GI Examination (Background Info)

Question 1

What are the relevant parts of GI exam? (8)

Answer 1

General Inspection
Set of basic observations
Hands/Face/Chest/Abdomen Inspection
Abdomen Palpation (light/deep)
Abdomen Auscultation

Question 2

Perform the general inspection as part of GI exam. (7)

Answer 2

Environment
Demeanour
Skin colour - jaundice/pale/flushed
Weight - obese or low BMI
Obvious pain/position
Abdominal distension
Colour - cyanosis/pallor

Question 3

Perform the hands inspection as part of GI exam. (6)

Answer 3

Temperature (infection/perfusion)
Clubbing (Cirrhosis/chronic disease)
Leukonychia
Koilonychia
Palmar erythema (liver disease / pregnancy)
Hepatic flap (Uraemia)

Question 4

Perform the face inspection as part of GI exam. (9)

Answer 4

General, eyes, mouth
Cyanosis/pallor
Xanthelasma (hyperlipidaemia)
Eyes: Pale conjunctiva (anaemia)
Jaundice: Hepatitis/cirrhosis/biliary obstruction.
Mouth: Angular stomatitis (iron/B12 deficiency), Oral candidiasis (iron deficiency/immunodefiency). Mouth ulcers (CD/Coeliac disease) Tongue (Glossitis - iron/B12/folate deficiency.)

Question 5

Perform the chest inspection as part of GI exam. (4)

Answer 5

Expose chest
Spider naevi - CLD
Hair loss - pseudofeminisation/malnourishment/iron deficiency anaemia
Gynaecomastia - liver cirrhosis, digoxin, spironolactone

Question 6

Perform the abdominal inspection as part of GI exam. (7)

Answer 6

Position the px supine with their arms by their sides and legs uncrossed.
- Scars = past surgery/trauma
- Striae = abdominal distension
- Masses = assess organometallic / malignancy.
- Bruising
- Abdominal distension - fluid (ascites), fat (obesity), faecal (constipation), flatus/fetus (pregnancy), food, fibroids (7 Fs)
- Stoma = colostomy (LIF), Ileostomy (RIF), Urostomy (RIF.& contains urine)

Question 7

Perform the abdomen palpation as part of GI exam. (8)

Answer 7

Observe px for signs of discomfort
Light/deep palpation (greater pressure)
Palpate each of the 4 abdominal regions for:
- Tenderness (areas involved and pain severity)
- Rebound tenderness (pain is worsened on releasing pressure = peritonitis.)
- Guarding - involuntary tension in abdominal muscles = localised or generalised)
- Masses - large/superficial masses

Always palpate towards any area of pain noted.

Question 8

Perform the abdomen auscultation as part of GI exam. (5)

Answer 8

Begin in the RLQ and move in sequence up to the RUQ, LUQ and then LLQ.
How long should I take?
- Depending on peristalsis (active bowel/GI Hx)
- Normal (gurgling)
- Abnormal (e.g. tinkling i.e. bowel obstruction)
- Absent (ileus/pertinoitis)