GI Exam

GI Exam

1. GENERAL

   • Alert
   • wellbeing
   • colour
     • sallow yellow green  brown cyanotic well perfused
   • distress
   • dysmorphic
   • equipment
     • peritoneal dialysis catheter urinary catheter - spina bifida
   • fluids
   • feeding
     • NG tube Total Parenteral Nutrition Infatrini Ensures baby milk (Aptamil) PEG tube
   • growth
   • skin
     • increased body hair/ facial hair - ciclosporin rashes - dermatitis herpetiformis, telangiectasia  (Osler - Weber - Rendu) - hereditary hemorrhagic telangiectasia, rare autosomal dominant condition cafe-au-lait spots: NF1, GIST, palpable abdominal mass incontinetnia pigmentosa
   • hydration

2. INSPECTION

   • HANDS
     • Clubbing
       • CF, liver disease, IBD, coeliac disease
     • Koilonychia
       • iron deficiency anaemia
     • Leukonychia
       • cirrhosis
     • Palmar erythema
       • chronic liver disease
     • Pallor of palmar crease
       • anaemia
     • Hepatic flap
       • liver failure, renal failure, CO2 retention
   • FACE
     • EYES
       • scleral icterus
         • jaundice
       • conjunctival pallor
         • iron-deficiency anemia
       • Keiser-Flescher rings
         • Wilson's disease autosomal recessive condition liver does not filter copper correctly builds up in liver, brain, eyes & other organs
     • plethora
       • chronic liver disease
     • cyanosis
       • hepatopulmonary syndrome  requires liver transplantation
     • MOUTH
       • pigmentation
         • perioral freckling and pigmentation of oral mucosa - Peutz-Jeghers syndrome - also get benign hamartomatous polyps of GIT
       • ulcers
         • apthous ulcers: Crohn's disease, Ulcerative Colitis, Coeliac Disease, Behcet's Disease ( rare disorder causing blood vessel inflammation throughout the body
       • gum hypertrophy
         • myeloid leukaemia, ciclosporin, phenytoin
       • macroglossia
         • hypothyroidism, Beckwith-Wiedemann,  mucopolysaccaridoses, Pomp's, GSD, amyloid, haemangioma, lymphangioma
       • glossitis
         • iron, folate, b12 deficiency
   • ABDOMEN
     • shape
     • distension
       • central/flank, generalised/localised, symmetrical. 5FS - faecus(Hirschsprung constipation), flatus, fat, fluid(ascites, nephrotic syndrome), fetus
     • masses
       • herniae
         • get child to raise head - hernia, divarification of recti 
     • scars
       • see scar document
     • striae
     • caput medusae
       • blood flows away from umbilicus SVC obstruction - flows inferiorly IVC obstruction - flows superiorly
     • stomas
       • ileostomy vs colostomy
     • tubes
       • caecostomy tube for enterograde enemas in children with chronic constipation
   • ARMS
     • Pulse & BP
     • xanthomas
       • hypercholesterolaemia  - tuberous around the elbows
     • bruising
       • - liver dysfunction - haematological disorders
     • scratch marks
       • pruritus is a feature of cholestatic liver disease
     • spider naevi
   • Neck and chest
     • spider naevi
     • gynaecomastia
       • chronic liver disease

3. PALPATION

   • superficial
     • any pain? LIF and do backwards S shape to end in RUQ
   • deep
   • liver
     • palpate upwards from RIF to Rsubcostal amrgin until feel liver edge ( should be 2cm below) - take deep breath, feel edge as it descends - if mass, describe surface - smooth or nodular, hard or soft, regular or irregular edge
   • spleen
     • palpate from RIF towards left subcostal margin as you reach left subcostal margin, ask patient to turn slightly towards you and palpate in left subcostal area
   • kidney
     • place one hand under patient in right flank region and the other hand on top and try to ballot the kidney btwn two hands. repeat for the left side can get above it does not move with respirartion
   • Murphys sign
     • test for gallbladder disease inhale while holding fingers hooked under lower liver border pushes inflamed gallbladder against hand, causes pain

4. PERCUSSION

   • shifting dullness
     • if distended
   • fluid thrill
   • liver border
     • percuss from Right lower quadrant upwards until sound changes from resonant to dull - denotes liver lower border percuss from R upper chest downwards starting in midclavicular line 3rd intercostal space percuss inferiorly until dullness denotes liver's upper border. measure liver span in cms

5. AUSCULTATION

   • bowel sounds
     • present? hypoactive - one every 3 to 5 minutes - diarrhoea, anxiety, GE
   • renal bruits
     • hypertension, neurofibromatosis 2-3cm superior and lateral to umbilicus
   • liver bruit
     • neoplasm, hepatocellular ca, haemangioma, haemangiosarcoma arterial systolic bruit

6. OTHER

   • hernial orifices
   • external genitalia
   • back & perianal area
   • stool
   • renal
     • BP Urinalysis assess for signs of steroid toxicity