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
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
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
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