Gastrointestinal System examination
General Considerations
The patient should have an empty bladder.
The patient should be lying supine on the exam table and appropriately draped.
The examination room must be quiet to perform adequate auscultation and percussion.
Watch the patient's face for signs of discomfort during the examination.
Consider the inguinal/rectal examination in males. Consider the pelvic/rectal examination in females
INSPECTION
Look for scars, striae, hernias, vascular changes, lesions, or rashes
Look for movement associated with peristalsis or pulsations
Note the abdominal contour
Is it flat, scaphoid, or protuberant?
AUSCULTATION
Place the diaphragm of your stethoscope lightly on the abdomen
Listen for bowel sounds
Are they normal, increased, decreased, or absent?
Listen for bruits over the renal arteries, iliac arteries, and aorta
PERCUSSION
Percuss in all four quadrants using proper technique
Categorize what you hear as tympanitic or dull
-Tympany is normally present over most of the abdomen in the supine position
- Unusual dullness may be a clue to an underlying abdominal mass
Liver Span
Percuss downward from the chest in the right midclavicular line until you detect the top edge of liver dullness
Percuss upward from the abdomen in the same line until you detect the bottom edge of liver dullness
Measure the liver span between these two points
This measurement should be 6-12 cm in a normal adult
Splenic Dullness
Percuss the lowest costal interspace in the left anterior axillary line
This area is normally tympanitic
Ask the patient to take a deep breath and percuss this area again
Dullness in this area is a sign of splenic enlargement
PALPATION
General Palpation
Begin with light palpation
At this point you are mostly looking for areas of tenderness
The most sensitive indicator of tenderness is the patient's facial expression (so watch the patient's face, not your hands)
Proceed to deep palpation after surveying the abdomen lightly
Try to identify abdominal masses or areas of deep tenderness
Palpation of the Liver
Place your fingers just below the right costal margin and press firmly
Ask the patient to take a deep breath
You may feel the edge of the liver press against your fingers
Or it may slide under your hand as the patient exhales
A normal liver is not tender
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