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Put the steps in order of how you would perform a GI examination

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Percuss liver: RIF and then down from 5th ICS

Palpate for liver from RIF to costal margin, taking deep breath in and out

Pre-warm the patient of possible discomfort

Mentions examination of hernial orifices, external genitalia, digital rectal exam, urinary dipstick, pregnancy test

JVP

Palpate for spleen from RIF to left costal margin

Ankle oedema

Lie patient down

Lightly palpate all 9 areas

Right of umbilicus with diaphragm for 2 minutes. No bowel sounds = paralysis, tinkling = obstruction

Percuss spleen: RIF to left costal margin

Wash hands, introduce self, obtain patient's name and DOB

Inspect hands: white nails (leukonychia), spoon nails (kolionychia), Dupytren's contracture (thickening of palm), clubbing, palmar erythema (red palms), hepatic flap

End of bed inspection: colour (jaundice, pallor, grey)

Listen with diaphragm above umbilicus for aortic bruit

Ascites: percuss from midline to left flank (dull for fluid). Ask patient to roll onto right and percuss spot again after 10 seconds

Deep palpation: note voluntary (pain) or non-voluntary guarding (peritonitis)

Radial pulse - rate and rhythm

End of bed inspection: environment (drips, vomit bowl, urine/faeces sample)

Expose chest: spider naevia, scars, distension, caput medusae, gynaecomastia, masses

Inspect face: pallor (conjunctiva, face), jaundice, angular stomatitis (cracked skin at corner of mouth), glossitis (red, enlarged tongue), aphthous ulcers (mouth ulcers)

End of bed inspection: body habitus (malnourished, overweight, cachexia), gynaecomastia

Palpate aorta: halfway between xiphoid and umbilicus. Press fingers posteriorly and medially. Pulsatile/expansile

Listen with diaphragm 2-3 cm above and lateral to the umbilicus for renal bruit. Repeat on other side

Mention BP

Ask if patient has abdominal pain

Lymph nodes - sit up and swing lefts round

Thank patient and wash hands

Ballot both kidneys: left hand on back and right hand on front. Push together on exhalation then ballot


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