GIT EXAMINATION SYED AWAIS UL HASSAN SHAH

TRAINEE 1ST YR PAEDIATRICS

Before starting GI ExaminationWash hands / warm themProceed calmly / don’t make sudden movesShake hands and offer some candy or toyIntroduce yourself / explain what you are going to do (older

child/ parents)Ask the patient to point to the part which is tender(can be

unreliable)Position the patient (depends upon child’s comfort)Expose the patient on required basisApproach from right side of the patientGather as much data as possible by observation firstAlter the sequence of examination if required but present it

in a sequential mannerOrder of exam: least distressing to most distressing

Components of GIT ExaminationAbdominal examinationOral cavity examinationGenitalia examinationRectal examinationRelevant physical examination

ABDOMINAL EXAMINATION

ABDOMENINSPECTION

Shape of the abdomen Movements of abdominal wallUmbilicusVisible loops of bowel/ visible peristalsisScarStriaeProminent veinsPubic hairHernial orifices

ABDOMENPalpation

Light palpation To test muscle tone/ rigidity / guarding

Deep palpation Tenderness and rebound tenderness Palpation for viscera

Liver Size, edge, surface, consistency, tenderness,

pulsations Spleen

Size, surface, consistency, splenic notch

Kidneys Bimanual technique (lower pole may normally be

palpable) Tenderness (Murphy’s renal punch)

Urinary bladder Grasping the upper border by thumb and index

finger of left hand

One hand ballottement

Bimanual ballottement

ABDOMEN

Masses palpable other than visceraHard fecesAbdominal aortaGastric mass (HPS) Abdominal lymph nodes

Para aortic lymph nodes / mesenteric lymph nodes

Dipping method of palpationHelpful in palpation of viscera in ascitesPlacing hand over the abdomen and making quick

dipping movements (also known as one hand ballottement)

Skin turgor

PERCUSSIONTo determine boundaries of mass and organsTo detect ascites

PERCUSSIONLIVER

Percuss for both upper and lower bordersSpleen

Start percussing from RIF to LHCPlace left middle finger parallel to the LCM

Urinary BladderPercuss from epigastrium towards

hypogastrium

PERCUSSION FOR ASCITESShifting dullnessFluid thrill

AUSCULTATIONBOWEL SOUNDS

ABSENTLOUD

VENOUS HUMSB/W XIPHISTERNUM AND UMBILICUS

Renal BruitHepatic BruitSuccussion SplashPuddle Sign

ORAL CAVITYLips Gums Teeth Tongue Mucous membraneOthers ( aphthous ulcers, thrush, palate)

Examination of Genitalia and Groin Male

Urethral orifice (hypospadias, epispadias)Size of penis (CAH)Testes (swelling, cryptchordism, retractile

testes, inguinal hernia, torsion)Developmental abnormalities / ambiguous

genitalia Orchidometer (precocious puberty, macro

orchidism)

Examination of Genitalia and Groin Female

VulvaVagina (discharge, FB, suspected abuse)ClitorisDevelopmental abnormalities / ambiguous

genitalia

Rectal examinationNormally done in

Acute abdomenChronic constipationRectal bleeding

Look for Tone of anal sphincter and tenderness (anal stenosis loose

patulous anus [myelomeningocele], imperforate anus)Masses ( feces, polyps, teratomas, foreign bodies)Local abdominal tenderness Blood or other staining Rectal prolapsePerianal area (thread worms, skin tags, protruding polyps,

anal fissures, fecal soiling)

RELEVANT GENERAL PHYSICAL EXAMINATION

Vital signs Anthropometric measurements along with plotting on growth

chart (PEM, malabsorption, obesity) Dysmorphic features Clubbing Pallor Dehydration Edema (facial, sacral, pedal) Odours

RELEVANT GENERAL PHYSICAL EXAMINATIONBruising , petechiae , purpura Inspection of stools and urineHairSkin Spider angiomatasNails

RELEVANT GENERAL PHYSICAL EXAMINATIONJaundice Lymph nodesSpinal examination such as swellings,

tufts of hair, or indentationsMeningeal signs

RELEVANT GENERAL PHYSICAL EXAMINATION

EyesGynaecomastia Thyroid (diarrhea)Papilledema Joint swellingFlapping tremorsCVS examinationHyperreflexia and extensor plantars (CLD)