Thank you for the detailed document on pediatric gastrointestinal examination techniques. I will keep these guidelines in mind as I continue to develop my clinical skills.

1. SYED AWAIS UL HASSAN SHAH
TRAINEE 1ST YR PAEDIATRICS

2. Before starting GI Examination
 Wash hands / warm them
 Proceed calmly / don’t make sudden moves
 Shake hands and offer some candy or toy
 Introduce yourself / explain what you are going to do (older
child/ parents)
 Ask the patient to point to the part which is tender(can be
unreliable)
 Position the patient (depends upon child’s comfort)
 Expose the patient on required basis
 Approach from right side of the patient
 Gather as much data as possible by observation first
 Alter the sequence of examination if required but present it in a
sequential manner
 Order of exam: least distressing to most distressing

3. Components of GIT Examination
 Abdominal examination
 Oral cavity examination
 Genitalia examination
 Rectal examination
 Relevant physical examination

4. ABDOMINAL
EXAMINATION

6. ABDOMEN
 INSPECTION
 Shape of the abdomen
 Movements of abdominal wall
 Umbilicus
 Visible loops of bowel/ visible peristalsis
 Scar
 Striae
 Prominent veins
 Pubic hair
 Hernial orifices

7. ABDOMEN
 Palpation
 Light palpation
 To test muscle tone/ rigidity / guarding
 Deep palpation
 Tenderness and rebound tenderness
 Palpation for viscera
 Liver
 Size, edge, surface, consistency, tenderness, pulsations
 Spleen
 Size, surface, consistency, splenic notch

8.  Kidneys
 Bimanual technique (lower pole may normally be palpable)
 Tenderness (Murphy’s renal punch)
 Urinary bladder
 Grasping the upper border by thumb and index finger of left
hand

9. One hand ballottement
Bimanual ballottement

10. ABDOMEN
 Masses palpable other than viscera
 Hard feces
 Abdominal aorta
 Gastric mass (HPS)
 Abdominal lymph nodes
 Para aortic lymph nodes / mesenteric lymph nodes
 Dipping method of palpation
 Helpful in palpation of viscera in ascites
 Placing hand over the abdomen and making quick dipping
movements (also known as one hand ballottement)
 Skin turgor

11. PERCUSSION
 To determine boundaries of mass and organs
 To detect ascites

12. PERCUSSION
 LIVER
 Percuss for both upper and lower borders
 Spleen
 Start percussing from RIF to LHC
 Place left middle finger parallel to the LCM
 Urinary Bladder
 Percuss from epigastrium towards hypogastrium

13.  PERCUSSION FOR ASCITES
 Shifting dullness
 Fluid thrill

14. AUSCULTATION
 BOWEL SOUNDS
 ABSENT
 LOUD
 VENOUS HUMS
 B/W XIPHISTERNUM AND UMBILICUS
 Renal Bruit
 Hepatic Bruit
 Succussion Splash
 Puddle Sign

15. ORAL CAVITY
 Lips
 Gums
 Teeth
 Tongue
 Mucous membrane
 Others ( aphthous ulcers, thrush, palate)

16. Examination of Genitalia and Groin
 Male
 Urethral orifice (hypospadias, epispadias)
 Size of penis (CAH)
 Testes (swelling, cryptchordism, retractile testes,
inguinal hernia, torsion)
 Developmental abnormalities / ambiguous genitalia
 Orchidometer (precocious puberty, macro orchidism)

17. Examination of Genitalia and Groin
 Female
 Vulva
 Vagina (discharge, FB, suspected abuse)
 Clitoris
 Developmental abnormalities / ambiguous genitalia

18. Rectal examination
 Normally done in
 Acute abdomen
 Chronic constipation
 Rectal bleeding
 Look for
 Tone of anal sphincter and tenderness (anal stenosis loose
patulous anus [myelomeningocele], imperforate anus)
 Masses ( feces, polyps, teratomas, foreign bodies)
 Local abdominal tenderness
 Blood or other staining
 Rectal prolapse
 Perianal area (thread worms, skin tags, protruding
polyps, anal fissures, fecal soiling)

19. RELEVANT GENERAL PHYSICAL
EXAMINATION
 Vital signs
 Anthropometric measurements along with plotting on growth chart
(PEM, malabsorption, obesity)
 Dysmorphic features
 Clubbing
 Pallor
 Dehydration
 Edema (facial, sacral, pedal)
 Odours

20. RELEVANT GENERAL PHYSICAL
EXAMINATION
 Bruising , petechiae , purpura
 Inspection of stools and urine
 Hair
 Skin
 Spider angiomatas
 Nails

21. RELEVANT GENERAL PHYSICAL
EXAMINATION
 Jaundice
 Lymph nodes
 Spinal examination such as swellings, tufts of
hair, or indentations
 Meningeal signs

22. RELEVANT GENERAL PHYSICAL
EXAMINATION
 Eyes
 Gynaecomastia
 Thyroid (diarrhea)
 Papilledema
 Joint swelling
 Flapping tremors
 CVS examination
 Hyperreflexia and extensor plantars (CLD)