inspection General appearance – nutritional status Patients may be cachexic Sign of jaundice and anaemia Look for any visible peristalsis or abdominal mass pyloric obstruction causes epigastric distension and visible peristalsis) Sister Mary Joseph nodes Trancoelomic spread of gastric carcinoma to around the umbilicus Look for edema of the lower limbs Venous thrombosis is a recognized complication of neoplastic disease, classically presenting as an oedematous lower extremity Hypoalbuminemia can cause pitting oedema Palpation Feel for any mass An abdominal mass may be palpated, depending on the location and extent of the tumor Describe the lump (Site, size, shape, margin, surface, consistency and pulsation) Palpate for any lymph node swellings especially the Left axillary (Irish node) Supraclavicular (Virchow node) – Troisier’s sign Check for any organomegaly Hepatomegaly may result from obstruction or liver metastasis The liver may be palpable, edge and surface knobby and irregular) Demonstrate Succussion Splash in cases of carcinoma causing Gastric Outflow Obstruction Nicholson maneuver: a type of abdomen palpation where pressure is exerted on the lower end of sternum with the base of left palm. This will cause patient to breathe abdominally thereby making the various organs easily palpable (just for knowledge only, commonly not practice) Metastatic nodules may be felt in the pelvis Rectovesical pouch (Bloomer’s Shelf) & ovaries (Krukenberg’s tumours) Percussion On percussion look for ascites in advanced disease Auscultation Bowel sounds usually normal unless ileus presence Lung examination Look for presence of pleural effusion (reduced vocal fremitus/ vocal resonance, stony dullness on percussion) The presence of pleural effusion – pulmonary metastases) Rectal examination Per-rectal examination to feel for any anal/rectal mass Take note of faeces colour and odour, is that malenic stool or fresh blood *Taken from Doctrina Perpetua Clinical Surgery 2nd edition. Doctrina Perpetua Clinical Surgery 2nd edition

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