GI Exam

Question 1

What are the 3 phases of GI exam?

Answer 1

1. Inspection of hands, eyes, mouth and oral cavity and palpation of lymph nodes
2. Abdomen- inspection, palpation (superficial and deep), specific organ palpation, percussion and auscultation
3. Rectal examination on a specimen model

Question 2

What are signs of GI disease seen on inspection of the hands?

Answer 2

Palmar erythema, spider naevi, leukonykia (signs of chronic liver disease), flapping tremor (occurs with hepatic encephalopathy), finger clubbing (associated with liver cirrhosis, inflammatory bowel disease and malabsorption syndromes) and dupuytren’s contracture (alcohol-related chronic liver disease)

Question 3

What are signs of GI disease seen on inspection of the face?

Answer 3

Foetor hepaticas (distinctive ‘mousy’ odour on breath due to portosytemic shunting), pale conjunctivae (anaemia), oral ulcers, angular chelitis, oral pigmentation, confusion, dentition, and enlarged salivary glands

Question 4

What is important during inspection the abdomen?

Answer 4

• Patient in correct position, as flat as comfortably possible
• Inspection from side and end of bed, reporting on presence or absence of signs, including movement with respiration, scars, veins, signs of weight loss, masses, bruising, swelling, excoriation and visible peristalsis

Question 5

What are the steps involved in palpation of the abdomen?

Answer 5

• Adopts the correct position- right side of bed, seated at the level of the patient if possible
• Superficial palpation: beginning away from site of any reported pain watching patient’s face, palpate each region/quadrant in turn
• Deep palpation: repeat with deeper palpation of each region
• Test abdominal muscle tone by lightly dipping with fingers, testing for rebound tenderness
• Feel for aorta

Question 6

What are the steps involved in specific organ palpation?

Answer 6

• Feel for liver, starting in the right iliac fossa, commenting on the character of the liver edge, with confirmation by percussion
• Feel for spleen, starting in RIF, percussion to confirm
• Feel for kidneys (balloting)

Question 7

How can you describe the liver edge?

Answer 7

Describe size, surface (smooth or irregular), edge (smooth or irregular), consistency (soft or hard), tenderness and whether it is pulsatile

Question 8

How do you test for shifting dullness?

Answer 8

• With the patient supine, percuss from the midline out to the flanks. Note any changes from resonant to dull, along with areas of dullness and resonance
• Keep your fingers on the site of dullness in the flank and ask the patient to turn on to their opposite side
• Pause for 10 seconds to allow any ascites to gravitate, then percuss again. If the area of dullness is now resonant, shifting dullness is present, indicating ascites

Question 9

What is the examination sequence for auscultation?

Answer 9

• With the patient supine, place your stethoscope diaphragm to the right of the umbilicus and do not move it
• Listen for up to 2 minutes before concluding that bowel sounds are absent
• Now listen 2-3 cm above and lateral to the umbilicus for bruits from renal artery stenosis
• Listen over the liver for bruits
• A succussion splash sounds like a half-filled water bottle being shaken. Explain the procedure to the patient, then shake the patient’s abdomen by lifting him with both hands under his pelvis

Question 10

What is the last thing to do in a GI exam?

Answer 10

Wash hands and summarise

Question 11

What would you advise be done after the GI exam?

Answer 11

Examination of hernial orifices, and external genitalia rectal exam and check BMI if indicated