Gastrointestinal Physical Exam Checklist Learnpediatrics.com – written by Dr. R. Acedillo, modified by Dr. E. Statham

EXAMINATION OSCE ITEMS General Growth parameters (HC, L, Wt, BMI) Extra-intestinal Stigmata of Chronic Inspection Well/Unwell Manifestations of IBD: Disease: Mental Status Aphtous Ulcers Muscle wasting Posture (writhing vs. minimal movement) Uveitis Palmar erythema Colour (icterus, , pale) Arthritis Leukonychia Nutritional status Clubbing Asterixis Peripheral edema Rashes Strawberry angiomas Rashes (eg. Dermatitis Herpetiformis) Caput medusae Gynecomastia Jaundice Edema Parotid enlargement

Inspection Abdominal  Scars (surgical – risk for Bowel obstruction)  Abdominal contours (scaphoid, bulging  Skin abnormalities (abdominal wall veins, flanks, protuberant, etc) hemangiomas)  Peristaltic waves (eg in. Pyloric Stenosis)  Protrusions (umbilical , diastasis recti)

Auscultation A. Bowel Sounds B. Vascular  Sounds (Presence vs absence)  Bruits (aorta, iliac, femoral, renal)  Quality (Frequency and Pitch [high?])  Bruits/venous hums around palpable liver mass (if applicable) Percussion General:  (Traube’s space - below left 6th rib,  Presence of tenderness above costal margin, medial to axillary line)  Specific: o o Fluid wave

Palpation A. General Palpation Special tests for Superficial Palpation  Rovsing’s sign (pressure wave)  Tenderness (peritoneal irritation, somatic  (pain on hip int. rotation) or visceral pain).  (pain on hip flexion hip)  Guarding (voluntary vs involuntary) Deep Palpation Sitting up:  Rebound tenderness (peritonitis)  Assess for CVA tenderness  McBurny point tenderness (appendicitis)  Murphy’s sign for Groin:  Femoral hernia :  Inguinal  Hepatomegaly (liver span, liver edge  Inguinal lymphadenopathy consistency – boggy or fibrotic)  Testicular mass or torsion  Splenomegaly  Anus – Imperforate, malpositioned, evidence of  Enlarged kidneys (hydronephrosis or renal abuse or adrenal masses)