Gastrointestinal Examination Educational Materials

Gastrointestinal Examination Component What to do/look for and rationale • • • Wash hands Introduce self. Briefly explain purpose and obtain consent. • Begin by getting the patient to be positioned at 45 degrees. • Ask about pain before you begin. • Ask for vitals. General Inspection • • • • • • Mobility aids. Attachments, lines, somas. Alertness. Confusion. Signs of anaemia. Jaundice -> Liver issues (such as cirrhosis, hepatitis etc.), haemolytic anaemia, autoimmune conditions. • • • Weight -> Digestion issues, such as celiac diseases. Skin pigmentation -> malabsorption. Frankle like spots (discrete brown, black lesions) around the mouth, fingers, and toe -> Peutz-Jegherns syndrome -> most associated within small bowel hematoma (50%) and large bowel hematoma (30%). Can present alongside bleeding or intussusception. Brown to black elevations of the epidermis -> acanthosis nigricans can be due to GIT carcinoma, diabetes etc. Signs of herniation. Rendu Osler Weber Syndrome. • • • Hands • • Nails -> white nails -> chronic liver diseases -> hypoalbuminemia -> leukonychia (terry’s nails) Clubbing -> AV shunting in the lungs -> oxygen desaturation -> chronic liver diseases, especially cirrhosis (seen in 1/3 of patients) • • • Arms • • • • Eyes • • Cheeks • Mouth • • • Chest -> from here onwards position the patient at 180 degrees. Abdomen inspection • • • • • • Asterixis -> liver diseases -> decrease inflow of joint position to the brain. Palmar erythema -> hormonal imbalances (increase estrogen -> increased vasodilation) due to chronic liver diseases. Dupuytren’s contracture -> due to large amounts of xanthine -> diabetes, males, alcoholism. Large bruises -> due to clotting issues -> liver disease or obstructive jaundice (because there will be decrease lipid absorption and hence lipid soluble vitamins -> reduced vitamin K synthesis -> reduction in the production of vitamin K dependent clotting factors. Petechiae (pinhead-sized bruises) -> due to chronic and excess alcohol consumption. Muscle wasting -> malabsorption or late manifestation of chronic alcohol consumption. Scratch marks -> due to severe itch which is present in obstructive or cholestatic jaundice. Tattoos and needle marks. Look at sclerae -> look for signs of anaemia or jaundice or signs of increased cholesterol (yellowish plaques -> xanthelasmata) Parotid gland enlargement -> diabetes, covid, influence, mumps, herpes. Dentition, ulcers, glossitis, angular stomatitis, telangiectasias, aphthous ulcers. Also make a note of the smell of breath. Note tongue thickness and colour as can give an indication of an infection. Spider naevi -> liver diseases -> liver cannot metabolise estrogen. Gynaecomastia -> liver inability to metabolise estrogen. Hair loss -> liver disease. Feel for SC nodes. Scars -> surgery, injury etc. Caput medusae -> portal hypertension. Abdomen palpation • • Masses -> tumours. Do nine quadrants. - Before ask for pain. - Do it gently. - Apply more pressure. Liver • Palpate -> feel for masses. Do it as the patient takes deep breaths. Inspiration, expiration, advance hand. - Feel for enlargements. - Feel for masses. - Feel for pain. - In a normal patient the liver should not be palpable. Percuss. - Begin at either third 3rd or at ASIS. - Measure the size of the liver -> should be 10 -12 cm. Palpate moving diagonally from RLQ to LUQ. Fingers should be pointing down. If can be felt -> splenomegaly -> liver diseases, right heart failure, haemolytic anaemia, tumor. If cannot be felt, position poster laterally. - Left hand posteriorly and right hand anteriorly. Palpate - Position hands opposite to spleen. ONLY if there is a building flank. Percuss from midline to flanks to listen for a change from resonant to dull, then roll to side and percuss the dame spot on flanks to see it is goes from dull to resonant. If changes from dull to resonant -> ascites What different sounds mean: - Dull -> organ/fluid. - Hyperresoant -> obstruction. - Resonant -> air. Bowel sounds -> should be absent. Bruits: - Higher pitched than venous hum, not continuous and well localised. - May indicate alcoholism, hepatocellular cancer. Peripheral edema -> liver disease. Rectal exam/vitals. Hernias. • Spleen • • • • Kidney • Percuss for ascites • • • • Asculate • • Legs • • •