Examination

Question 1

What are the steps in general examination of the abdomen?

Answer 1

1. Introduction
2. General inspection
3. Fat and protein stores
4. Upper limbs
5. Head and neck
6. Abdomen -anterior
7. Abdomen- posterior
8. Lower limbs
9. Other

Question 2

What do you see on general Inspection of the abdomen?

Answer 2

Anthropometry
Nutritional status
Sick or well
Pallor
Jaundice
Bruising, petechiae
Peripheral stigmata of CLD
Oedema
Tachypnoea
Involuntary movements
Access devices

Question 3

What do you look for in the upper limbs- Gi?

Answer 3

Nails, palms, xanthomata, asterixis, wrists and other joints

Dermatitis herpetiformis

Question 4

Head and neck exam in GI?

Answer 4

Face
Eyes: lids, conjunctivae, sclerae, iris, cornea, lens, retina
Mouth

Question 5

Steps and signs in anterior abdomen examination?

Answer 5

Inspection
-distension
-scars
-access devices
-injection sites
-stoma
-hernia
-abdominal wall veins
-striae
Palpation, percussion, auscultation
-abdominal tenderness
-hepatomegaly
-Hepatic bruit (hepatoma)
Splenomegaly
-Enlarged kidneys (PCKD)
-ascites
-Abdominal masses
-Inguinal hernia

Question 6

Steps and signs in posterior abdomen exam?

Answer 6

Inspection

• Purpura on buttocks
• Xanthomata on buttocks (CLD)
• Gluteal wasting
• Perianal fissures
• Imperforate anus

Question 7

Signs in lower limb of GI exam?

Answer 7

Bowing
Erythema nodosum
Joint swelling
Ankle oedema (palpate)

Question 8

Other findings on GI exam?

Answer 8

Urinalysis
Stool analysis
Temperature
+/- Neuro/Resp/CVS

Question 9

DDx of pallor

Answer 9

GIT blood loss
CLD
nutritional deficiencies of iron, folate, vitamins

Question 10

DDx Jaundice

Answer 10

CLD

Vit B12 dfciency with ileal resection or disease

Question 11

DDx bruising

Answer 11

CLD
Thrombocytopaenia in hypersplenism
HSP

Question 12

DDx petechiae

Answer 12

Hypersplenism in petechiae

Question 13

Peripheral stigmata of CLD

Answer 13

Spider naevi
Red palms
scratch marks (pruritis secondary to cholestasis)
Xanthomata (cholestasis)

Question 14

DDx Oedema in GI?

Answer 14

CLD, PLE

Question 15

DDx dysarthria in GI?

Answer 15

Wilsons

Question 16

DDx of involuntary movements in GI

Answer 16

Athetosis
chorea
tremor
dystonia or myoclonus (Wilson’s)

Question 17

Clinical evidence of rickets?

Answer 17

Bow legs
Prominent wrists and ankles
rib rosary

Question 18

Nail signs and associations in GI

Answer 18

Clubbing- CLD, IBD, CF
Leuconychia- CLD
Koilonychia - Fe deficiency
Cyanosis- CF
brown spots- Peutz Jeghers

Question 19

Palm signs in GI?

Answer 19

Crease pallor- anaemia
erythema- CLD
Crease pigmentation- addisons
-

Question 20

Facial signs in GI?

Answer 20

Cushingoid

Doll face ‘cherub’- GSD types 1 and 3

Question 21

Eye signs in GI?

Answer 21

Pigmentation periocular- PJ
Xanthelasma- Hyperlipidaemia
Pale conjunctivae- 
Xerosis- Vit A deficiency
Jaundiced sclerae
Iritis- IBD
Cornea
-Xerosis, Clouding- Vit A deficiency
-Kayser Flascher rings- Wilsons
Lens- Cataracts (TORCH, steroid Rx, Wilsons
Retina
-pigmentation (abetalipoproteinaemia, Alagille)
-chorioretinitis (TORCH)
-ROP (Ex prem with NEC)

Question 22

Mouth signs in GI?

Answer 22

Breath- hepatic fetor
Lips
-angular cheilosis (iron deficiency)
-pigmentation (PJ)
Buccal mucosa
-brown-black pigmentation (PJ, Addisons)

Question 23

Anterior abdomen signs in GI?

Answer 23

Distension
- weak abdo muscles (PCM, coeliac)
-Ascites (CLD, PLE, PCM)
Scars- Kasai, colectomy, liver transplant
Access devices
Injection sites- CF
Stoma
Prominent veins
Striae

Question 24

Neurological exam in GI? (Infants)

Answer 24

Alertness- decreased in Zellweger, TORCh
Hypotonic- Zellweger
Choreoathetoid mvts (kernicterus)
Gross motor - hypotonic in Zell, hypertonic in TORCH
Persistent primitive reflexes- TORCH, Bilirubin encephalopathy

Question 25

Neuro exam in GI? >5

Answer 25

Gait
Cerebellar ataxia (Vitamin E deficiency)
Peripheral neuropathy (Vitamin E deficieny)
Involuntary movements (WIlsons)
Antalgic gait (Arthritis with IBD)
Rombergs- Vitamin E
Wings beating tremor- Wilsons
Diminished reflexes- Vitamin E def
Diminished sensation- Vitamin E def

Question 26

Resp exam in GI?

Answer 26

Full exam

Question 27

CVS exam in GI

Answer 27

Full praecordial exam

• Alagille (Pulmonary arterial stenosis)
• Congenital rubella
• CF (cor pulmonale)