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Gastrointestinal Examination

A 15-step gastrointestinal examination checklist, including reporting requirements and assessment limitations.

Gastroenterology · Self-paced

Step 1. Introduction

  1. Hand hygiene

    Hand wash/rub

  2. Introduce yourself

    Introduce self

  3. Explain the purpose

    Explain purpose

  4. Obtain consent

    Obtain consent

  5. Position and exposure

    Position patient and expose as necessary

Step 2. General Inspection

  1. Posture

    Posture

  2. Comfort and distress

    Comfort/distress

  3. Mental state

    Mental state

  4. Body habitus

    Body habitus

  5. Colour

    Colour

  6. Wasting

    Wasting

  7. Distension

    Distension

  8. Hydration

    Hydration

  9. Bedside chart

    Check bedside chart for vital signs

  10. Report findings

    Report findings correctly

Step 3. Hands and Upper Limbs

  1. Palmar erythema

    Palmar erythema

  2. Clubbing

    Clubbing

  3. Palmar crease pallor

    Palmar crease pallor

  4. Dupuytren's contracture

    Dupuytren's contracture

  5. Nail changes

    Nail changes (koilonychia, leukonychia, Muehrcke's lines)

  6. Hepatic flap

    Hepatic flap

Step 4. Upper Limbs Inspection

  1. Upper arms

    Upper arms: bruising, scratch marks, wasting, spider naevi

  2. Report findings

    Report findings correctly

  3. Comment only — do not perform

    Comment only (do not perform): radial pulse, BP and respiratory rate.

Step 5. Face

  1. Eyes

    Eyes: jaundice, redness, Kayser-Fleischer rings, conjunctival pallor, xanthelasma

  2. Parotids

    Inspect and palpate parotids

  3. Mouth

    Mouth: teeth, gums, palate, tonsils, pigmentation, ulceration, leucoplakia, candidiasis, glossitis, cheilitis

  4. Report findings

    Report findings correctly

Step 6. Neck – Lymph Nodes

  1. Comment only — do not perform

    Comment on, but do not perform, lymph node palpation.

Step 7. Inspection of Chest and Abdomen

  1. Exposure and position

    Expose and position appropriately

  2. Chest

    Chest: spider naevi, bruises, gynaecomastia, hair distribution

  3. Abdomen

    Abdomen: posture, movement with respiration, distension

  4. Masses

    Masses: visible masses, peristalsis, pulsations

  5. Surface features

    Surface features: scars, prominent veins, striae, bruising, pigmentation

  6. Report findings

    Report findings correctly

Step 8. Palpation of Abdomen

  1. Ask about tenderness

    Ask patient about any abdominal tenderness

  2. Superficial palpation

    Superficial palpation

  3. Deep palpation

    Deep palpation

  4. Nine regions

    Adequate and thorough technique (all nine regions)

  5. Report findings

    Report findings: soft/tender/guarding/rigidity/masses/rebound tenderness

  6. Focal tenderness

    Comment on focal tenderness over McBurney's point and Rovsing's sign

  7. Assessment limitation

    Percussion tenderness is an alternative to rebound; no need to elicit rebound if there is no tenderness otherwise.

Step 9. Liver

  1. Palpation

    Palpation: correct technique

  2. Murphy's sign

    Murphy's sign

  3. Liver span

    Percuss liver span

  4. Report findings

    Report findings correctly

Step 10. Spleen

  1. Palpation

    Palpation: correct technique

  2. Positioning

    Positioning: roll to right lateral decubitus

  3. Report findings

    Report findings correctly

Step 11. Kidneys and Bladder

  1. Palpate kidneys

    Palpate kidneys: adequate ballottement technique, tested bilaterally

  2. Comment only — do not perform

    Comment only (do not perform) on how to palpate and percuss the bladder

  3. Report findings

    Report findings correctly

Step 12. Abdominal Aorta

  1. Palpation

    Palpation: correct technique

  2. Report findings

    Report findings correctly

Step 13. Ascites

  1. Percuss flanks

    Percuss flanks

  2. Shifting dullness

    Shifting dullness

  3. Fluid thrill

    Fluid thrill

  4. Report findings

    Report findings correctly

Step 14. Auscultation

  1. Diaphragm

    Diaphragm: bowel sounds, succussion splash

  2. Bell

    Bell: epigastric, renal and common iliac bruits

  3. Report findings

    Report findings correctly

Step 15. Conclusion

  1. Thank the patient

    Thank patient and indicate they may redress

  2. Appropriate communication

    Appropriate communication

  3. Hand hygiene

    Hand rub/hand wash

  4. Further examinations — do not perform

    Comment on further examinations (do not perform): lower limb, inguinal, genital and DRE

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