Clinical skills: GI exam

Question 1

What are the components of a GI exam?

Answer 1

Initial approach
General inspection
Vital signs
Hands/wrists/arms
Face and neck
Chest
Abdomen
Lower limbs
Finish the exam

Question 2

GENERAL INSPECTION
What are you looking for?

Answer 2

Body build
Obvious pain/distress
Mental state

Jaundice
Pallor
Pigmentation
Lesions
Hydration
Sweating

Question 3

GENERAL INSPECTION
Jaundice can affect which 2 parts of the body?
What can be a cause of abnormal mental state (hepatic encephalopathy) and jaundice (in a GI context?)

Answer 3

Skin and eyes
Buildup of unconjugated bilirubin (a toxin)

Question 4

VITAL SIGNS
What vital signs would you take?

Answer 4

Blood pressure
Pulse
Resp rate
Temperature

Question 5

HANDS, WRISTS, ARMS
What are the 4x groups of 3?
What is in each group of 3?

Answer 5

Fingers - clubbing, leukonychia, Muehrcke’s lines
Palms: pallor (anemia), erythema, Dupuytren’s contracture
Arms - skin: spider naevi, bruising, scratch marks
Arms - musculature: muscle wasting, fine tremor, hepatic flap

Question 6

HANDS, WRISTS, ARMS
Leukonychia
- What is it?
- What deficiency is it often caused by?

Muerche’s lines
- What is it?
- What deficiency is it often caused by?

Answer 6

Question 7

HANDS, WRISTS, ARMS
Palmar erythemia
- What can cause it?

Duypuytren’s contracture
- What is it?
- What can cause it?

Answer 7

Question 8

HANDS, WRISTS, ARMS
Scratch marks: why do they occur?
Bruising: why does bruising occur?
Spider naevi: describe their distribution? What are they associated with?
Hepatic flap: how to perform? What causes hepatic flap?

Answer 8

Question 9

HANDS, WRISTS, ARMS
What are you examining for?

Answer 9

Axillary lymph nodes: anterior, posterior, lateral, central, apical

Question 10

FACE AND NECK
What are you examining for?

Answer 10

Eyes
- Jaundice
- Conjunctival pallor (anemia)
- Kayser Fleischer rings
- Iritis
- Xanthelasma

Mouth
- Angular stomatitis
- Breath (fetor hepaticus)
- Teeth and gums
- Oral mucosa
- Tongue (glossitis and candidiasis)
- Pharynx

Question 11

FACE AND NECK
Fetor hepaticus, gingivitis, and glossitis are potential signs of:
What are Kayser-Fleischer rings and its causes?
What is iritis and its causes?

Answer 11

Liver disease

Question 12

FACE AND NECK
What do you examine?

Answer 12

Salivary glands (parotid and submandibular)
Cervical lymph nodes

Question 13

FACE AND NECK
What cervical lymph node is clinically important?

Answer 13

Virchow’s node - left supraclavicular lymph node.
Site of abdominal/pelvic cancer metastasis (gets there via lymphatic system)

Question 14

CHEST
What are you inspecting for?

Answer 14

Spider naevi
Males: gynaecomastia, hair loss

Question 15

ABDOMEN
What are you inspecting for?
What are the 3 groups?

Answer 15

Skin:
- Skin lesions
- Scarring
- Scratch marks
- Striae
- Signs (Turner’s, Grey-Cullen’s)

CV
- Visible veins
- Visible pulsations
- Abnormal breathing symmetry

Swellings
- Swelling
- Distension
- Hernias
- Visible peristalsis

Question 16

ABDOMEN
- Describe general palpation and percussion
- What 2 abnormalities are you looking for?
- If there is pain, what 4 additional things would you assess for?

Answer 16

Across 9 regions: light (1 hand), deep (2 hands), percuss
Masses and pain
Guarding and rigidity, rebound tenderness, cross tenderness

Question 17

ABDOMEN
Define guarding, rigidity, rebound tenderness

Answer 17

Guarding: when you push down on someone’s sore belly, they involuntarily contract stomach muscles to protect underlying organs

Rigidity: result of guarding

Rebound tenderness: when you press down (ordinarily hurts), releasing/rebound also hurts (not normal)

Question 18

ABDOMEN
Describe the rest of the ORGAN palpation and percussion you must do

Answer 18

Liver
- Palpate (between breaths)
- Percuss (and above for males)

Gall bladder
- Press in at 90 degrees where liver is, mid clavicular line. Positive Murphy’s sign is pain (may indicate acute cholecystitis)

Spleen
- Palpate (between breaths)
- Percuss

Kidneys
- Ballot

Aorta
- Palpate - 2 fingers, above umbilicus

Bladder
- Palpate (from umbilicus down)
- Percuss

Question 19

Describe the 2 tests for ascites

Answer 19

Question 20

What 3 additional things would we palpate for?

Answer 20

Hernias
Inguinal lymph nodes
Rectum

Question 21

ABDOMEN
What are we auscultating for?

Answer 21

Bowel sounds (4 quadrants)
Renal artery bruits (with bell; just above umbilicus either side)
Hums and friction rubs: with diaphragm - epigastrium for aorta, over liver and spleen.

Question 22

LEGS
What are we assessing for?

Answer 22

Pitting oedema
Scratch marks
Bruising