SCHEME AND PROFORMA FOR GASTROINTESTINAL SYSTEM EXAMINATION INCLUDING ABDOMEN AND GENITOURINARY SYSTEM

In general examination, look for nutritional state( height, weight, BMI), confusion, fetor hepaticus.

All vitals and PILCCOD

Signs of CLD:

Clubbing, leukonychia, koilonychia, palmar erythema, dupuytrens contracture, flapping tremor

Loss of hair, Icterus, pallor

Parotid swelling, angular stomatitis, cheilitis

Spider naevi, gynecomastia, breast atrophy, testicular atrophy

Ascites, caput medusa, hepatosplenomegaly, bruising

UPPER GI TRACT: EXAMINE ORAL CAVITY AND OROPHARYNX-use torch and tongue depressor

                       EXAMINE Lips, teeth, gum, cheek, tongue, tonsils, palate, oropharynx {look for ulcer, erythema, signs of malnutrition, angular stomatitis}

ABDOMEN EXAMINATION:

Inspection: (legs should be extended at this point)

Shape: scaphoid

Flanks: concave/ full

Movement with respiration: all quadrants or not?

Umbilicus: position? Everted/inverted? Slit like?

Peristalsis: visible or not?

Venous prominences (ask the patient to sit or stand up and cough)

Scar marks:

Striae

Scratch marks

Pigmentation and bruising: cullens sign and grey turners sign

Hernial orifices: intact or not? (inguinal, femoral, umbilical, epigastric, incisional)

At last inspect back of abdomen

Palpation: make sure to flex the knee and keep hands by the side.

                        Ask patient about pain anywhere and examine that part at last.

Superficial:

     Temperature: localized rise of temperature (compare with facial temperature)

     Tenderness: (look at face while examining for tenderness) {rebound tenderness will be in deep palpation}

     Tone of abdominal muscles (by light and dipping movements with fingers): elastic/ guarding or rigidity

     Girth of abdomen @ umbilicus level

     Direction of blood flow if venous prominences

     Cough impulse @hernial orifices.

Deep:

  Palpation of liver: (go IN during Inspiration)

Size: extent of hepatomegaly (either….cm below costal margin & total span of liver)

Tenderness(CHF, acute viral hepatitis, amoebic abscess)

Margin:leafy/irregular

Surface: smooth/ nodular

Consistency: soft/ firm/ hard(cirrhotic)

Pulsations: present or not

Mobility with respiration:

        Palpation of spleen (different manouvers)

       Palpation of gall bladder (Murphy’s sign)

  Palpation of kidney (with ballottment and renal angle tenderness)

   Palpation of testes

  Palpation of urinary bladder

   Palpation of any mass(site, size, shape, surface, consistency, edges, mobility, tenderness, attachment      with skin, within or outside abdominal wall)

  Rebound tenderness

  Tenderness at McBurney’s point

   Palpation of hernia orifices (with and without cough)

Percussion: (in full expiration)

Abdominal note over all quadrants: Tympanic/dull

Percuss upper and lower border of hepatic dullness(Span of liver)

Shifting dullness (if –ve, do puddle sign which is present if fluid is 300-400ml)

Fluid thrill

Percussion over mass

Percussion over bladder (in case of renal)

Traubes space percussion

Auscultation:

Bowel sounds (for 2 minutes on right of umbilicus): heard or not? If heard, no of sounds per minute

Aortic bruits

Renal artery bruits

Liver bruits

Venous hum

Succusion splash and auscultopercussion

PER RECTAL EXAMINATION AS A PART OF ABDOMINAL EXAMINATION

RENAL SYSTEM EXAMINATION IN BRIEF:

In general observation, look for consciousness and uremic fetor.

All vitals and PILCCOD

In head to toe: Face: puffiness and periorbital edema

                      Skin: excoriations, rashes, purpura

                      Nails: leukonychia, brown line banding

                      Hands: asterixis & AV FISTULA

Inspection:

Abnormal distension of abdomen or back, scar marks

Palpation:

RLQ: (if there is mass SUGGESTIVE OF TRANSPLANTED KIDNEY) size, surface consistency

Renal angle tenderness

Percussion:

Bladder: resonant

Auscultation:

Bruits in renal artery

Both loins and epigastrium