GI Examination

Question 1

What steps should be taking when examining the hands and arms with regards to a GI examination?

Answer 1

Look at hands and compare both for:
Tar staining 
Nail colour- anaemia or leukonychia 
Nail shape- clubbing or koilonychia
Palms- palmar erythema, pale palmar creases or Dupuytren's contractures

Look at arms for: 
Bruising 
Scratch marks
Muscle wasting 
Track marks 
Check forearm for loss of skin turgor 

Look for fine and flapping tremors
Check pulse, respiratory rate and BP

Question 2

What steps should be taking when examining the head with regards to a GI examination?

Answer 2

Look at the face for alimentary facies
Look at the eyes for jaundice and anaemia
Look at the mouth for angular stomatitis and sore red tongue, or detect the odour of foetor hepaticus

Question 3

What steps should be taking when examining the mouth with regards to a GI examination?

Answer 3

Examine gums for swelling or bleeding 
Examine dentition 
Examine salivary glands 
Examine floor of mouth and tongue
Examine for mouth ulcers 
Examine for infections 
Examine mouth if history suggests IBD

Question 4

What steps should be taking when examining the lymph nodes with regards to a GI examination?

Answer 4

Check the following lymph nodes:
Supraclavicular- particularly scalene and Virchow's node
Anterior chain including tonsillar 
Submandibular 
Submental
Pre and post auricular 
Occipital 
Posterior cervical chain

Question 5

What steps should be taking when examining the necklace region with regards to a GI examination?

Answer 5

Examine for spider naevi, gynaecomastia and loss of body hair in males

Question 6

What steps should be taking when examining the legs with regards to a GI examination?

Answer 6

Examine for peripheral oedema, loss of body hair and erythema nodosum

Question 7

What steps need to be taken when inspecting the abdomen in a GI examination?

Answer 7

Inspect from bottom of bed too
Look for: 
Scars 
Visible pulsation 
Movement with respiration 
Skin lesions
Scratch marks
Abdominal shape
Stoma 
Distended veins
Petechiae 
Striae 
Abdominal distension

Question 8

What steps need to be taken when palpating the abdomen in a GI examination?

Answer 8

Ask if patient has any pain before beginning palpation
Watch the patients facial response while performing examination
Light palpation- feeling for guarding, rebound tenderness and rigidity
Deep palpation- feeling for areas of tenderness
Palpate up to liver, feeling for liver on deep inspiration
Palpate up to spleen- ask patient to take deep inspiration
Palpate kidneys- ask patient to take deep breath in and as they breathe out clamp hands down

Question 9

What steps need to be taken when percussing the abdomen in a GI examination?

Answer 9

Liver- begin percussing from right iliac fossa and percuss up to right costal margin in a stepwise manner. Percussion note will become dull when liver is reached
Spleen- begin percussing from right iliac fossa (resonant) and progress diagonally to the left costal margin. If enlarged spleen, note will become dull
Detecting free fluid- shifting dullness and fluid thrill

Question 10

What steps need to be taken when auscultating the abdomen in a GI examination?

Answer 10

Bowel sounds- place diaphragm of stethoscope in LLQ and note if bowel sounds present. If absent, work backwards through the Track of the colon
Arterial bruits- listen over abdominal aorta, renal arteries, liver and spleen
Rubs- hepatic and splenic (ask patients to take deep breaths)