GI Exam

Question 1

Hands and Arms

Answer 1

Tar staining

Nail Colour - anaemia or leukonychia

Clubbing

Koilonychia

Palms (erythema, pale palmar crease, dupytrens contracture)

Look at arms:

• Bruising
• Scratch marks
• Muscle wasting
• Track marks
• Skin turgor

Tremor - flapping tremor (liver flap), fine tremor (alcohol and alcohol withdrawal and DT)

Pulse respiratory rate and blood pressure

Question 2

Head exam

Answer 2

Parotid swelling

Eyes (jaundice / anaemia0

Mouth:

• angular stomatitis
• sore red tongue
• odour of foetor hepaticus - mouldy hay in liver failure
• gum swelling/bleeding
• dentition
• salivary glands and ducts
• floor of mouth
• apthous ulcers
• candidiasis/tonsillitis

Question 3

Lymph nodes

Answer 3

Full, with particular attention to virchows node

Tonsillar drains oropharynx

Submandibular drains 2/3 of tongue and floor of mouth

Submental drains tip of tongue and anterior floor of mouth

Preauricular drains face including parotid

Question 4

Necklace region

Answer 4

Spider naevi

Gynaecomastia

Loss of body hair in males

Question 5

Legs

Answer 5

Peripheral oedema

Loss of body hair

Erythema nodosa

Question 6

Abdomen inspection

Answer 6

Scars

Pulsation

Movement with respiration

Skin lesions

Scratch marks

Abdominal Shape (scaphoid/obese)

Stoma

Distended veins (caput medusae)

Petechiae

Striae

Abdominal Distension (fat, faeces, flatus, fluid or foetus)

Question 7

Abdomen Palpation 9 areas

Answer 7

Start palpation away from site of pain

Ensure hands are as warm as possible

Watch patients face

Light palpation - superficial masses, tenderness, muscle tension, rigidity

Deep palpation - tenderness

Other things - pulsation of abdominal aorta, caecum in the right lower quadrant (squelch)

Descending and sigmoid colon on the left side (containing varying amounts of faeces)

Liver edge is palpable in 10% of the population

Question 8

Abdomen palpation - liver

Answer 8

Upper border = 5th right intercostal space on full expiration

Lower border = MCL, costal margin, full inspiration

Question 9

Abdomen palpation - spleen

Answer 9

Located on 9th-11th ribs

Remember to bi-manually palpate the spleen

Question 10

Abdomen palpation - Kidneys

Answer 10

T12 - L3

Right kidney is 2-3cm lower than the left

Question 11

Percussion of liver

Answer 11

Percuss down the chest wall in the mid-clavicular line

At 2nd intercostal space should be resonant

5th intercostal space should be dull - indiciating the upper edge of the liver

Question 12

Percussion of spleen

Answer 12

Percussion

Question 13

What else do you percuss?

Answer 13

Free fluid - Shifting dullness and fluid thrill

Eliciting sign of shifting dullness indicates over 1.5 litres of fluid

Question 14

What do you auscultate?

Answer 14

Bowel sounds

Arterial bruits

Rubs

Question 15

Where do you listen for bowel sounds

Answer 15

LLQ

High pitched tinkling may indicate obstruction

Listen for 2 minutes before saying bowel sounds are absent

Question 16

Where do you listen for arterial bruits?

Answer 16

Abdominal aorta

Renal arteries

Liver (hepatocellular carcinoma)

Spleen (AV fistula)

Question 17

What causes the rubbing sound?

Answer 17

Inflammation of the capsule surrounding the organ, makes a rubbing sound when against the peritoneum

Deep breaths can make it easier to hear

Question 18

What does a complete examination include?

Answer 18

Full abdominal examination, hernial orifices, male genitalia and DRE