example, can you feel the liver? Is the liver
enlarged? So let’s talk about the physical
We’re going to first just inspect. We’re
just looking at the patient. Number one: is
there evidence of trauma? Is there any evidence
that the patient has had previous surgery
and, if so, ask what kind and what was it
for? Is there muscle wasting or are the muscles
asymmetrical – that is bigger on one side
than on the other. Is there swelling or edema
as we’ve talked about in the last lecture?
Is there erythema or redness? Are there ulcers
– that is areas where the skin has broken
down and where sometimes there’s infection?
Is the hair absent, particularly in the lower
extremities where poor blood flow results
in shiny, thin skin and loss of hair? Finally,
are there brown spots on the lower part of
the leg because blood has leaked out of capillaries
into the surrounding tissues and results in
this iron deposit that changes the colour
from normal to brown? And finally, is there
evidence of lipids in the tissues or is there
evidence of areas where the tissue has really
lost much of its vigour and its ability to
feel normal where it becomes fibrous and scarred?
Here’s an example of something that you
can see on a physical exam. Did you notice
this yellowish plaque, this little nodule
on the eyelid of this patient? This occurs
because of cholesterol deposition in the skin
and this is a sign that the patient has hypercholesterolemia
or very high blood cholesterol. And this is
a very strong risk factor for atherosclerosis.
And you notice all you had to do was look
in order to pick it up.