GIT EXAMINATION

Guide to Gastrointestinal (GIT) System Physical Examination

This guide will walk you through the step-by-step process of performing a thorough physical examination of the gastrointestinal (GIT) system, including general inspection, palpation, percussion, and auscultation.

1. General Inspection

Before touching the patient, observe them carefully while they are in a comfortable, relaxed position.

Patient Positioning

• Ensure the patient is lying supine on the examination table, with their arms resting at their sides.

• Expose the abdomen adequately while maintaining patient dignity (cover the chest and lower body with a drape).

• Ensure good lighting for proper visualization.

Observe for the Following:

General Appearance

• Is the patient in distress, discomfort, or pain?

• Do they appear malnourished, cachectic, or overweight?

Hands & Nails (Peripheral Signs)

• Palmar erythema (suggests liver disease).

• Clubbing (seen in inflammatory bowel disease, cirrhosis).

• Leukonychia (white nails – seen in liver disease, malnutrition).

• Koilonychia (spoon nails – seen in iron deficiency anemia).

• Asterixis (liver flap – suggests hepatic encephalopathy).

Face & Eyes

• Jaundice (yellow sclera → liver disease, hemolysis).

• Pallor (suggests anemia, which can be due to GI bleeding).

• Angular stomatitis (B-vitamin deficiency).

• Glossitis (smooth tongue seen in iron, B12, or folate deficiency).

• Mouth ulcers (Crohn’s disease, celiac disease).

• Parotid gland enlargement (chronic alcoholism, mumps).

Chest & Abdomen Inspection

• Spider nevi (chronic liver disease).

• Gynaecomastia (liver failure, hormonal imbalance).

• Caput medusae (distended periumbilical veins – suggests portal hypertension).

• Ascites (bulging flanks, everted umbilicus).

• Scars, hernias, surgical marks (previous surgeries).

• Striae (stretch marks in Cushing’s syndrome or rapid weight gain).

• Pulsations (visible aortic pulsations → aneurysm?).

• Masses or lumps (tumors, organomegaly?).

2. Abdominal Examination

Steps to Follow:

• Stand on the patient’s right side.

• Warm your hands before touching the patient.

• Always examine the four quadrants systematically (Right Upper, Left Upper, Right Lower, Left Lower).

• Examine painful areas last to avoid patient discomfort early in the exam.

Auscultation (First Step Before Palpation or Percussion!)

Why first? Because palpation/percussion can alter bowel sounds.

• Use the diaphragm of the stethoscope to listen to bowel sounds.

• Place the stethoscope in at least four quadrants.

• Normal bowel sounds: gurgling every 5–10 seconds.

• Absent bowel sounds → Paralytic ileus, peritonitis.

• Hyperactive bowel sounds → Gastroenteritis, early obstruction.

• Bruits (abnormal vascular sounds) → Listen over the aorta, renal arteries (suggests aneurysm or stenosis).

Palpation

Superficial Palpation (Check for tenderness, guarding, rigidity)

• Use light pressure with flat fingers, moving in all four quadrants.

• Ask: “Does this hurt?” and observe facial expressions.

• Look for guarding (voluntary muscle contraction due to pain).

• Look for rigidity (involuntary muscle contraction → peritonitis).

Deep Palpation (Check for masses, organomegaly)

• Use both hands (one pressing, one feeling).

• Feel for masses, noting size, mobility, tenderness.

• Rebound tenderness (press slowly, release quickly; pain upon release suggests peritonitis).

Specific Organ Palpation

Liver (RUQ, below costal margin)

• Ask the patient to take deep breaths while pressing gently.

• A firm, enlarged liver → hepatitis, cirrhosis, malignancy.

• Tender liver → Hepatitis, congestive heart failure.

Spleen (LUQ, under left costal margin)

• Normally not palpable.

• Enlarged spleen (splenomegaly) → Infections, liver disease, hematologic disorders.

Kidneys (Both flanks)

• Use bimanual technique (one hand behind the patient, one in front).

• Enlarged kidney → Hydronephrosis, polycystic kidney disease.

Aorta (Midline, above umbilicus)

• Feel for pulsation (if wide → suggests aneurysm).

Percussion

• Start from the right side of the patient.

• Helps assess organ size, fluid accumulation, or gas distension.

Liver Span

• Percuss from the right midclavicular line downward.

• Normal span: 6–12 cm (smaller → cirrhosis; larger → hepatomegaly).

Spleen

• Normally not percussible.

• If dullness extends beyond the 9th intercostal space, consider splenomegaly.

Shifting Dullness (Ascites Test)

• Percuss from mid-abdomen to flank while the patient is supine.

• Then, turn the patient onto their side and percuss again.

• If the dullness “shifts,” it suggests ascitic fluid.

Special Tests

1. Murphy’s Sign (Gallbladder Inflammation)

   • Place fingers under the right costal margin, ask the patient to inhale deeply.

   • Pain and inspiratory arrest? → Positive Murphy’s sign (suggests cholecystitis).

2. McBurney’s Point Tenderness (Appendicitis)

   • Press 2/3 the distance from the umbilicus to the right iliac crest.

   • Pain suggests acute appendicitis.

3. Rovsing’s Sign (Referred Pain in Appendicitis)

   • Press deeply on the left lower quadrant.

   • Pain in the right lower quadrant? → Positive sign for appendicitis.

4. Psoas Sign (Appendicitis)

   • Ask the patient to lift their right leg against resistance.

   • Pain? → Suggests irritation of the psoas muscle (retrocecal appendicitis).

5. Obturator Sign (Pelvic Appendicitis)

   • Flex the right hip and knee, then internally rotate.

   • Pain? → Suggests pelvic appendicitis.

Final Step: Thank the Patient

• Let the patient cover themselves.

• Summarize findings aloud (if in an exam setting).

• Wash hands before leaving.

Pro-Tips to Stand Out

-Always examine painful areas last.
-Speak clearly and explain what you’re doing to the patient.
-Observe subtle signs (e.g., facial grimacing during palpation).
-Use gentle but firm movements to ensure patient comfort.
-Be confident but compassionate and professional.