12 Steps Gastrointestinal Examination Checklist

(1) Well-being - jaundice (2) posture – lying down supine, (3) respiratory status, (4) height and (5) built.
No. Steps Tick
1. (a) Check Palmar crease for pallor.
(a) Check Palm for Palmar Erythema & Dupuytren’s contracture (at ring finger)
(c) Nail for Leuconychia (hypoalbuminemia), koilonychia (iron deficiency).
2. (a) Radial Pulse (rate, rhythm, character - collapsing, volume)
3. Throughout upper limb, look for:
(a) Puncture wounds (IV drugs users – hepatitis B/C)
(b) Tattoos (hepatitis B/C)
(c) Scratch marks (Pruritus)
(d) Bruises ( Coagulation factors especially PT + 4 liver function tests 
bilirubin/ast/alt/alp)
(e) Spider naevi (How to confirm that it is a S. Naevus… ?)
4. Axilla for Loss of hair and Acanthosis Nigricans
5. (a) Eyes for Subconjunctival pallor & Scleral jaundice
(b) Mouth for glossitis, angular stomatitis & ulcers [hydration status]
6. Neck for palpation of LYMPH NODES (Virchow’s node)
7. Inspect Chest for spider naevi and gynaecomastia
8. Lower extremities Pitting edema
9. Abdominal Inspection [Ensure adequate exposure]
(a) Umbilicus central/midline? Inverted everted?
(b) Ask patient to cough – hernia at umbilical / inguinal region?
(c) Size and shape – Distended? Tense? [Ascites?]
(d) Engorged blood vessels seen? [Portal hypertension; Caput medusa]
(e) Scars & Visible movement?
Grey-Turner’s (bruises at flanks) and Cullen’s sign (bruises at umbilicus)
10. Abdominal Palpation
(a) General – Superficial & Deep
Ask patient the site of pain and leave that area to the last & Palpate all 9 quadrant.
- Soft? Tense?
- Tenderness? Guarding?
- Mass?
(b) Liver
- Palpable? Hepatomegaly – If yes, surface, border & Crosses midline?
- Percussion to measure size in cm.
(c) Spleen
- Palpable? Splenomegaly – If yes, surface, border and notch, size?
- Percussion at Traube’s space – dullness?
(d) Kidney
- Ballotable?
- Costovertebral angle tenderness?
Superficial inguinal nodes enlargement – rectal tumour
11. Abdominal Percussion:
- Across the abdomen – Dullness or Tympanitic?
- Shifting Dullness?
- Fluid thrill? (If grossly tense and distended)
12. Abdominal Auscultation:
- Bowel sounds – Active? Hypoactive? Hyperactive? Normal – 5 to 15 per minute
Complete with Rectal Examination………………………. & Genitalia (if necessary)!

Koilonychia