Gastrointestinal Examination

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Introduction

  • Rapport with patient
    • Introductions
    • Note mental state/drowsiness (encephalopathy)
  • Patient lying supine on 1 pillow Exposure nipples to knees

Inspection of patient & surroundings (Note Mental State)

  • Jaundice
  • Cachexia
  • Pigmentation
    • (haemochromatosis, Addison’s, Peutz-Jeghers)
  • IV access
  • NGT
  • IDC
  • Drains

Asking for relevant Vitals

  • BP
  • Temp

Examination of Hands

  • Nails
    • Clubbing
    • Leuconychia
  • Palms
    • Palmar erythema
      • (liver disease, also thyrotoxicosis, pregnancy, RA, polycythaemia, idiopathic)
    • Palmar creases
      • Hyperpigmentation
      • Pallor
    • Dupuytren’s
      • (alcoholism, manual workers, familial)
  • Assessing for hepatic flap
    • extend wrists with spread fingers for 15s, also in HF, RF, Resp failure
  • Pulses

Examination of Arms

  • Bruising
  • Scratch marks
  • Wasting

Examination of Eyes

  • Jaundice
  • Pallor / Anaemia
  • Iritis
  • Corneal rings
    • (Wilsons disease)

Examination of Mouth

  • Stomatitis
  • Foetor hepaticus
  • Ulceration
  • Telangectasia
  • Gingivitis
  • Candida
  • Pigmentation
  • Hydration

Examination of Tongue

  • Atrophic glossitis
  • Leucoplakia

Examination of Neck

  • Lymphadenopathy
    • cervical, auricular, occipital, supraclavicular & axillary lymph nodes

Examination of Chest

  • Spider naevi
  • Gynecomastia
  • Hair loss

Inspection of Abdomen

  • Distension
  • Prominent veins
  • Scars
  • Masses
  • Peristalsis
  • Bruising, Cullen’s/Grey-Turner’s, pigmentation

Palpation

  • Superficial Palpation
    • Ask if any area tender first
    • Outline masses
    • Hernias
  • Deep Palpation
    • Liver palpation
      • Liver edge
      • Measure height
      • Describe
        • Tender
        • Pulsatile
        • Consistency
    • Gallbladder
      • Murphy’s sign
      • Courvoisier’s Law – Gallstones unlikely to be cause of enlarged GB if jaundiced
    • Spleen palpation
      • Rolling to right
    • Ballot kidneys
    • Palpate and percuss bladder
    • Masses
      • Describe…

Percussion

  • Liver size (up to 6th IC in MCL)
  • Spleen size
  • Ascites
    • Shifting dullness
    • Fluid thrill

Auscultation

-  Bowel sounds 
-  Bruits 
-  Venous hum

Additional GIT Examination

  • Examine Groin
    • Herniae
      • Size, tenderness, reducible, cough impulse, transillumination
    • Testicles
    • Inguinal nodes
    • Repeat examination standing
  • Examination of Lower Limbs
    • Bruising
    • Oedema
  • Ask for rectal examination
    • Blood loss
    • Fissures
    • Tags
    • Haemorrhoids
    • Fistulae
  • Ask for pelvic examination if female
  • Ask for urinalysis
  • Other systems
    • Higher centres
    • Cardiovascular for CCF
    • Cerebellar Function
    • Peripheral neuropathy
  • Wash hands

Summary & Interpretation