Show Gastrointestinal examination and questions for doctors, medical student exams, finals, OSCEs and MRCP PACES Introduction (WIIPPPE)
General Inspection
Hands
Dupytren’s contracture Wrist
Video illustrating asterixis (flapping tremor) Arms
Face
Neck and Chest
Video on how to examine the lymph nodes Abdominal Examination
Inspection of the Abdomen
Palpation
Palpating for the Liver and GallbladderLiver
Gallbladder
Abdominal anatomy. (A) Liver (B) Gallbladder (C) Ascending colon (D) Spleen (E) Stomach (F) Transverse colon
Palpating for the Spleen The normal adult spleen lies immediately under the diaphragm in the left upper quadrant of the abdomen. It is not normally palpable, and can only be felt once it has increased in size threefold.
Palpating for the Kidneys The kidneys lie retroperitoneally in the paravertebral gutter of the abdominal cavity.
Abdominal anatomy. Transverse section at L1 level: (A) Liver (B) Gallbladder (C) Stomach (D) Transverse colon (E) Jejunum (F) Spleen (G) Left colic (splenic) flexure (H) Neck of pancreas (I) Abdominal aorta (J) L1 vertebral body (K) Inferior vena cava (L) Right kidney (M) Left kidney
Palpating for the Aorta The aortic pulse is palpable in thin individuals, but is usually impalpable in muscular or obese patients. Palpation of the aorta is primarily to detect an abdominal aortic aneurysm (AAA) which may be asymptomatic but rupture of which can have a very high mortality.
The examiner uses both hands, parallel to the costal margins (certainly always above the umbilicus), to palpate for the aorta PercussionRoutine examination of the abdomen should include percussion. The whole abdomen should be percussed to demonstrate the presence of bowel gas (resonant) and solid or fluid-filled structures (dull). Percussion can also be used to map out a tender area identified during palpation. To gain maximum information from percussion, a good technique is important.
Examining for AscitesNow try to ascertain whether the patient has ascites (free fluid in the abdominal cavity). Bear in mind that in most cases, ascites is associated with abdominal distension which you may already have detected on inspection.
Succussion SplashLastly, if you suspect gastric outflow obstruction you can try holding the patient at the hips and shaking the abdomen from side to side.
AuscultationAuscultation for Bowel Sounds
Auscultation for Bruits A bruit is an abnormal blowing or swishing sound resulting from blood flowing through a narrow or partially occluded artery.
Hernias
External Genitalia and Digital Rectal Exam
Completing the examination
Questions about the abdominal examinationCommon Abdominal Examination exam questions for medical students, finals, OSCEs and MRCP PACES |