Gastrointestinal tract physical examination

Inorganic Mercury. Ingestion of metallic mercury results in negligible absorption and little effect on the gastrointestinal tract. The two case histories identified are unusual in that the dose levels could be reasonably well quantified. The first case history reported ingestion of 15 mL (204 g) of metallic mercury by a 17-year-old male storekeeper who swallowed mercury from the pendulum of a clock (apparently out of curiosity rather than as a suicide attempt). On admission, and 24 hours later, he was symptom free, and physical examination was normal. The patient complained of no gastrointestinal symptoms, and was treated with a mild laxative and bedrest (Wright et al. 1980). 

Depletional hyponatremia (excess loss of Na ) is almost always accompanied by a loss of ECF water, but to a lesser extent tlian the Na loss. Hypovolemia is apparent in the physical examination (orthostatic hypotension, tachycardia, decreased skin turgor). Loss of isosmotic or hypertonic fluid is the cause and this can occur through renal or extrarenal losses. If urine Na is low (generally <10 mmol/L), the loss is extrarenal (see Figure 46-2) because the kidneys are properly retaining filtered Na in response to increased aldosterone (stimulated by the hypovolemia and hyponatremia). Causes of extrarenal loss of Na" in excess of H2O include losses from the gastrointestinal tract or skin (see Figure 46-2). 

Physical assessment should include examination of all common sites of infection, including mouth/pharynx, nose and sinuses, respiratory tract, gastrointestinal tract, urinary tract, skin, soft tissues, perineum, and intravascular catheter insertion sites. 

Physical examination and endoscopy are stiU mainstays of cancer detection, e.g., in the gastrointestinal (GI) tract, the skin, and the lower urogenital tract (Gupta et ak 2008 Palka et ak 2008 Rex and Eid 2008 Shi-RODKAR and Lokeshwar 2008). Screening for cervical cancer (and cervical intraepithelial neoplasia) with... 

---