GI exam Flashcards
What are you looking for in general inspection in a GI exam?
- Bed area: stoma bags, catheter bags, surgical drains, feeding tubes
- Patient: colour (jaundice?, pallor?), build (wasting? obesity?), pain, conscious level
What are you looking for in the hands in a GI exam?
- Koilonychia: anaemia
- Leukonychia: anaemia
- Clubbing: IBD, coeliac, liver cirrhosis
- Palmar erythema/pallor: chronic liver disease/anaemia
- Dupuytren’s contracture: genetic, alcohol, diabetes
- Asterixis (liver flap): hepatic encephalopathy, renal failure
- Temperature
- Radial pulse
What are you looking for in the arms in a GI exam?
- Bruising: clotting abnormalities due to liver disease
- Scratch marks: pruritis
- Needle track marks: IVDU
- Acanthosis nigricans (in axillae): insulin resistance
What are you looking for in the eyes in a GI exam?
- Conjunctival pallor: anaemia
- Jaundice (in superior sclera)
- Corneal arcus: hypercholesterolaemia
- Xanthelasma: hypercholesterolaemia
- Kayser-Fleischer rings: Wilson’s disease
What are you looking for in the mouth in a GI exam?
- Angular stomatitis: anaemia
- Glossitis: anaemia
- Ulcers: anaemia, Chron’s, coeliac
- Dehydration
What are you looking for in the neck in a GI exam?
Palpation of the lymph nodes in the neck and supraclavicular fossae
- enlargement of the left supraclavicular lymph node is an early in sign of metastatic intrabdominal malignancy
What are you looking for in the chest wall in a GI exam?
- Spider naevi: liver cirrhosis
- Gynaecomastia: liver cirrhosis
What are you looking for in inspection of the abdomen in a GI exam?
- Scars: surgery
- Distention: fluid, faeces, flatus, foetus, fat
- Striae/stretch marks: ascites, malignancy, obesity, pregnancy, Cushing’s syndrome
- Hernias: umbilical/incision
- Visible masses and pulsations
- Distended veins: portal hypertension
- Bruising (Cullen’s around umbilicus or Grey-Turner’s around flank): late sign of pancreatitis
What does palpation of the abdomen involve?
- Light palpation of the nine regions, looking for:
- tenderness
- rebound tenderness
- guarding
- rigidity - Deep palpation of the nine regions to assess the characteristics of any masses
- location
- size and shape
- consistency
- mobility
- pulsatility
How do you palpate the liver?
- Begin in the right iliac fossa
- While the patient breathes in, press deeply with the edge of your hand
- While the patient breathes out, withdraw hand and reposition higher up
- The liver is normally felt 1cm below the costal margin
- greater than 2cm below the costal margin = hepatomegaly
- nodular consistency = cirrhosis
- tenderness = hepatitis or cholecystitis
How do you palpate the spleen?
- Begin the right iliac fossa
- While the patient breathes in, press deeply with the edge of your hand
- While the patient breathes out, withdraw hand and reposition towards the left costal margin
- palpation of the spleen at the left costal margin = enlargement by x 3
How do you ballot the kidneys?
- Place your left hand behind the patients back under the right flank, and your right hand on the anterior abdomen in the right flank
- Push your fingers together, pressing upwards with your left hand and downwards with your right hands
- the kidneys are not usually ballotable, but the lower pole may be felt in thin individuals
- if the kidney is palpable, describe its size and consistency
How do you palpate the aorta?
Place both hands either side of the midline just superior to the umbilicus, and note the movement of your fingers:
- healthy individuals = finger move superiorly with each pulsation
- hands will move outwards with an expansile mass e.g. AAA
How do you palpate the bladder?
Warn the patient that this may make them feel the urge to urinate
Palpate the suprapubic region for a distended bladder (in most healthy patients the bladder is not palpable)
How do you check for Murphy’s sign?
Place your fingers at the right costal margin in the mid-clavicular line
Ask the patient to breathe in
If the causes pain and stops inspiration, but not when done on the left, this is a positive Murphy’s sign and is suggestive of acute cholecystitis
How do you percuss the liver?
- Begin in the right iliac fossa and percuss upwards 1-2cm at a time towards the right costal margin
- The percussion note will change from resonant to dull, indicating the lower liver border
- Continue upwards until the note changes from dull to resonant, indicating the upper liver border
How do you percuss the spleen?
- Percuss in lowest intercostal space (8th/9th) in the anterior axillary line
- In a positive finding the note will change from resonant on full expiration (air-filled stomach/colon) to dull on full inspiration as an enlarged spleen moves inferiorly
How do you percuss the bladder?
- Percuss down the midline from the umbilical region towards the pubic symphysis
- A dull percussion note indicates the distended bladder
How do you test for shifting dullness?
- Percuss from the centre toward the left flank
- If a dull note is heard, keep your finger over the area and as the patient to roll onto their right side (towards you)
- Wait for 30 seconds, then repeat the percussion in the same area
- If ascites is present, this area should now be resonant, as the fluid has shifted
How do you auscultate the abdomen?
Asses bowel sounds, in at least 2 places for…
- normal bowel sounds
- tinkling bowel sounds: bowel obstruction
- absent bowel sounds: ileus
Listen for bruit…
- aortic bruit (1-2cm superior to umbilicus): AAA
What further assessments and investigations are needed for a GI exam?
ISHRUG
I - Inguinal lymph nodes
S - stool sample
H - hernial orifices
R - rectal examination
U - urinalysis
G - genital exam
