ABSTRACT
GASTROINTESTINAL SYSTEM Mr Desai is a 60-year-old gentleman complaining of abdominal pain. Please examine his gastrointestinal system.
Introduces self and seeks permission to examine Confirms patient’s name and age Asks if patient is currently in any pain
Positions patient supine with one pillow, with abdomen exposed to groin Inspects hands for clubbing, leuconychia, liver asterixis, palmar erythema and Dupuytren’s contracture Inspects eyes for jaundice and clinical anaemia Palpates for cervical lymphadenopathy (Virchow’s node) Inspects trunk back and front for spider naevi and gynaecomastia Inspects abdomen for scars, distension, masses, dilated abdominal veins and ascites Palpates the abdomen, superficial and deep in all four quadrants whilst observing the face for tenderness Palpates and percusses for hepatomegaly starting in the right iliac fossa Palpates and percusses for splenomegaly starting in the right iliac fossa Ballots kidneys Palpates and percusses for a distended bladder Palpates the abdominal aorta Auscultates for bowel sounds and abdominal aorta bruit Inspects and examines the groin for hernias Offers to perform a digital rectal examination and examination of genitalia If appropriate, offers to examine for shifting dullness
Cleans hands by washing or using alcohol gel
Fluency of examination Competence in presenting findings, summarizing and forming differential diagnoses
KEY State to the examiner that you would normally expose the patient from nipple to groin but for the purposes of this particular examination you will expose the abdomen only. Obviously, when you come to examine the groin you will need to expose it for a short time. Stand at the end of the bed and observe for jaundice, abdominal distension and wasting. Whilst looking for scars, remember to look in the loins or you may miss a nephrectomy scar. To palpate the abdomen you need to get onto your knees, or raise the level of the bed, ensuring that your forearm and hand are flat against the patient’s abdomen.
