GI examination

Question 1

From the end of the bed.

Answer 1

• Pallor
• Jaundice
• Weight loss
• Distress, pain
• Muscle wasting
• Scars
• Abdominal distention (Ascites)
• Masses
• Stomas

Question 2

Hands.

Answer 2

• Clubbing (Loss of Shamroth’s window)
• Koilonychia (Thin, spoon shaped nails, a sign of iron-deficiency anaemia)
• Leukonychia (Abnormal whiteness of the nails)
• Palmar erythema (Reddening of the skin on the palm)
• Dupuytrens contracture (Abnormal thickening of the elastic tissue beneath the skin of the palm)
• Scratch marks (Obstructive jaundice)
• Needle track marks/tattoos or piercings (Hepatitis)

Question 3

Pulse and blood pressure

Answer 3

Tested after arms and hands examination

Question 4

Face.

Answer 4

• Pallor (Haemolytic anaemia)
• Jaundice
• Spider naevi (Also found on arms and chest)
• Parotid swelling

Eye:

• Icterus (Yellow sclera)
• Xanthelasma (Hyperlipidaemia)
• Conjunctival pallor (Anaemia)

Question 5

Mouth.

Answer 5

• Angular stomatitis
• Glossitis
• Oral candidiasis
• Oral ulcers
• Smell (Alcohol? infection?)
• Dentition

Question 6

Neck.

Answer 6

Lympadenopathy:

• Infection
• Metastasis (Left supraclavicular fossa is associated with gastric malignancy)

Question 7

Inspection of the abdomen and chest. *Remember the patient should be supine.

Answer 7

• Scars
• Swelling
• Distended vein (Caput medusae)
• Obesity
• Weight loss
• Spider naevi
• Stomas
• Pulsation
• Gynaecomastia in men
• Breast atrophy in women

Question 8

Palpation of the abdomen.

Answer 8

• Hepatomegaly (Normal lower border = Costal margin)
• Splenomegaly = (Normal lower border = 11th rib)
• Kidneys = (Normal upper border is under 12th rib, 7cm from the midline)
• Bladder
• Any guarding or tenderness?
• Any masses?

Question 9

Percussion of the abdomen.

Answer 9

• Ascites (Shifting dullness)
• Hepatospenomegaly:
  Also percuss upper border of the liver (Normal = 5th right intercostal space on expiration)
  Spleen cannot move up and moves towards the left iliac fossa (Normal is left 9th, 10th, 11th ribs in the mid axillary line)

Question 10

Auscultation of the abdomen.

Answer 10

• Bowel sounds

- Bruits

Question 11

Examination of the groin.

Answer 11

• Hernias

- Lympadenopathy

Question 12

Perianal.

Answer 12

Rectal examination:

• Skin tags, haemorrhoids
• Rectal bleeding, faecal occult blood

Question 13

Genital examination.

Answer 13

• Masses
• Size of testicles
• Tenderness

Question 14

Examination of the legs.

Answer 14

• Oedema

- Hair loss

Question 15

Flapping tremor.

Answer 15

Liver disease

Question 16

Inspect axillae.

Answer 16

Acanthosis nigricans (Hyperpigmentation of the skin, can also be seen in neck or groin)

Question 17

Inspection of the eyes.

Answer 17

Eye:

• Icterus (Yellow sclera)
• Xanthelasma (Hyperlipidaemia)
• Conjunctival pallor (Anaemia)

Question 18

How do you examine for ascites?

Answer 18

Percuss from midline towards midaxillary line. When you hear dullness, whilst keeping your hand in the same position ask the patient to lay on their side. Wait 30 seconds and percuss again