PE23.17-21 | Gastrointestinal Clinical Assessment — Summary & Reflection

KEY TAKEAWAYS

Paediatric GI and hepatobiliary clinical assessment integrates five competency areas. History-taking should systematically cover the colour of urine and stools (dark urine + pale stools = conjugated/cholestatic jaundice) and aetiological domains including perinatal events, family history, drugs, diet, and immunisation status. The 11 external markers of CLD (PE23.18) must be sought head-to-toe: jaundice, pallor, gynaecomastia, spider angiomata (>5 = significant; blanches centrally), palmar erythema, ichthyosis, caput medusae (flow away from umbilicus), clubbing, FTT, vitamin A signs (Bitot's spots, night blindness), and vitamin D signs (rickets). Abdominal examination starts palpation from the right iliac fossa; hepatomegaly is measured in cm below costal margin; ascites detected by shifting dullness. LFT pattern: ALT >> ALP = hepatocellular; ALP/GGT >> ALT = cholestatic; low ALP in active liver disease = Wilson disease. HBsAg positive >6 months = chronic HBV. Indications for OGD: haematemesis/malaena (urgent, within 12–24h after stabilisation, therapeutic EVL for varices), coeliac biopsy, H. pylori biopsy, variceal surveillance/banding, foreign body, dysphagia, unexplained anaemia.

REFLECT

Spend five minutes before your next ward round practising the 'silent case' technique — walk up to a child with liver disease and, without reading the notes, perform a full external marker survey and abdominal examination in your mind: how many spider angiomata would you count? where would you start palpating? what would shifting dullness feel like under your hand? Then check your findings against the documented examination. Kolb's reflective cycle: describe a specific examination you performed or observed, analyse what you got right and what you missed, conclude by naming the one sign you are least confident about detecting (shifting dullness? liver nodularity? caput medusae flow direction?), and plan a targeted practice opportunity in your next hepatology or outpatient clinic.