Gastrointestinal exam

Question 1

GI exam: General inspection

Answer 1

• Well/unwell
• Posture
  
  • Writhing (colicky pain)
  • Lying very still (appendicitis/peritonitis)
• Body habitus
  
  • Cachectic (buttock wasting)
    
    • Coeliac
• Colour
  
  • Jaundice
  • Pale
• Peripheral oedema (hypoalbuminaemia)
• Bruising (chronic liver disease)
• Vomit bowl/bed pan

Question 2

GI exam: Hands

Answer 2

• Inspect
  
  • Nails
    
    • Clubbing
      
      • Crohn’s
      • Ulcerative Colitis
      • Cirrhosis
    • Leukonychia (chronic liver disease)
    • Koilonychia (iron deficiency anaemia)
  • Hands
    
    • Palmar erythema (chronic liver disease)
    • Asterixis
• Palpate
  
  • Pulse

Question 3

GI exam: Face

Answer 3

• Eyes
  
  • Conjunctival pallor
  • Scleral icterus
  • Periorbital oedema (nephrotic syndrome)
• Mouth
  
  • Atrophic glossitis (deficiency anaemia)
  • Angular stomatitis (iron/B12 deficiency)
  • Ulcers (Crohn’s)

Question 4

GI exam: Abdomen - Inspection

Answer 4

• Lift head off the pillow/cough (hernias)
• Distension
  
  • Fat, Fluid, Flatus, Faeces
  • Organomegaly
  • Ascites + everted umbilicus
• Peristalsis (pyloric stenosis)
• Signs of chronic liver disease
  
  • Gynaecomastia
  • Spider naevi
  • Caput medusae
    
    • Engorged cutaneous collateral veins with blood flowing away from the umbilicus due to portal hypertension
• Scars (→ obstruction/stenosis secondary to adhesions)

Question 5

GI exam: Palpation

Answer 5

• Enquire about pain
• Palpate for tenderness/mass
  
  • Guarding
  • Rebound (more tender on release - appendicitis/peritonitis)
• (Percuss liver/spleen edge)
• Palpate liver/spleen edge
• Ballot kidneys
• Shifting dullness (if required)

Question 6

GI exam: Constipation

Answer 6

• Abdominal distension
• Mass in LIF
  
  • Hard
  • Indentable
  • Non-tender

Question 7

GI exam: Appendicitis

Answer 7

• Child lying very still, minimal movement, may have knees bent
• Abdominal pain beginning in umbilical region, moving to RIF
  
  • McBurney’s point
    
    • 1/3 of the distance from the anterior superior iliac spine to the umbilicus
• Guarding, rebound tenderness
• Signs
  
  • Rovsing’s
    
    • Pain in RIF when pressure in LIF
  • Psoas
    
    • Pain in RIF with hip flexion
  • Obturator
    
    • Pain in RIF with internal rotation of the hip

Question 8

GI exam: Completion

Answer 8

• Plot height and weight on growth chart
• Examine:
  
  • Hernial orifices
  • External genitalia
  • Urine dipstick