PE: GI/GU/Pelvic Exams

Advanced assessment of the gastrointestinal and genitourinary systems requires skill and competence! The listed resources are not comprehensive; however, are intended to provide resources to guide assessment considerations and diagnostic decision-making. 

REFERENCES regarding GI assessment

  • Ahn, S., Lee, H., Choi, W., Hong, J. S., Sohn, C. H., Seo, D. W., . . . Kim, W. Y. (2016). Clinical importance of the heel drop test and a new clinical score for adult appendicitis. PLoS One, 11(10), e0164574. doi:10.1371/journal.pone.0164574
  • American Academy of Pediatrics & American Society of Pediatric Nephrology. (2018). Five things physicians and patients should question. Retrieved from https://www.choosingwisely.org/wp-content/uploads/2018/07/AAP-ASPN-Choosing-Wisely-List.pdf
  • American College of Emergency Physicians. (2018). Ten things physicians and patients should question. Retrieved from https://www.choosingwisely.org/societies/american-college-of-emergency-physicians
  • American College of Radiology. (2017). Ten things physicians and patients should question. Retrieved from https://www. American College of Radiology
  • American Gastroenterology Association. (2012). Five things physicians and patients should question. Retrieved from https://www.choosingwisely.org/societies/american-gastroenterological-association/
  • American Urological Association. (2022). Fifteen things physicians and patients should question. Retrieved from https://www.choosingwisely.org/societies/american-urological-association/
  • Benabbas, R., Hanna, M., Shah, J., & Sinert, R. (2017). Diagnostic accuracy of history, physical examination, laboratory tests, and point-of-care ultrasound for pediatric acute appendicitis in the emergency department: A systematic review and meta-analysis. Academy of Emergency Medicine, 24(5), 523–551. doi:10.1111/acem.13181
  • Bundy, D. G., Byerley, J. S., Liles, E. A., Perrin, E. M., Katznelson, J., & Rice, H. E. (2007). Does this child have appendicitis? Journal of the American Medical Association, 298(4), 438–451. doi:10.1001/jama.298.4.438
  • Cosford, P. A., Leng, G. C., & Thomas, J. (2007). Screening for abdominal aortic aneurysm. Cochrane Database of Systematic Reviews, (2), CD002945. doi:10.1002/14651858.CD002945.pub2
  • Dokumcu, Z., Kurtmen, B. T., Divarci, E., Tamay, P. B., Kose, T., Sezak, … Celik, A. (2018). Retrospective multivariate analysis of data from children with suspected appendicitis: A new tool for diagnosis. International Journal of Emergency Medicine, 12. 4810730. doi:
  • Drake, A., Franklin, N., Schrock, J. W., & Jones, R. A. (2021). Auscultation of bowel sounds and ultrasound of peristalsis are neither compartmentalized nor correlated. Cureus, 13(5), e14982. doi: 10.7759/cureus.14982
  • Durup-Dickenson, M., Christensen, M. K., & Gade, J. (2013). Abdominal auscultation does not provide clear clinical diagnosis. Danish Medical Journal, 60, 1–5. Retrieved from http://ugeskriftet.dk/dmj/abdominal-auscultation-does-not-provide-clear-clinical-diagnoses
  • Felder, S., Margel, D., Murrell, Z., & Fleshner, P. (2014). Usefulness of bowel sound auscultation: A prospective evaluation. Journal of Surgical Education, 71, 768–773. doi:10.1016/j.jsurg.2014.02.003
  • Gade, J., Kruse, P., Anderson, O. T., Pedersen, S. B., & Boesby, S. (1998). Physicians’ abdominal auscultation. A multi-rater agreement study. Scandinavian Journal of Gastroenterology, 33, 773–777. doi:10.1080/00365529850171756
  • Gu, Y., Lim, H. J., & Moser, A. A. J. (2010). How useful are bowel sounds in assessing the abdomen? Digestive Surgery, 27, 422–426. doi:10.1159/000319372
  • Gupta, K., Dhawan, A., Abel, C., Talley, N., & Attia, J. (2013). A re-evaluation of the scratch test for locating the liver edge. BMC Gastroenterology, 13, 35. doi:10.1186/1471-230X-13-35
  • Huang, C. B., Yu H. R., Hung, S. C., & Chuang, J. H. (2001). Clinical features and outcome of appendicitis in children younger than three years of age, Chang Gung Medical Journal, 24(1): 27-33.
  • Huelsen, A., Fischer, J., Hegarty, J., Ashcroft, A., Frampton, C. M. A., Barclay, M. L., & Frampton, C. M. (2016). The scratch test for identifying the lower liver edge is at least as accurate as percussion and is significantly more effective for young trainees-a randomised comparative trial. New Zealand Medical Journal, 129(1446), 53–63.
  • Jain, A., Mehta, N., Secko, M., Schechter, J., Papanagnou, D., Pandya, S., & Sinert, R. (2017) History, physical examination, laboratory testing, and emergency department ultrasonography for the diagnosis of acute cholecystitis. Academic Emergency Medicine, 24(3):281-297. doi: 10.1111/acem.13132
  • Kharbanda, A. B., Taylor, G. A., Fishman, S. J., & Bachur, R. G. (2005). A clinical decision rule to identify children at low risk for appendicitis. Pediatrics, 116(3), 709–716. doi:10.1542/peds.2005-0094
  • Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016). Bowel disorders. Gastroenterology, 150(6), 1393–1407. doi:10.1053/j.gastro.2016.02.031
  • Leidi, A., Saudanm A., Soret, G., Rouyer, F., Marti, C., Stirnemann, J., Reny, J. L., & Gosgurin, O. (2022). Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey. Internal and Emergency Medicine, 17(1), 113-122. doi: 10.1007/s11739-021-02781-1
  • Malhotra, A., Sturgill, M., Whitley-Williams, P., Lee, Y. H., Esochaghi, C., Rajasekhar, H., Olson, B., & Gaur, S. (2021). Pediatric COVID-19 and Appendicitis: A Gut Reaction to SARS-CoV-2?. The Pediatric infectious disease journal, 40(2), e49–e55. https://doi.org/10.1097/INF.0000000000002998
  • Mambatta, A. K., Jayarajan, J., Rashme, V. L., Harini, S., Menon, S., & Kuppusamy, J. (2015). Reliability of dipstick assay in predicting urinary tract infection. Journal of Family Medicine and Primary Care, 4(2), 265–268. doi:10.4103/2249-4863.154672
  • Massey, R. L. (2012). Return of bowel sounds indicating an end of postoperative ileus: Is it time to cease this long-standing nursing tradition? Medical Surgical Nursing, 21, 146–150. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22866434
  • McGee, S. (2022). Evidence based physical diagnosis (5th ed.). St. Louis, MO: Elsevier.
  • Mostbeck, G., Adam, E. J., Nielsen, M. B., Claudon, M., Clevert, D., Nicolau, C., . . . Owens, C. M. (2016). How to diagnose acute appendicitis: Ultrasound first. Insights Imaging, 7(2), 255–263. doi:10.1007/s13244-016-0469-6.
  • North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. (2018) Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Retrieved from https://naspghan.org/files/Pediatric_Gastroesophageal_Reflux_Clinical.33.pdf
  • Prosenz, J., & Hirtler, L. (2014) Rovsing sign revisited – effect of an erroneous translation on medica teaching and research. Journal of Surgical Education, 71(5): 738-742. doi: 10.1016/j.jsurg.2014.03.002.
  • Rosen, R., Vandenplas, Y., Singendonk, M., Cabana, M., DiLorenzo, C., Gottrand, F., . . . Tabbers, M. (2018). Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 66(3), 516–554. doi:10.1097/MPG.0000000000001889
  • Schmulson, M. J., & Drossman, D. A. (2017). What is new in Rome IV. Journal of Neurogastroenterological Motility, 23(2), 151–163. doi:10.5056/jnm16214
  • Simel, D.L., Rennie, D., & Keitz, S. (Eds.). (2009). The rational clinical examination: Evidence-based clinical diagnosis. New York, NY: McGraw-Hill.
  • Stewart, K. R., Derck, A. M., Long, K. L., Learman, K., & Cook, C. (2013). Diagnostic accuracy of clinical tests for the detection of splenomegaly. Physical Therapy Reviews, 18(3), 173–184. doi:10.1179/1743288X13Y.0000000081
  • Ueda, T., & Ishida, E. (2015). Indirect fist percussion of the liver is a more sensitive technique for detecting hepatobiliary infections than Murphy’s sign. Current Gerontology and Geriatrics Research, 2015, 6. doi:10.1155/2015/431638
  • U.S. Preventive Services Task Force. (2021). Final recommendation statement: Colorectal cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
  • Williams, J. W., & Simel, D. L. (1992). Does this patient have ascites? How to divine fluid in the abdomen. Journal of the American Medical Association, 267, 2645–2648. doi:10.1001/jama.1992.034801900870387
  • Wright, W. (2016). Cullen sign and Grey Turner sign revisited. The Journal of the American Osteopathic Association, 116, 398–401. doi:10.7556/jaoa.2016.081
  • Zuin, M., Rigatelli, G., Andreotti, A. N., Fogato, L., & Roncon, L. (2017). Is abdominal assessment still a relevant part of the physical examination? European Journal of Internal Medicine, 43, e24–e25. doi:10.1016/j.ejim.2017.04.013

REFERENCES regarding GU/pelvic exams/Breast and screeenings

  • American Academy of Pediatrics, Section on Urology. (2022). Do not perform diagnostic imaging to establish the diagnosis of cryptorchidism. Retrieved from https://www.choosingwisely.org/clinician-lists/do-not-perform-diagnostic-imaging-to-establish-the-diagnosis-of-cryptorchidism/
  • American College of Obstetricians and Gynecologists. (2016a). Practice Bulletin No. 168: Cervical cancer screening and prevention. Obstetrics & Gynecology, 128(4), e111–e130. https://doi.org/10.1097/aog.0000000000001708
  • American College of Obstetricians and Gynecologists. (2016b). Practice Bulletin No. 174: Evaluation and management of adnexal masses. Obstetrics & Gynecology, 128(5), e210–e226. https://doi.org/10.1097/AOG.0000000000001768
  • American College of Obstetricians and Gynecologists. (2017). Committee Opinion No. 706: Sexual health. Obstetrics & Gynecology, 130(1), e42–e47. https://doi.org/10.1097/aog.0000000000002161
  • American College of Obstetricians and Gynecologists. (2018). Committee Opinion No. 755: Well-woman visit. Obstetrics & Gynecology, 132(4), e181–e186. https://doi.org/10.1097/AOG.0000000000002897
  • ACOG Committee Opinion No. 754: The Utility of and Indications for Routine Pelvic Examination. (2018). Obstetrics and gynecology, 132(4), e174–e180. https://doi.org/10.1097/AOG.0000000000002895
  • American Society for Colposcopy and Cervical Pathology. (2017, February 14). Five things physicians and patients should question. http://www.choosingwisely.org/clinician-lists/asccp-screening-tests-for-low-risk-hpv-types
  • American Society of Clinical Oncology. (2021). Don’t routinely perform PSA testing for prostate cancer screening in men with no symptoms of the disease. Retrieved from https://www.choosingwisely.org/clinician-lists/american-society-clinical-oncology-psa-testing-for-prostate-cancer/
  • Cheng, T. M., Freund, K. M., Winter, M., & Orlander, J. D. (2015). Limited adoption of current guidelines for clinical breast examination by primary care physician educators. Journal of women’s health (2002), 24(1), 11–17. https://doi.org/10.1089/jwh.2014.4772
  • Close, R. J., Sachs, C. J., & Dyne, P. L. (2001). Reliability of bimanual pelvic examinations performed in emergency departments. The Western journal of medicine, 175(4), 240–245. https://doi.org/10.1136/ewjm.175.4.240-a
  • Doroudi, M., Kramer, B. S., & Pinsky, P. F. (2017). The bimanual ovarian palpation examination in the Prostate, Lung, Colorectal and Ovarian cancer screening trial: Performance and complications. Journal of medical screening, 24(4), 220–222. https://doi.org/10.1177/0969141316680381
  • Ebell, M. H., Culp, M., Lastinger, K., & Dasigi, T. (2015). A systematic review of the bimanual examination as a test for ovarian cancer. American journal of preventive medicine, 48(3), 350–356. https://doi.org/10.1016/j.amepre.2014.10.007
  • Farrukh, S., Sivitz, A. B., Onogul, B., Patel, K., & Tejani, C. (2018). The Additive Value of Pelvic Examinations to History in Predicting Sexually Transmitted Infections for Young Female Patients With Suspected Cervicitis or Pelvic Inflammatory Disease. Annals of emergency medicine, 72(6), 703–712.e1. https://doi.org/10.1016/j.annemergmed.2018.05.004
  • Fontham, E. T. H., Wolf, A. M. D., Church, T. R., Etzioni, R., Flowers, C. R., Herzig, A., Guerra, C. E., Oeffinger, K. C., Shih, Y. T., Walter, L. C., Kim, J. J., Andrews, K. S., DeSantis, C. E., Fedewa, S. A., Manassaram-Baptiste, D., Saslow, D., Wender, R. C., & Smith, R. A. (2020). Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: a cancer journal for clinicians, 70(5), 321–346. https://doi.org/10.3322/caac.21628
  • Guirguis-Blake, J. M., Henderson, J. T., & Perdue, L. A. (2017). Periodic Screening Pelvic Examination: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, 317(9), 954–966. https://doi.org/10.1001/jama.2016.12819
  • Naji, L., Randhawa, H., Sohani, Z., Dennis, B., Lautenbach, D., Kavanagh, O., Bawor, M., Banfield, L., & Profetto, J. (2018). Digital rectal examination for prostate cancer screening in primary care: A systematic review and meta-analysis. Annals of Family Medicine, 16(2), 149–154. https://doi.org/10.1370/afm.2205
  • Qin J, Saraiya M, Martinez G, Sawaya GF. Prevalence of potentially unnecessary bimanual pelvic examinations and Papanicolaou tests among adolescent girls and young women aged 15–20 years in the United States. JAMA Internal Medicine 2020;180(2):274–280. DOI: 10.1001/jamainternmed.2019.5727.
  • Simms, I., Warburton, F., & Weström, L. (2003). Diagnosis of pelvic inflammatory disease: time for a rethink. Sexually transmitted infections, 79(6), 491–494. https://doi.org/10.1136/sti.79.6.491
  • Siu, A. L., & U.S. Preventive Services Task Force (2016). Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of internal medicine, 164(4), 279–296. https://doi.org/10.7326/M15-2886
  • U.S. Department of Human Services Office of Minority Health. (2021). Minority population profiles: Black/African Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61
  • U.S. Preventive Services Task Force. (2016). Final recommendation statement: Testicular cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/ Page/Document/RecommendationStatementFinal/testicular-cancer-screening
  • U.S. Preventive Services Task Force. (2018a, February). Final recommendation statement: Ovarian cancer: Screening. https://www.uspreventiveservicestaskforce .org/Page/Document/RecommendationStatementFinal/ovarian-cancer-screening1
  • U.S. Preventive Services Task Force. (2018b, August). Clinical summary: Cervical cancer: Screening. https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/cervical-cancer-screening2
  • U.S. Preventive Services Task Force. (2019). Final summary: Prostate cancer: Screening. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prostate-cancer-screening1
  • U.S. Preventive Services Task Force. (2019, June). Human immunodeficiency virus (HIV) infection: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/human-immunodeficiency-virus-hiv-infection-screening#fullrecommendationstart
  • U.S. Preventive Services Task Force. (2019b, August). BRCA-related cancer: Risk assessment, genetic counseling, and genetic testing. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing1
  • U.S. Preventive Services Task Force. (2021, September). Chlamydia and gonorrhea: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening