Gastrointestinal Examinations

Question 1

Abdominal Examination:

What do you look for at the end of the bed?

Causes of abdominal distention split into the 4F’s - list them

Answer 1

Weight loss
Obvious jaundice
Respiratory rate and pattern

Fat 
Fluid (ascites) 
Faeces (constipation) 
Fiatus - a fart basically 
Fetus

Question 2

Abdominal Examination:

Hands:

What does clubbing indicate in GI?

What is the white area on the nail called and what causes it?

What are spoon shaped nails called and what does it indicate?

Answer 2

IBD
Cirrhosis
Coeliac Disease
GI lymphoma

Leukonychia - low albumin - hypoalbuminaemia

Koilonychia - iron deficiency anaemia

Question 3

Abdominal Examination:

What 2 other things on the hands could indicate chronic liver disease (CLD)?

• Colour
• Fingers

Answer 3

Palmar erythema

Dupuytren’s contracture - also linked to phenytoin use and DM

Question 4

Abdominal Examination:

What do you look for in the arms especially? What do you get the patient to do?

What causes this?

Answer 4

Flapping tremor

Stick hands out and cock wrists back

Hepatic encephalopathy
Hypercapnia

Question 5

Abdominal Examination:

What does spider naevi indicate? - get pic

What can you do with spider naevi that no other angioma does?

How many do you need for it to be concerning?

Who else can you find them in?

Answer 5

Alcoholic liver disease (ALD)

Blanching - can press down and the blood will refill it

More than 3

Pregnancy - caused by raised oestrogen

Question 6

Abdominal Examination:

What 2 things do you look for in their eyes?

What sign would you see in the eyes with Wilson’s Disease?

What does dry mucosa around and inside the mouth suggest?

Signs of IBD and coeliac disease:

• What deficiency does angular stomatitis suggest?
• What deficiency does glossitis suggest?

Answer 6

Anaemia
Jaundice

Golden-brown eye discoloration (Kayser-Fleischer rings)

Hypovolaemia

Low iron

Low B12

Question 7

Abdominal Examination:

What might you see around the shoulder region and what could it suggest?

Answer 7

Virchows node

Gastric cancer

Question 8

Abdominal Examination:

Closer inspection - what do you look for?

Where is caput medusae and what does it suggest? - look at pic

Where else could you find a similar pathology and how may they present?

Answer 8

Distention
Scars
Masses

Umbilical region

Portal hypertension

Question 9

Abdominal Examination:

Palpitation:

What does hepatomegaly suggest? - 3

What does splenomegaly suggest?

Why is splenomegaly dangerous?

What does kidney tenderness suggest?

What does an enlarged kidney suggest?

What 2 things would suggest there was a AAA?

Answer 9

Liver disease
Congestive heart failure
Cancer

Infections
Cirrhosis and other liver diseases
Blood diseases characterized by abnormali blood cells, problems with the lymph system, or other conditions.

A greater risk of rupture.
A ruptured spleen can lead to heavy internal bleeding that can be life-threatening.

UTI
Cancer
Stones

Hydronephrosis

Pulsatile
Expansile mass

Question 10

Abdominal Examination:

Why do you percuss?

How do you percuss for ascites?

Answer 10

Organomegaly and ascites

From mid-line to flank region
If dullness noted at flank, get them to roll towards you
Wait 10 seconds
Tap again to see if the dullness has shifted

Look at pics

Question 11

Abdominal Examination:

How do auscultate the aorta?

How do you auscultate the renal arteries?

What does no bowel sounds suggest?

What sounds suggest there is an obstruction?

Answer 11

3cm above umbilicus

3cm either side of a point 3 cm above umbilicus

Paralytic ileus
Peritonitis

Tinkling/high pitched sound

Question 12

Abdominal Examination:

What 4(men)/5(women) exams do you say you will order or do after the examination?

Answer 12

Hernial orifices - you basically check sites of hernias
PR/DRE - digital rectal exam
Examination of external genitalia
Urine dipstick

Pregnancy

Question 13

Abdominal Examination:

What comment if normal would you say after palpation?

Answer 13

Abdomen soft and non-tender throughout with no organomegaly felt

Question 14

Digital rectal examination:

Why do you need to do this?

Answer 14

Bowel symptoms

Prostate disease including urinary symptoms

Checking neurological function

Question 15

Digital rectal examination:

How should a patient position themselves?

What might you see from inspection?

What else ends to be done after inspection before moving on?

Answer 15

Lie on left side
Buttocks at edge of couch
Knees drawn up to chest
Heels clear of the perineum

Skin lesions
External haemorrhoids
Fistulae

Test sensation - just ask them if they can feel you touching the anus and for the anal reflex

Question 16

Digital rectal examination:

What can you do to relax the patient if you aren’t able to advance your finger?

What do you ask the patient to do when your finger is inside and why?

Answer 16

Ask them to breathe deeply and relax to prevent anal spasm

Ask patient to squeeze finger to check for weakness

Question 17

Digital rectal examination:

If mass found, how should it be recorded?

What is felt in the anterior rectum in women and men?

What does faeces feel like and how does it compare to a tumour? How do you differentiate the two?

Answer 17

Record distance from anus
% of rectal circumference it involves

Uterine cervix
Prostate

Faeces - soft and mobile but can be hard
Tumour - hard and fixed

Ask them to defecate and reexamine

Question 18

Digital rectal examination:

How do you examine the prostate?

What does BPH feel like?

What does cancer feel like?

Why might you not be able to feel the top of the gland? - 3

Answer 18

Move finger in circular motion

Size 
Shape 
Symmetry 
Margins 
Mobility 
Nodules 
Tenderness 
Induration or firmness 

Firm nodular enlargement

Ill defined enlargement

Patient obesity
Your fingers are to small
Large prostate

Question 19

Digital rectal examination:

If faeces is left on your fingers, what should be looked for?

Answer 19

Look for blood either black or tarry

Question 20

Weight Loss:

Mneumonic for causes;

FIND THAT MAN

Answer 20

GI:

Flour (gluten) sensitivity i.e. coeliac disease
IBD
Neoplasia (GI and non-GI)
Dysphagia

Endocrine:

(Th)yrotoxicosis
Addison’s
T1DM

Psych:

Mood low - depression
Anorexia nervosa