Gastrointestinal Examination Checklist

Question 1

What should you do during Step 1: Introduction?

Answer 1

Hand wash/rub

Introduce self

Explain purpose

Obtain consent

Position patient and expose as necessary

Question 2

What is included in the general inspection (Step 2)?

Answer 2

Posture

Comfort/distress

Mental state

Body habitus

Colour

Wasting

Distension

Hydration

Check bedside chart for vital signs

Report findings correctly

Question 3

What do you inspect for in the hands and upper limbs (Step 3)?

Answer 3

Palmar erythema

Clubbing

Palmar crease pallor

Dupuytren’s contracture

Nail changes (koilonychia, leukonychia, Muehrcke’s lines)

Hepatic flap

Question 4

What is included in Step 4: Upper limbs inspection?

Answer 4

Bruising

Scratch marks

Wasting

Spider naevi

Report findings correctly

Comment only (do not perform): Radial pulse, BP, Resp rate

Question 5

What do you assess in the face (Step 5)?

Answer 5

Eyes: jaundice, redness, Kayser-Fleischer rings, conjunctival pallor, xanthelasma

Parotids: inspect and palpate

Mouth: teeth, gums, palate, tonsils, pigmentation, ulceration, leucoplakia, candidiasis, glossitis, cheilitis

Report findings correctly

Question 6

What is done in Step 6: Neck examination?

Answer 6

Comment on lymph node palpation (do not perform)

Question 7

What is included in Step 7: Inspection of chest and abdomen?

Answer 7

Chest: spider naevi, bruises, gynaecomastia, hair distribution

Abdomen: posture, movement with respiration, distension

Masses: visible masses, peristalsis, pulsations

Surface features: scars, prominent veins, striae, bruising, pigmentation

Report findings correctly

Question 8

What is the technique for abdominal palpation (Step 8)?

Answer 8

Ask about tenderness

Superficial and deep palpation

All nine regions covered

Report: soft/tender/guarding/rigidity/masses/rebound tenderness

Comment on McBurney’s point and Rovsing’s sign

Note: Use percussion tenderness if no other tenderness

Question 9

How is the liver assessed in Step 9?

Answer 9

Palpate with correct technique

Murphy’s sign

Percuss for liver span

Report findings correctly

Question 10

How is the spleen assessed (Step 10)?

Answer 10

Palpate with correct technique

Patient rolls to right lateral decubitus

Report findings correctly

Question 11

What is done in Step 11: Kidneys and bladder?

Answer 11

Palpate kidneys with ballottement technique (both sides)

Comment only (do not perform): Palpation and percussion of bladder

Report findings correctly

Question 12

What is included in Step 12: Abdominal aorta examination?

Answer 12

Palpation with correct technique

Report findings correctly

Question 13

How is ascites assessed (Step 13)?

Answer 13

Percuss flanks

Shifting dullness

Fluid thrill

Report findings correctly

Question 14

What is auscultated in Step 14?

Answer 14

Diaphragm: bowel sounds, succussion splash

Bell: bruits over epigastric, renal, common iliac arteries

Report findings correctly

Question 15

What should be done during Step 15: Conclusion?

Answer 15

Thank patient

Indicate patient may redress

Appropriate communication

Hand rub/wash

Comment on further exams: Lower limb, inguinal, genital, DRE (do not perform)

Question 16

What could palmar erythema indicate?

Answer 16

Chronic liver disease (especially cirrhosis), Pregnancy, Rheumatoid arthritis, Thyrotoxicosis

Question 17

What conditions are associated with digital clubbing?

Answer 17

Chronic hypoxia (lung diseases: bronchiectasis, lung cancer, cystic fibrosis), Inflammatory bowel disease, Cirrhosis (especially primary biliary cholangitis), Congenital heart disease

Question 18

What does pallor of the palmar creases suggest?

Answer 18

Anemia (especially if Hb is significantly reduced)

May correlate with general pallor or conjunctival pallor

Question 19

What is Dupuytren’s contracture associated with?

Answer 19

Alcoholic liver disease, Diabetes mellitus, Manual labor, Epilepsy (possibly due to medication), Idiopathic in many cases

Question 20

What do the following nail changes suggest?

Answer 20

Koilonychia (spoon nails): Iron-deficiency anemia, Leukonychia (white nails): Hypoalbuminemia, chronic liver disease, Muehrcke’s lines: Hypoalbuminemia (often due to nephrotic syndrome or liver disease)

Question 21

What does a hepatic flap (asterixis) indicate?

Answer 21

Hepatic encephalopathy, CO₂ retention, Uremia (less common), Severe metabolic encephalopathies

Question 22

What could unexplained bruising indicate?

Answer 22

Coagulopathy (e.g. liver disease, DIC), Vitamin K deficiency, Thrombocytopenia, Anticoagulant use, Trauma or abuse (context-dependent)

Question 23

What might scratch marks on the skin suggest?

Answer 23

Pruritus (common in cholestasis, e.g. primary biliary cholangitis), Allergic reactions or dermatologic conditions, Renal failure, Jaundice-associated itching

Question 24

What does muscle wasting indicate?

Answer 24

Chronic illness or malnutrition, Advanced liver disease, Cachexia (e.g. in malignancy), Neuromuscular disorders

Question 25

What are spider naevi associated with?

Answer 25

Chronic liver disease (especially cirrhosis), Pregnancy, Estrogen excess, May be normal in small numbers (especially upper chest/face)

Question 26

Jaundice in eyes (scleral icterus)

Answer 26

Suggests elevated bilirubin levels — seen in liver disease (e.g., hepatitis, cirrhosis), hemolysis, or biliary obstruction.

Question 27

Redness of eyes

Answer 27

Could be due to conjunctivitis, allergies, or systemic diseases like autoimmune conditions.

Question 28

Kayser-Fleischer rings

Answer 28

Brownish or greenish rings around the cornea; associated with Wilson's disease (copper accumulation).

Question 29

Conjunctival pallor

Answer 29

Sign of anemia — often due to chronic disease, blood loss, or iron deficiency.

Question 30

Xanthelasma

Answer 30

Yellowish plaques around eyelids — associated with hyperlipidemia and possibly liver disease.

Question 31

Enlarged or asymmetrical parotids

Answer 31

May indicate chronic alcohol use (parotid swelling), infection, tumors, or Sjögren’s syndrome.

Question 32

Poor dental hygiene, decayed teeth

Answer 32

Risk of systemic infection; poor nutrition or neglect.

Question 33

Bleeding or inflamed gums

Answer 33

May suggest vitamin C deficiency (scurvy), gingivitis, or blood dyscrasias.

Question 34

Pigmentation in mouth (e.g., buccal mucosa)

Answer 34

Can be seen in Addison’s disease or Peutz-Jeghers syndrome.

Question 35

Oral ulceration

Answer 35

Non-specific; may indicate aphthous ulcers, infection, Crohn’s disease, or malignancy.

Question 36

Leucoplakia

Answer 36

White patches that cannot be scraped off — premalignant lesion often related to smoking or alcohol.

Question 37

Candidiasis (oral thrush)

Answer 37

White, scrapable patches — fungal infection, often due to immunosuppression or recent antibiotic use.

Question 38

Glossitis

Answer 38

Inflammation of the tongue — seen in B12 deficiency, iron deficiency, or niacin deficiency.

Question 39

Cheilitis (angular stomatitis)

Answer 39

Cracked skin at the corners of the mouth — may indicate iron or B-vitamin deficiencies.

Question 40

Spider naevi on chest

Answer 40

Central red spot with radiating vessels — seen in chronic liver disease, especially cirrhosis (due to elevated estrogen levels).

Question 41

Bruising on chest

Answer 41

May suggest clotting abnormalities (e.g., from liver dysfunction or anticoagulant use).

Question 42

Gynaecomastia

Answer 42

Enlargement of male breast tissue — due to liver disease (impaired estrogen metabolism), drugs (spironolactone, digoxin), or endocrine disorders.

Question 43

Reduced chest hair distribution

Answer 43

May indicate chronic liver disease with hormonal imbalance (low androgens).

Question 44

Abdominal posture (e.g., guarding, lying still)

Answer 44

Guarding or lying still suggests peritonitis; restlessness may indicate colic.

Question 45

Movement of abdomen with respiration

Answer 45

Reduced movement could suggest peritonitis or inflammation.

Question 46

Abdominal distension

Answer 46

Could be due to '5 F's' — Fat, Fluid (ascites), Fetus, Flatus, or Faeces.

Question 47

Epigastric tenderness

Answer 47

Could indicate gastritis, peptic ulcer disease, or pancreatitis.

Question 48

Right hypochondriac tenderness or mass

Answer 48

May suggest hepatomegaly, liver mass, or gallbladder pathology.

Question 49

Left hypochondriac tenderness or mass

Answer 49

May suggest splenomegaly, splenic infarct, or trauma.

Question 50

Right lumbar region mass

Answer 50

Could be kidney enlargement or retroperitoneal mass.

Question 51

Left lumbar region mass

Answer 51

May suggest enlarged kidney, constipation, or retroperitoneal mass.

Question 52

Umbilical region mass or tenderness

Answer 52

May indicate hernia, aortic aneurysm, or intestinal pathology.

Question 53

Right iliac fossa tenderness

Answer 53

Common in appendicitis — check McBurney’s point.

Question 54

Left iliac fossa tenderness

Answer 54

Could be diverticulitis or sigmoid volvulus.

Question 55

Suprapubic region tenderness

Answer 55

Bladder distention, UTI, or pelvic pathology.

Question 56

Soft abdomen

Answer 56

Normal finding — absence of guarding or rigidity.

Question 57

Guarding or rigidity

Answer 57

Involuntary rigidity = peritonitis; voluntary guarding = anxiety or ticklishness.

Question 58

Rebound tenderness

Answer 58

Sharp pain on release — suggests peritonitis.

Question 59

McBurney’s point tenderness

Answer 59

1/3 distance from ASIS to umbilicus — classic sign of appendicitis.

Question 60

Rovsing’s sign

Answer 60

Pain in RIF when pressing LIF — suggests appendicitis (peritoneal irritation).

Question 61

Murphy’s sign

Answer 61

Arrest of inspiration with RUQ palpation — positive in acute cholecystitis.

Question 62

Percussion tenderness in lieu of palpation

Answer 62

Use if abdomen too painful to palpate — tenderness still localizes disease.

Question 63

Liver span (percussion)

Answer 63

Normal span: 6–12 cm at midclavicular line — increased in hepatomegaly, decreased in cirrhosis.

Question 64

Shifting dullness

Answer 64

Indicates ascites — dullness shifts as patient turns lateral.

Question 65

Fluid thrill (fluid wave)

Answer 65

Large-volume ascites — impulse transmitted across abdomen when tapped.

Question 66

Percussion of flanks

Answer 66

Dullness may indicate fluid collection — assess for shifting dullness or fluid thrill.

Question 67

Ballottement technique

Answer 67

Used to assess kidneys — palpate bimanually from behind (ballotable in enlargement or hydronephrosis).

Question 68

Right lateral decubitus (patient rolled)

Answer 68

Helps assess spleen (may become palpable in splenomegaly).

Question 69

Palpation/percussion of bladder (comment only)

Answer 69

Palpable when distended; dull on percussion — indicative of retention.

Question 70

Bowel sounds (diaphragm)

Answer 70

Normal = gurgling every 5–15 secs; absent in ileus or peritonitis; high-pitched in obstruction.

Question 71

Succussion splash

Answer 71

Sloshing sound over epigastrium — free fluid, air or gas in a hollow organ - suggests gastric outlet obstruction.

Question 72

Epigastric, renal, iliac bruits (bell)

Answer 72

Turbulent flow — could suggest renal artery stenosis or aortic aneurysm.