Gastrointestinal examination

Question 1

Consent and examination

Answer 1

Patient sitting upright on examination couch and comfortable

Expose patient from nipples to knees sitting upright on the examination couch

Question 2

End of bed observation

Answer 2

Well/ ill

Comfortable/ distressed

Well nourished/ cachetic ‘thin’

Question 3

Peripheral examination starting with hands

Answer 3

Finger clubbing

Leukonychia

Koilonychias

Palmar erythema

Dupuytren’s contracture

Liver flap

Question 4

Arms

Answer 4

Radial pulse: rate and rhythm

Question 5

Eyes

Answer 5

Scleral jaundice

Conjunctival pallor

Question 6

Mouth

Answer 6

Angualr stomatitis

Atrophic glossitis of the tongue

Mouth ulcers

Dentition status

Question 7

Neck

Answer 7

Lymph nodes

• submandibular
• cervical chain
• supraclavicular

Then check spider naevi

Question 8

After neck and spider naevi

Answer 8

Ask patient to lie flat after altering back rest of the examination couch

Question 9

Abdomen observation

Answer 9

Scars

Distension

Caput medusae

Question 10

Palpation

Answer 10

Superficial then deep

9 areas

Question 11

Organs

Answer 11

Liver, spleen

Ask patient to breath in and out, moving towards organ on inspiration

Question 12

Kidneys

Answer 12

Ballot kidneys left and right

Question 13

If abdominal distension

Answer 13

Perform shifting dullness

Question 14

Auscultation

Answer 14

Bowel sounds

In one area around umbilicus

Listen for up to 1 minute

Question 15

Further examinations

Answer 15

Hernial orifices

External genitalia

Rectal examination

Question 16

Special investigations

Answer 16

Urinalysis