GI examination

Question 1

GI examination

Answer 1

General
• ICE
• Wash hands
• Position patient – lying flat, 1 pillow

Question 2

General inspection

Answer 2

(from end of bed)
CHARTS – medications, vital signs (temp, BP, pulse, RR), fluids
JAUNDICE: hyperbilirubinemia
WEIGHT
WASTING- malabsorption syndromes, malignancy, cirrhosis
PIGMENTATION- haemochromatosis, peutz-jeghers
TELANGIECTASIA– dilation of capillaries, spidery appearance usually caused by Cushing’s
VESICLES
Thickened/tethered skin – systemic sclerosis
MENTL STATE– encephalopathy

Question 3

Hands

Answer 3

Nails:
o Clubbing - CLD
o Leukonychia – hypoalbuminemia
o Koilonychias - spoon nails, iron deficiency anemia
o Meuhrcke’s lines – transverse white lines hypoalbuminemia, nephrotic syndrome
o Mee’s lines – renal failure
o Blue lunulae – copper deposition in Wilson’s disease

Palms
o Erythema – increased oestrogen in CLD
o Pallor of palmar creases – anemia (blood loss, malabsorption, haemolysis, chronic disease etc)
o Dupuytren’s contracture – alcoholism, familial

Question 4

ARMS

Answer 4

• Asterixis
• Pulse: rate, rhythm & character
• BP
• Skin changes:
o Ecchymoses – clotting abnormalities, CLD
o Petechiae – thrombocytopenia, chronic alcoholism suppressing bone marrow or portal hypertension causing splenomegaly & platelet destruction
o Scratch marks – pruritis due to increased bile acids, obstructive jaundice
o Spider naevi – cirrhosis, most frequently due to alcohol
o Pigmented lesions

Question 5

FACE

Answer 5

• Eyes:
o Jaundice, pallow
o Kayser-Fleischer rings – brown/green deposits of copper in Wilson’s
o Iritis – IBD
o Xanthelasma – cholestasis causing raised lipoprotein X, raised serum cholesterol
• Parotids – bilateral enlargement in alcoholism
• Mouth
o Dentition, gum ulceration or hypertrophy, pigmentation, hepatic fetor
o Leukoplakia, candidiasis, tongue coating, glossitis

Question 6

NEck

Answer 6

Neck
• Cervical & supraclavicular lymph nodes
o Virchow’s node – left supraclavicular fossa, takes its supply from LN in abdominal cavity (upper GI mets)

Question 7

Axilla

Answer 7

Axilla
• Lymph nodes
• Acanthosis nigricans – dark pigmentation seen in cushing’s disease

Question 8

Abdomen (lying flat)

Answer 8

Abdomen (lying flat)
• Inspection: scars, striae, skin changes, distension, masses, veins, pulsations, visible peristalsis, umbilicus discolouration (Cullen’s sign – ectopic pregnancy ,haemorrhagic pancreatitis), flank discolouration (Grey-Turner’s sign – retroperitoneal blood; pancreatitis, ruptured/leaking AAA)
• Palpation
o Ask if they are tender, get them to relax
o 9 quadrants : tenderness, masses, guarding (do light percussion for this) & rigidity
• Any abdominal masses, 10 s’s: site, size, shape, soft/cystic, sensitivity (sore), sliding (mobility), surface (regularity), symmetry, swing (pulsatile)
o Liver palpation & percussion - liver usually comes to 5th intercostal space, span <13cm is normal
o Gallbladder palpation
o Spleen palpation (bimanually) & percussion
o Bladder
o Ascites
• Auscultation
o Bowel sounds

Legs
• Skin changes (not spider naevi)
• Oedema

Question 9

Mention

Answer 9

• Groin examination for inguinal & femoral lymph nodes, checking for hernias or enlargement
• Testicular examination
• Rectal examination including prostate

Question 10

Other

Answer 10

Other
• Temperature, weight & BMI
• JVP & targeted cardiovascular examination if hepatomegaly had been present
• Urine dipstick
• Neurological exam – if signs of altered mental state
• Faecal occult blood if relevant
• If liver metastasis – breast exam, chest exam & all lymph nodes