GI

Question 1

Introduction

Answer 1

State name, level in profession

Ask for patient to confirm ID

Explain the examination and gain consent

Hand wash

Expose the patient

• Nipples to knees
• Upright position

Question 2

End of bed observation

Answer 2

Well/ unwell
Comfortable?
Jaundice?
In pain?
Nourished?

Question 3

Hands

Answer 3

Clubbing

Leukonychia

Koilonychia

Palmar erythema

Dupuytren’s contracture

Asterixis
- Liver flap

Radial pulse
- Rate and rhythm (count 30 secs x 2)

Question 4

Face

Answer 4

Eyes [2]

• Conjuctiva pallor
• Jaundice

Mouth [4]

• Angular stomatitis
• Glossitis
• Mouth ulcers
• Dentition

Question 5

Neck

Answer 5

Lymph nodes

• Submandibular
• Cervical
• Supraclavicular–> Virchow’s node

Question 6

Chest

Answer 6

Spider naevi

>3 = liver disease, esophageal varicies

Question 7

Abdomen

- Scars

Answer 7

Appendectomy

• Lanz
• Mcburney’s

Midline

Kochers
- Cholecystectomy

Pfannenstiel

• Cystectomy
• Prostectomy

Paramedian
- Left= colectomy

Laproscopic scars

Drainage scars

Question 8

Abdomen

- Observation

Answer 8

Scars

Distention

Caput medusae

Question 9

Abdomen

- Palpations

Answer 9

Superficial then deep [9 sections]
- Zig zag pattern

After percussion

• Liver
• Spleen
• Kidney

Question 10

Percussion

Answer 10

Liver, spleen

Then palpate afterwards

If distension
- Shifting dullness

Question 11

Liver palpation

Answer 11

Ask patient to breathe in then palpate deeply with edge of hand.

Question 12

Kidney

Answer 12

Balloting

Question 13

Ausculatation

Answer 13

Bowel sounds around umbilicus

- Listen for at least 30 seconds.

Question 14

Other investigations [4]

Answer 14

Hernial orifices

External genitalia

Digital rectal exam

Urinalysis