GI Examination Becky Ollerenshaw - Paediatrics Society
18.04.15
Slide 2
Introduction To Mum/Dad and to child If parents are on your
side things are easier! Explain what you're going to do
Slide 3
General Inspection Observe Observe! Observe!!!
Slide 4
General inspection Well or ill? Appearance Nutritional status
Behaviour Cannulae, creon, inhalers, wiggly bags (cartoon bags for
central lines),walking aids etc.
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Rapport Depends on age of child Get mum/dad involved Explain
with detail appropriate to age of child
Slide 6
Positioning On parents lap for wiggly/scared toddlers and small
children
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Hands Leukonychia, Koilonychia, Clubbing Crohns, UC, coeliacs
Beaus lines horizontal white lines caused by any acute severe
illness grow out in 12 weeks Asterixis realistically only in older
children
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Hands Pulse, perfusion (cap refill on sternum) Colour, skin
Single palmar crease - thyroid problems, small bowel obstruction
Bruising liver failure / vitamin K deficiency (in neonates)
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Face Sunken fontanelle - dehydration Yellow sclera - jaundice
Pale conjunctiva - anaemia Keyser-Fleischer rings Wilsons disease
(mean age of presentation 6-20)
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Face Ulceration Crohns, Angular stomatitis, Glossitis Gum
hypertrophy leukaemia, anti-epileptics (phenytoin) Candida
immunodeficiency (AIDs, leukaemia) Freckling around the mouth
Putz-Jehgers syndrome associated with polyps in the bowel. High
risk of cancer / obstruction
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Warm hands! And stethoscopes!!!
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Tummy! Can be tickley Get down to their level Get them to move
before you touch- Puff out tummy = rebound tenderness Pain less
localised than in adults (abdo pain can be pneumonia!) Normal to be
rounded Normal to be rounded and feel up to 2 finger widths of
liver and spleen in babies and toddlers.
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Abdomen Inspection - peristalsis, 4 Fs (not 5!), bruises,
scars, etc. Pyloric stenosis visible peristalsis Palpate as for
adult in older child Check for pain and distension in babies (&
toddlers if unco-operative) Hydration status (skin pinch)
Percussion and auscultation technique as for adult
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Abdomen Listen for cornflakes!!!
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Don't forget!! Dipstick the urine Plot a growth chart PR not
routinely done
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Case 1 Creon by bed, small for age, patient comfortable at
rest. Old laporotomy scar No tenderness, no organomegaly
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Cystic Fibrosis Creon by bed exocrine pancreatic insufficiency
Small for age - malabsorption Old laporotomy scar may be due to
neonatal complicated meconium ileus No tenderness, no
organomegaly
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Case 2 Young child of afro-caribbean ethnicity, patient
comfortable at rest. No jaundice, some conjunctival pallor No scars
No tenderness, splenomegaly
Slide 19
Early Sickle cell/ Thalassaemia Young child of afro-carribean
ethnicity not likely spherocytosis/eliptocytosis No jaundice, some
conjunctival pallor - Anaemia No tenderness, splenomegaly Late SC
anaemia spleen would be infarcted (not palpable)
Slide 20
Congenital Abnormalities requiring surgery Congenital
abnormalities which require abdominal surgery but leave the child
well: Omphalacele, Gastroschisis, Meconium ileus, NEC (necrotising
enterocolitis usually premies), Malformations of gut (eg duodenal
atresia, biliary atresia- livertransplant etc.) Its worth making a
short list of what you would expect to find dont spend too much
time doing this though (they dont expect you to be paediatrician
just yet!!)