1. Gastrointestinal Examination
Josh Exley

2. introduction Wash hands Introduce self Explain procedure, gain consent
Positioning
45 degrees until examining abdomen
Exposure
‘For this examination, I’ll need you to undress from the waist up. Would you like a chaperone for this?’
‘Are you in any pain or discomfort at all?’

3. Initial inspection TALK AS YOU GO ALONG Surroundings
Fluids
Oxygen
Stoma/Catheter bags
From the end of the bed
Unwell/in pain
Visibly jaundiced
Cachexia

4. Hands Look for: Feel for: Clubbing, leukonychia, koilonychia
Palmar erythema
Asterixis – ‘liver flap’
Feel for:
Dupuytren’s contracture
Capillary refill
Radial pulse

6. Head and neck Look for: Sclera – jaundice Conjunctival pallor
Angular stomatitis
Glossitis
Apthous ulcers
Feel for:
Lymph nodes of neck – particularly left supraclavicular (Virchow’s)
Eyes
Mouth

8. Inspection of chest/abdomen
Gynaecomastia
Spider naevi
Abdominal distension – 6 Fs
Faeces, Fat, Flatus, Foetus, Fluid, F*cking huge masses
Caput medusa
Scars/Stoma

10. Palpation Bed now flat Get down to patient’s level
Double check no pain – Start furthest away from any tender region
General palpation, first superficial then deep, all 9 areas
KEEP WATCHING PATIENT’S FACE

12. Organ specific palpation
‘Take deep breaths in and out’
Press down on inspiration, don’t take your hand off
Liver – start in RIF and work towards right costal margin
Spleen – start in RIF and work towards left costal margin
Kidneys – two-handed balloting

13. Shifting dullness
Percuss from midline to left flank, listening for a change in percussion note
Leave finger at first point of note change (resonant to dull)
Roll patient towards you and percuss again
Test is positive if percussion note is now resonant

14. Auscultation Bowel sounds Renal bruits
Just below umbilicus, should hear within 1 minute
Renal bruits
Superior and lateral to umbilicus

15. if you have time Examine legs
Peripheral oedema
Erythema nodosum
Pyoderma gangrenosum
‘I would like to conclude by examining the hernial orifices, the external genitalia and performing a PR exam.’

16. Finishing up Thank patient and offer to help them get dressed
Wash your hands
Report to the examiner, if you haven’t done so already
Systematic & Concise
Always state negative findings