Gastrointestinal Bleeding: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin and mucous membranes [accompanying symptom: pallor (anemia)]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart.
    • Auscultation of the lungs [due todifferential diagnosis (leading to upper gastrointestinal bleeding): hemoptysis (coughing up blood)]
    • Examination of the abdomen (abdomen)
      • Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel sounds?]
      • Percussion (tapping) of the abdomen.
        • [Ascites (abdominal fluid): phenomenon of fluctuation wave. This can be triggered as follows: if one taps against one flank a wave of fluid is transmitted to the other flank, which can be felt by placing the hand on it (undulation phenomenon); flank attenuation.
        • Meteorism (flatulence): hypersonoric tapping sound.
        • Attenuation of the tapping sound due to enlarged liver or spleen, tumor, urinary retention?
        • Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size.
        • Cholelithiasis (gallstones): tapping pain over gallbladder region and right lower rib]
      • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?) [due todifferential diagnoses (lead to upper gastrointestinal bleeding):
        • Erosive duodenitis (duodenitis).
        • Erosive gastritis (gastritis).
        • Ulcus duodeni (duodenal ulcer)
        • Ulcus ventriculi (gastric ulcer)]
    • Digital rectal examination (DRU): examination of the rectum (rectum) [leading symptoms: Hematochezia (red blood stool or rectal bleeding); melena (tarry stool) – stool abnormally black in color due to blood admixtures, usually also foul-smelling and shiny][due todifferential diagnoses (lead to lower gastrointestinal bleeding):
  • Cancer screening[due todifferential diagnoses (lead to upper gastrointestinal bleeding):
    • Gastric carcinoma (stomach cancer).
    • Esophageal carcinoma (esophageal cancer)]

    [due todifferential diagnoses (lead to lower gastrointestinal bleeding):

    • Colon tumors
    • Small bowel tumors]
  • Gynecological examination [due todifferential diagnosis (leading to lower gastrointestinal bleeding):
    • Endometriosis (presence of endometrium (lining of the uterus) outside the uterus, for example, in or on the ovaries (ovaries), tubes (fallopian tubes), urinary bladder, or bowel)]

Square brackets [ ] indicate possible pathologic (pathological) physical findings.