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: Liver Disease: Mental Status Aphtous Ulcers Muscle wasting Posture (writhing vs. minimal movement) Uveitis Palmar erythema Colour (icterus, jaundice, 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 hernia, 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: Splenomegaly (Traube’s space - below left 6th rib, Presence of tenderness above costal margin, medial to axillary line) Ascites Specific: o Shifting dullness Hepatomegaly o Fluid wave Palpation A. General Palpation Special tests for Appendicitis Superficial Palpation Rovsing’s sign (pressure wave) Tenderness (peritoneal irritation, somatic Obturator sign (pain on hip int. rotation) or visceral pain). Psoas sign (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 cholecystitis Groin: Femoral hernia Organomegaly: Inguinal hernias 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) .