Gastrointestinal Physical Examination

Question 1

Order of areas in examination

Answer 1

General Inspection
Hands
Arms
Face 
Neck
Axillae
Chest
Abdomen
Groin (mention only)
Rectal Examination (mention only)
Legs
Other

Question 2

General Inspection?

Answer 2

Patient looks well
Mental State
Weight
Muscle Wasting
Pigmentation - jaundice
Telangectasia (spider veins)

Question 3

Hands?

Answer 3

Nails: Clubbing and Leukonychia

Pamls: erythema, pallor of palmar creases

Signs of Dupuytren’s Contracture

Question 4

Cause of leukonychia

Answer 4

Damage to the nail bed resulting in ‘milk spots’. Most commonly due to hypoalbuninaemia as a consequence of chronic liver disease

Question 5

Nail clubbing indicates what?

Answer 5

Can indicate heart, lung or gastrointestinal pathologies

Question 6

What is dupuytren’s contracture

Answer 6

Palmar fascia becomes abnormally thickened and can result in reduced function of the fingers. Result is abnormally contracted fingers: usually affecting the little and ring fingers. Middle fingers affected in extreme cases

Question 7

Arms?

Answer 7

Asterixis - hepatic flap

Skin markings: ecchymoses, petichiae, scratch marks, spider naevia

Muscle Wasting

Question 8

Causes of asterixis

Answer 8

Usually hepatic encephalopathy
Primarily related to abnormal ammonia metabolism
(believed to affect brain cells)

Question 9

Face?

Answer 9

Eyes: Jaundice and pallor. xanthelasma, parotids

Mouth: Dentition, Fetor, Gum hypertrophy, Ulceration, Pigmentation

Question 10

Neck?

Answer 10

Nodes: Cervical and Supraclavicular lymph nodes

Question 11

Axillae?

Answer 11

Lymph nodes: Lateral, Posterior, Anterior, Middle, Central

Question 12

Chest?

Answer 12

Skin markings: ecchymoses, petichiae, scratch marks, spider naevi

Palpate for gynacomastia in males

Question 13

Cause of gynacomastia?

Answer 13

Liver failure or cirrhosis: Liver’s ability to metabolise oestrogen is impaired.

Also risk associated with alcoholic liver disease: ethanol may directly disrupt the synthesis of testosterone, leading to higher oestrogen levels than testosterone

Leads to development of uni- or bilateral breast tissue.

Question 14

Abdomen - inspection

Answer 14

(Exposure)
INSPECTION:
Scars
Striae
Distension
Masses
Abnormal pulsations
Visible peristalsis
Obvious cutaneous veins

Question 15

Abdomen: Palpation

Answer 15

Reassure patient, inform of potential discomfort, and check re tenderness

Light palpation of the 9 regions: looking for tenderness, masses, or guarding

Deep palpation of the 9 regions: looking for tenderness, masses, or guarding

Liver span: feel with respiration, percuss down to top edge, measure span (should be <11cm)

Spleen: palpate from lower-right. THEN ALSO roll patient onto their R side

Kidneys: Palpate bimanually

Question 16

Abdomen: Percussion & Auscultation

Answer 16

Percuss spleen if impalpable: From L costal margin in AAL in complete expiration

Percuss bladder

Percuss for ascites: Midline to flanks, then roll patient to check for shifting dullness

Auscultate bowel sounds

Question 17

Groin, Rectal Examination and Legs.

Answer 17

Groin: mention only - Palpation of testes, palpate for inguinal and femoral hernias, and inguinal lymph nodes

Rectal Examination: Including prostate

Legs: Inspect for skin changes - ecchymoses, petichiae, scratch marks, spider naevi

Palpate for oedema

Question 18

Other information I’d like to know>

Answer 18

Actual weight and BMI

Temperature charts

Would like to perform a urine dipstick

Would perform CVS and inspect JVP if found hepatomegaly