gastrointestinal disorders
Evaluation of the Gastrointestinal Patient
Physical Examination of the GI Patient
The physical examination might begin with inspection of the oropharynx to assess hydration, ulcers, or possible inflammation. Inspection of the abdomen with the patient supine may show a convex appearance when bowel obstruction, ascites, or, rarely, a large mass is present. Auscultation to assess bowel sounds and determine presence of bruits should follow. Percussion elicits hyperresonance (tympany) in the presence of bowel obstruction and dullness with ascites and can determine the span of the liver. Palpation proceeds systematically, beginning gently to identify areas of tenderness and, if tolerated, palpating deeper to locate masses or organomegaly. When the abdomen is tender, patients should be assessed for peritoneal signs such as guarding and rebound. Guarding is an involuntary contraction of the abdominal muscles that is slightly slower and more sustained than the rapid, voluntary flinch exhibited by sensitive or anxious patients. Rebound is a distinct flinch upon brisk withdrawal of the examiner's hand. The inguinal area and all surgical scars should be palpated for Hernias of the Abdominal Wall . Digital rectal examination (see Physical examination ) with testing for occult blood and (in women) 