Common symptoms of gastrointestinal and

abdominal disease
• Dysphagia and • Abdominal pain
odynophagia • Abdominal distension
• Heartburn and reflux
• Weight loss
• Indigestion
• Haematemesis
• Flatulence
• Vomiting • Rectal bleeding
• Anorexia • Melaena
• Constipation • Jaundice
• Diarrhoea • Itching
• Alteration of bowel pattern • Urinary symptoms
 PREPARATION
• Assemble the necessary equipments
• Greet the patient
• Introduce yourself
• Explain to the patient what you will be doing
and if they feel any discomfort to let you know
• Stand on the right side
 GASTROINTESTINAL EXAMINATION

• General examination
– General inspection
– Hands and arms
– Face, eyes and mouth  Abdominal examination
– Neck  Inspection
 Palpation
 Percussion
 Auscultation
 GENERAL INSPECTION
• Comfortable at rest or distressed
• Nutritional status
• Hands
– Finger clubbing
– Palmar erythema/pallour
– Leukonychia - hypoalbuminemia
– Hepatic flap (asterixis) – ask the patient to stretch out the
arms in front, separate the fingers and extend wrists for
15s
• Elevated JVP
 GENERAL INSPECTION
• Nutritional state (wasting)
• Pallor
• Jaundice (liver disease)
• Pigmentation (hemochromatosis)
• Mental state (encephalopathy)
 HANDS

• Nails
– Clubbing
– Koilonychia
– Leuconychia
• Palmar erythema
• Dupuytren’s contractures
• Hepatic flap
 ARMS
• Spider naevi (telangiectatic lesions)
• Bruising
• Wasting
• Scratch marks (chronic cholestasis)
 FACE, EYES …
• Conjuctival pallor (anaemia)
• Sclera: jaundice, iritis
• Cornea: Kaiser Fleischer’s rings (Wilson’s disease)
• Xanthelasma (primary biliary cirrhosis)
• Parotid enlargement (alcohol)
Parotid enlargement

Xanthelasma
 … AND MOUTH
• Breath (fetor hepaticus)
• Lips
– Angular stomatitis
– Cheilitis
– Ulceration
– Peutz-Jeghers syndrome
• Gums
– Gingivitis, bleeding
– Candida albicans
– Pigmentation
• Tongue
– Atrophic glossitis
– Leicoplakia
– Furring
Atrophic glossitis Thrush
 NECK AND CHEST

• Cervical lymphadenopathy
• Left supraclavicular fossa (Virchov’s node)
• Gynaecomastia
• Loss of hair
 General inspection
• Eyes – Jaundice, pallour
• Breath fetor
• Lymph nodes
• Spider naevi: upper trunk, head, neck and
arms
• Bruising, petechiae, pruritic marks
• Gynaecomastia in males
• Obvious medical appliances around the bed
• Expose the patient’s abdomen while
maintaining dignity.
• The patient should be lying flat at 180° supine
hands by the side.
 Inspection
• Remember to inspect from foot of the bed.
– Shape – normal contour and fullness, scaphoid or
distended;
– Symmetry of the abdomen, localized swellings
– Umbilicus – inverted or everted
– Scars- previous surgery or traditional marks
 Inspection
– Movements of abdominal wall – moving with
respiration, visible pulsations of abdominal aorta,
visible peristalsis

– Skin and surface of abdomen – smooth and shiny

(gross distension), striae, scars, prominent
superficial veins, pigmentations
 ABDOMINAL EXAMINATION
INSPECTION
• Shape and movements
• Scars
• Distension
– Localized: mass, organomegaly
– Generalized: 5 F’s
• Prominent veins (caput medusae)
• Striae
• Bruises
• Pigmentation
• Visible peristalsis
 Campbell de
Morgan spots

Ascitic abdomen
 Palpation
– Ask about pain location
– Superficial palpation of each of the 9 quadrants.
You should be looking at the patient's face. Start at
the point furthest away from any pain 

– Deep palpation of the 9 quadrants with two

hands, one on top of the other again flexing at the
MCP joints.
 Palpation
– Palpate for left kidney, spleen, right kidney, liver,
urinary bladder

– If you find a mass – site, size and shape, surface,

edge, consistency, mobility and attachments
 ABDOMINAL EXAMINATION
PALPATION
1. Ensure that your hands are warm
2. Stand on the patient’s right side
3. Help to position the patient
4. Ask whether the patient feels any pain before
you start
5. Begin with superficial examination
6. Move in a systematic manner through the
abdominal quadrants
7. Repeat palpation deeply.
 ABDOMINAL EXAMINATION
PALPATION
• Tenderness: discomfort and resistance to palpation
• Involuntary guarding: reflex contraction of the
abdominal muscles
• Rebound tenderness: patient feels pain when the
hand is released
• Tenderness + rigidity: perforated viscus
• Palpable mass (enlarged organ, faeces, tumour)
• Aortic pulsation
 ABDOMINAL EXAMINATION
MURPHY’S SIGN
• Pain in RUQ
• Inflammation of gallbladder
(cholecystitis)
• Courvoisier's law
 ABDOMINAL EXAMINATION
BLUMBERG’S SIGN
• a.k.a. rebound tenderness
• Pain upon removal of pressure rather than application
of pressure to the abdomen
• Peritonitis and/ or appendicitis
 ABDOMINAL EXAMINATION
MCBURNEY’S POINT
• 1/3 ASIS to umbilicus
• Location of AV in retrocecal position
• Deep tenderness (= acute appendicitis)
 ABDOMINAL EXAMINATION
FLUID THRILL
 Place the palm of your left hand
against the left side of the
abdomen
 Flick a finger against the right side
of the abdomen
 Ask the patient to put the edge of
a hand on the midline of the
abdomen
 If a ripple is felt upon flicking we
call it a fluid thrill = ascites
 ABDOMINAL EXAMINATION
PALPATION OF THE LIVER
1. Start palpating in the right iliac fossa
2. Ask the patient to take a deep breath in
3. Move your hand progressively further up the abdomen
4. Try to feel the liver edge
 ABDOMINAL EXAMINATION
PALPATION OF THE SPLEEN
1. Roll the patient towards you
2. Palpate with your left hand while using your left hand to press
forward on the patient’s lower ribs from behind
3. Feel along the costal margin
 Percussion

– Define boundaries of liver, spleen and other

masses

– Ascites - shifting dullness, fluid thrill

 ABDOMINAL EXAMINATION
PERCUSSION

• Dull sounds: solid or fluid-filled structures

• Resonant sounds: structures containing air or gas

 Auscultation
• You should listen with the diaphragm next to
the umbilicus for up to 30 seconds
– Bowel sounds
– Aortic bruits and renal bruits
 ABDOMINAL EXAMINATION
AUSCULTATION
• Place the diaphragm of the stethoscope to
the right of the umbilicus

• Bowel sounds (borborygmi) are caused by

peristaltic movements

• Occur every 5-10 sec.

• Absence of b.s.: paralytic ileus or peritonitis

• Bruits over aorta and renal a. could be a

sign of an aneurysm and stenosis
Examination of the hernial orifices
• Inguinal hernias- reducible or irreducible,
contents, direct or indirect hernia
• Femoral hernia
• Examine patient while lying down and sitting
up
 Rectal examination
• Patient lie on left lateral position

• Inspection- perianal skin abnormalities like red, moist, weeping,

skin tags, piles, prolapse rectum, warts, abscesses, sinuses, fistulas

• Digital rectal examination(DRE)- enlarged prostate, malignant

ulcers, polyps, carcinomas, pelvic abscesses

• DRE in females- retroverted uterus, fibroid mass, ovarian cyst,

malignant nodule or pelvic abscess may all be palpated in the
pouch of Douglas (rectouterine pouch)