The Gastrointestinal Exam
The gastrointestinal exam is used to assess patients for pathology affecting the gastrointestinal tract, hepatobiliary system or other abdominal organs.
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Around the Room
Cigarettes, O2 devices, emesis bag
General Features
Age, gender, general comfort
Level of Consciousness
Alert, oriented, confused, obtunded
Body Habitus
BMI, waist-hip ratio
Colour
Jaundice, bronzing, pallor
Fluid Status
Tachycardia, hypotension, dry oral mucosa
The Skin
Rashes, hyperpigmentation, purpura
The Eyes
Xanthelasma, icterus, conjunctival pallor, KF rings
Salivary Glands
Parotid, sublingual & submandibular glands / ducts
Foetor
Foetor hepaticus, acetone breath, alcoholic foetor
The Lips
Angular cheilitis, ulcer, pigment, telangiectasia
The Mouth
Candidiasis, ulcers
The Tongue
Hydration, size, texture, masses, plaques, ulcers
The Teeth
Condition, caries, erosions, fracture, luxation
The Gums
Inflammation, bleeding
Palpation
Superficial → Deep
Tenderness, signs of peritonism, masses
Signs of Peritonism
Percussion tenderness, rebound tenderness
Signs of Appendicitis
McBurney's point tenderness, Rovsing's sign
The Liver
Palpate, percuss, assess for Murphy's sign
The Spleen
Right iliac fossa toward left hypochondrium
The Kidneys
Percuss and then ballot renal angles bilaterally
The Bladder
Palpate downward from the umbilicus
Abdominal Aorta
Palpate for abdominal aortic aneurysm
Signs of Ascites
Shifting dullness, fluid thrill
Offer to perform a digital rectal examination
Prepare the Patient
Consent, chaperone, undress, position
Perianal Inspection
Fissure, fistula / sinus, rash, mass, blood
Rectal Wall Palpation
Haemorrhoids, fissures, look for blood on glove
Prostate Palpation
Size, consistency, mobility, tenderness
Anal Tone
Patient squeezes against gloved finger