Gastrointestinal Exam

Question 1

What are the steps to a gastrointestinal exam?

Answer 1

Introduction
Assessment
Peripheral - hands, arms, head, LNs, neck/chest, legs
Abdomen
Extras

Question 2

What are you looking for in the hands/arms peripheral section of the examination?

Answer 2

• nail colour - tar, leukonychia, anaemia
• clubbing or koilonychia (spooning)
• palms - erythema, pale crease, dupuytren’s
• turgor
• tremor - flapping/fine
• bruises
• scratching/pruritus
• muscle wasting
• IV use
• pulse/resp/BP

Question 3

What are you looking for in the head during the peripheral section of the examination?

Answer 3

Parotid swelling
Jaundice/anaemia in eyes
Angular stomatitis, red tongue
Foetor hepaticus
Gums, dentition, glands

Question 4

What is an important lymph node to check during the examination?

Answer 4

Virchow’s node - drains GI tract

Question 5

What are you looking for during the examination of the chest?

Answer 5

Spider naevi
Gynaecomastia
Loss of body hair in males

Question 6

What are you looking for in the legs during the examination?

Answer 6

Peripheral oedema
Loss of body hair
Erythema nodosum

Question 7

What are the steps to the examination of the actual abdomen?

Answer 7

Inspection
Palpation
Percussion
Auscultation

Question 8

What are you looking for on inspection of the abdomen?

Answer 8

Scars
Skin lesions
Scratch marks
Petechia
Stria
Pulsation
Movement with respiration
Abdominal shape
Stoma
Distended veins
Distension (fat, faeces, flatus, fluid, foetus)

Question 9

What is the procedure for palpation of the abdomen?

Answer 9

Light palpation for tenderness and superficial masses
Deep palpation
Palpate for liver on inspiration
Palpate for spleen (R iliac fossa > L hypochondrium on inspiration)
Palpate for kidneys (bimanual, expiration)

Question 10

What is the procedure for percussion of the abdomen?

Answer 10

Percuss for liver - upper and lower borders
Percuss for spleen in same pattern as palpation
Shifting dullness
Fluid thrill

Question 11

What is the procedure for auscultation of the abdomen?

Answer 11

Bowel sounds in L lower quadrant
Bruits - abdominal, renal, liver, spleen
Rubs - liver and spleen

Question 12

What are the last procedures to perform in a full GI exam?

Answer 12

Groin examination
Hernial orifices
Male genitalia
Digital rectal examination