physical examination

of the GIT.

Dr Abdullah ALATAWI
 Introduction
• ethics of patient- doctor conduct.
- privacy and confidentiality.
- dress code and personal hygien.
- safty of contact.( isolation !)
- instruments + language skills.

• patients ( females with mahram – minors

with chaperon), if not present! ask for a
female nurse.
History taking:
Work up your DD.
Abdominal pain (examples)
 Clinical examination
• General status :
- conciousness ( use a score eg. Glasgow )
- orientation …….person, time and space.
- level of comfort or pain !
- room setting + instruments ( O2, Catheter , NGT…)

• Vital signs ( Temp, BP , HR , RR , O2 saturation )

• Nutritional status :
Body Mass Index ( BMI )
Schamroth’s window test
Causes of clubbing
Koilonychia
Koilonychia : Causes
• Lupus disease,
• Thyroid hormone disorders ,
• Reynaud’s syndrome,
• Iron deficiency ,
• hemochromatosis .
• soaps and detergents .
• chemotherapy or radiation therapy
• Insufficient amounts of vitamins and iron,
• trauma .
• Idiopathic.
 Leukonychia

Leukonychia totalis

Leukonychia partialis
Leukonychia striata
Leukonychia : Causes
• Arsenic poisoning
• Pneumonia
• Heart disease
• Renal failure
• Hypoalbuminemia .
• Vitamin deficiency
• Ulcerative colitis
• Hepatic cirrhosis
• Psychogenic stresses . Onychophagia
• Occupational trauma
• Iron deficiency . Zinc deficiency . Protein deficiency
• Psoriasis as well as eczema
• And may be found in healthy individuals .
Palmar erythema
Causes :
• Primary palmar erythema
• Heredity.
• Pregnancy
• Idiopathic.

• Secondary palmar erythema

• Liver cirrhosis and its many causes including alcohol abuse.(Palmar
erythema develops as a result of abnormal oestradiol levels.
• Hereditary liver disease such as Wilson's disease and hereditary
haemochromatosis
• Rheumatoid arthritis , Systemic lupus erythematosus
• Thyrotoxicosis , Diabetes mellitus ,
• Sarcoidosis
• Neoplastic disease (as a paraneoplastic disorder), particularly
primary or metastatic brain neoplasms However, also associated with
ovarian carcinoma.
• Drug-induced (amiodarone, cholestyramine, and salbutamol )
• Smoking.
• Chronic mercury poisoning
• Polycythaemia.
Dupuytren's contracture
Muscle wasting
Needle marks tattoo scratch marks
Flapping tremors ( Asterixis )
Stages of Asterixis
 Pallor

Jaundice
Iritis
Kayser Fleischer Rings( Wilson's Disease)

Slit lamp examination

Xanthalisma
Spider naevi
Angular Stomatitis
Glossitis
Parotid Salivary glands swelling

Lymphadenopathy

Virchow's node
Troisier’s sign
Gynecomastia
Signs of fluid retention
Ascites

Lower limbs edema

Scrotal edema
Pyoderma gangrenosum
 Inspection
• Patient should be
supine on bed.

• Area to be examined
exposed.

• Inspection from the

sides and from
midline.
Asymmetrical abdominal
distention
Distended abdominal wall viens
( eg. Caput medusae )
Discoloration

Cullen's_sign
Discoloration

Grey-Turner’s sign
 Palpation
• 1- superficial palpation.
- stay in eye contact with the patient.
- start always from non tender areas.
2- deep palpation.
- same as superficial palpation but with more
pressure to examen deep intra-abdominal
structures. Eg, rebound tenderness !
3- organ palpation and ( percussion )
- Liver for hepatomegaly , liver span , ( Murphi’s sign)
- spleen for spleenomegaly.
- kidneys for tenderness
Surface anatomy
Liver span
Spleen
 Percussion
• Shifting dullness

• Fluid thrill
 Auscultation
• Bowel sounds
• Vascular bruits

Complete abdominal examination includes PR

 Student study guide
• OSCE oriented questions :
• History taking :
- system related symptoms and definitions.
• Differential diagnosis ( DD) :
- DD of each symptom in relation to age, sex, site and
character with prioritizing the most frequent pathology.
• Clinical examination :
- identifying the clinical sign and it’s related systemic
pathology
- grading of identified sign if applicable , eg.
Asterixis , finger clubbing , Glasgow coma scale.